HomeMy Public PortalAbout5626 PAL MAL AVE_Mechanical__ WORKVt COMPENSATION DECLARATION 1 APPLICATION FOR' PERMIT -
•I hereby �ffrcm that I have a cerhfimte of consent to-self -
msui9,pr a tort( icate of Workers.Compensonon Insurance /� 76A364C HEATING - VENTILATING - AIR CONDITIONING -
or'a t f d c - thereof (Sec 3800' Lab �C ) CE eta(REV 10/et)
P❑ollc�tl�� or,R Compan�h'j'A`T2 /NO+
Certified copy is hereby furnished _ COUNTY OF LOS ANGELES -__ _ • BUILDING AND SAFETY
Corbfied copy is filed with the county building Inspec - FOR APPLICANT TO FILL IN - BUILDING +
tion department (PRINT OR TYPE ONLY) ADDRESS
�e �J
Date 90 Apphca nt ` I� LOCALITY Lp
NO TYPE OF APPLIANCE OR EQUIPMENT FEE r
"CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
COMPENSATION INSURANCE ICROSS ST C/(/e-O/{/*,'-
(Thls Sidlon need not be completed If the work involved by ABSORPTION UNIT BTU
DISTRICT NO PROCESSED BY .
''the,perp is for one,hundred dollars($100) or less ) V
i` ' AIR HANDLING UNIT CFM ` 6
I certify that In the performance of�ihe work for which this
permd Is Issued ,Ishall not employ any person in any manner t -
so Os f0 b( Rle subject to the'WorRers Compensation Laws BOILER BTU APPROVALS DATE INSPE TOR IGNATURE
,Date I , r Apphmnt r COMPRESSOR BTU - ROUGHS - !
NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM - FINAL
Exemption you should become subject to the Workers _ z _ _ ` !.�' l 'Z(pc
Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER Y t 'Jdl
` wl th comply with such provisions orthis permit shall be - f
deemed revoked a-• FURNACE FAU_GRAVITY• , '
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED—UNIT—
(commencing
USPENDED UNIT_(commencing with Section,7000) of Division 3 of the Business WALL Y O ,
and Professions Code��an�pd��m��y license is in full force and�effect � j� , R d
Llcense'Number 4JrZ.40-�5 Lc Class + - - - G[/ U
Contractor`.�.7_/¢ �'✓/-C'�Date V - , - - - V ' . 0
❑ I am exempt under Sec ,ti , W
Plan check fee
B 8P C for this reason s PERMIT ISSUING FEE $ - S Z
Date TOTAL FEE
Signature
OWNER BUILDER DECLARATION - PLAN CHECK APPCICANT,
I hereby affirm that I am ex'empt from the'Controct'or s License - - POO. -
Law for the following reason (Sec Hon 7031 5 Business and NAME ' r '
_Professions Code) - - <
❑ I as owner of the property or my employees with ADDRESS O -
i wages as their sole compensation will do the work and CITY TEL NO ACCT i
the structure Is not intended or offered for sale(Section , •T ,
7044 Business and Professmns,Code) •' ^C • -'/19WK/ 33107 20.50
- P OWNER - - X1.1
` ❑ 1 as owner of the property am exclusively contracting) MAIL 1 ITEMS
with licensed contractors to construct the project (Sec ADDRESS 6 6 + _
tion 7044 Business and Professions Code) .. _ _ ) TOTAL 200
CONSTRUCTION LENDING AGENCY C/ TEL NO
I hereby affirm that there is o construction leriding agency for w CAS j 20.5 i
s the performance of the work for which this permit is issued CONTRACTOR
(Ser 3097, Civ C ) , . - . - CHANII QIP,"
ADDRESS �7 /v/-r��E>/t/1�7K�s• /T✓`- A ` _ _ _ �.-q ". .� _ _ !
Lender's Name r1f1l1
Lender sAddress - CITY 0(/,9044 TEL NO 7_ y
STATE LIC _ _ �
certify that have readrthu apphcationI grid state that the LICENSE NO 'l /�7 S� vCL455 . +- - _o r--k ,
r 124 1 AM10:47
above information is correct I agree to'comply with all County '
ordinances and State jaws relating to building construction
and hereby authorize r presenrar vos of this County to enter
u the above mens ned prop for inspectmn purposes SEE REVERSE FOR EXPLANATORY,LANGUAGE
S"n tiW re Fri or Agent ' Data , , ' •-
�' e
r COUNTY OF LOS ANGELES TEMPLE CITY p 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ' ME 0508 0803030003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
1LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE 5626 PAL MAI. AV
IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802853
(ASSESSOR INFORMATION NUMBER I INEAREST CROSS STREET
18586-009-020 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3' -LOCALITY TEMPLE CITY C
102 COMPRSR c 100 KBTU 1 00 COM 27 00
TENANT 08 FURNACE/HEATER <100 1 00 UNI 27 00 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
130 AIR INLETS/OUTLETS 8 00 UNI 34 80 03/03/08 SR OB/30/08
41 VENTILATION FAN 1 00 FAN 15 75
OWNER TEL NO 147 ALTER EXIST DUCT SYS 1 00 SYS 27 00 (FINAL DATE FINAL BY CODE
SUN SARA (626) 411-1122- 1 TOTAL FEES 159 30 11
5626 PAL MAL AV I " � ybl
1TEMP 917802853 DE RIPTION OF WORK
I INEW HVAC SYSTEM IN ATTIC
(APPLICANT TEL NO
1
ISU (626) 376-1963-
9536 E NAOMI AVE I (SPECIAL CONDITIONS
ARCADIA CA 91007
CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE
SING-YUAN XIE (626) 579-2807-
4279 N PENN MAR AVE LIC NO FAO/WALL FURNACE
IEL MONTE CA 91732 864105 B /
1 1COMBUSTION AIR OPENINGS-l'
(ARCHITECT OR ENGINEER TEL NO (DUCT WORK
(PETER LEE ENEGINEERING (626) 280-9000-
18748 E VALLEY BLVD LIC NO 1AC/COMPRESSOR
ROSEMEAD CA 91770 53946
I THERMOSTAT
IFIRE DAMPERS
ISMOKE DETECTION DEVICES
1COMMERCIAL HOOD
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REPORT ID DPR264 ROUTE TO BS0508