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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1210020022
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID
I BIIILDING ADDRESS: I
ITR: 14533 LT: 2 I I 6326 OAK AV I
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917801335 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET- LONGDEN
15382-020-023 101 PERMIT ISSUANCE FEE 27.80 [ THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
141 VENTILATION FAN 1.00 FAN 15.80 [ I
ITENANT: I TOTAL FEES 43.60 ISSUED ON: PROCESSED BY: PLAN BY: I
1 110/02/12 SR
OWNER: TEL. NO: [ IFINAL DATE FI BY: CODE:
1YING FANG TAN (626) 616-1682-
16326 OAK AV
ITEMP 917801335 I IDESCRIPTION OF WORK 1
[ IVENTILATION FAN 1
]APPLICANT: TEL. NO: [
I
ILIII, MICHAEL (626) 641-8208- 1 1 [
12550 W. MAIN ST.#211 ] ISPECIAL CONDITIONS:
]ALHAMBRA, CA 91801 ] [ I
[CONTRACTOR: TEL. NO: [ (APPROVALS DATE INSPECTOR SIGNATURE 1
1YING FANG TAN (626) 616-1682- 1 I
16326 OAK AVENUE LIC. NO IFAU/WALL FURNACE I I ]
ITEMPLE CITY, CA 91780 NONE
I I 1COMBUSTION AIR OPENINGS I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK
- [ I I
I I
I LIC. NO: I 1AC/COMPRESSOR I I
I 1THERMOSTAT
I IFIRE DAMPERS
I I ]
I [ ISMOKE DETECTION DEVICES I I
COMMERCIAL HOOD
1
1 I I I
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I 1 I I I I
I I I
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I IREPORT ID: DPR264 ROUTE TO: BS0508
I I I I I I
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
I herei3y affrcm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
AIT a c rtt'Ified copy thereof(Sec. 33800, Labs.) 11 CE-818(REV. 10/81)
C
�b 9�7 ifmpa
PolicA
81
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. ADDRESS
Dat eJ/Applicant / (PRINT OR TYPE ONLY) �C n`T�
LOCALITY C:'
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. 1
(This section need not be completed if the work Involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner BOILER, BTU
so as to become subject to the Workers'Compensation Laws. APPROVALS DATE INSPECT SIGNA f1RE
Date Appl icanf COMPRESSOR,BTU d D ROUGH 1 J L
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL11 r
1
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY 71
LICENSED CONTRACTORS DECLARATION FLOOR BTU d D
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT `
(commencing with Section 7000) of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
License Number ",) tfoLic.Class e —�L� U
Contractor Date O
t°
❑ I am exempt under Sec.
Plan check fee
B.BP.C. for this reason H
PERMIT ISSUING FEE$ le J29
�
TOTAL FEE
Signature Date:
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT o o30, 50
I hereby affirm that I am exempt from the Contractor's License o o 5
Law for the following reason (Section 7031.5, Business and NAME I 20— 7 c'
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and CITY TEL. NO.
the structure is not intended or offered for sale(Section
7044, Business and Professions Code).
OWNER
❑ I, as owner of the property, am exclusively contracting MAIL n �
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY`21'�ro�/� e,,g TEL. NO,, k',31,9
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.). Ale-
ADDRESS ADDRESS
Lender's Name
Lender's Address CITY���ff�/—�fP TEL. NOP,. 1_1. /?
STATEI certify that I have read this application and state that the LICENSE NO.cZ �fTg� 1' CLASS C--2—t/
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 County to enter
upon the above-mention d property for inspection purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date