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Home My Public Portal About5514 MCCULLOCH AVE_Mechanical_6/2/2004_ .. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0406020004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: --LEGAL ID: FEES PAID BUILDING ADDRESS: BK: 60 PG: 40 PC: 3 5514 MCCULLOCH AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802943 ASSESSOR IN ORMATION NUMBER: NEAREST CROSS STREET: DAINES 8573-013-038 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, C 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PAN BY: EXPIRES ON: 30 AIR INLETS/OUTLETS 9.00 UNI 39.15 06/02/04 VG 11/29/04 TOTAL FEES 120.90 OWNER: TEL. NO: FI L �TE FINAL BY: CODE: SAVARE, YVONNE - 5514 MCCULLOCH AV TEMP 917802943 SC IPTI N OF WORK- INSTALL NEW HVAC APPLICANT: TEL. N0: AIR TRO (626) 357-5311- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DOTE INSPECTOR SIGNATUREE AIR TRO (626) 357-5311- 1630 MYRTLE AVE LIC. NO toVALL ACE MONROVIA CA 91016 258228C10 A COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THER:OS AT FIRE DAMPERS 1 SMOKE DETECTION DEVICES COMMERCIAL IIOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I herekty�affirm that I have a certifi4ate_,of consent to self irisurh,,�&�ertif!cote of Workers'Compensation Insurance, 764364C HEATING VENTILATING - AIR CONDITIONING or a cei ifled copy thereof(Sec. 3800, Lab. C.) CE-818(REV. 10/81) Policy.No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS T) , 1 Datemo2_/—g " APPlicant LOCALITY TP „Y"r / le �? - NO. � TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ' (This section need not be completed if the work involved by ABSORPTION UNIT,BTU DISTRICT NO. PRO 7Y the permit is for one hundred dollars'(;100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM permit is issued;I shall not employ anypBOILER,BTU erson in any manner so as to become subject to the Workers'Compensation L ws. APPROVALS DATE ! S c;9R'S SIGNAAIRE Date �r� Applicant y � COMPRESSOR, BTU ROUGH I JA h ' NOTICE TO APPLICANT: If, after making this Certificate ofVENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDA ON with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT "(commencing with Section 7000)of Division 3 of the Business - WALL and Professions Code,and my license is in full force and effect. lv O License Number' Lic. Class , (J 0 Contractor Date ❑ I am exempt under Sec. ee Plan check fee IL B.&P.C. for this reason' PERMIT ISSUING'FEE$ Q j�U Z Date TOTAL FEE J5 Signature664 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CIN TEL. NO. 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MIL tion 7044, Business and Professions Code). DRESS 2 5 53,3 A CONSTRUCTION LENDING AGENCY CITY TEL. NO. I hereby affirm that there is a construction lending agency for , # 0 0 0 0 0 8 the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). J 0 o 2 Q 5 Q Lender's Name ADDRESS 0 o 0 2 a 5 0•1-1 CITY TEL. NO. ILender's Address 0 9.3 0=8 6 1 certifythat I have read this application and state that the STATE LIC. pp LICENSE NO. CLASS above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authorize representatives of this Cqunty to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date '