HomeMy Public PortalAbout5451 PARMERTON AVE_Mechanical__ WORKERSCOMPENSATIONI have
a certificate
CEA 818 (280) ' APPLICATION FOR PERMIT
1 hereby affirm That 1 have a certificate of consent to self _
insure, or a certificate of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec 3800, Lab C)Pollcy,No Company COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is hereby furnished +
IEI�"rbhed copy is filed with th.county buildinp inspection BUILDING
department ' ^ FOR APPLICANT TO FILL IN ADDRESS .��.���
Date Applicant_{6�` (PRINT OR TYPE ONLY) t
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST _ y
(This section need not be completed If the work involved ABSORPTION UNIT BTU— CROSS ST 0
by the permit is for one hundred dollars (5100) or less) - DISTRICT NO PRocEssr,ev U
1 certify that in the performance of the work for which this AIR HANDLING UNIT CFM—
permit
FM permit is issued I shell not employ any person In any manner 3
so as to become'subject to the Workers Compensation Laws BOILER BTU ,
APPROVALS DATE NSPECTDR S SIGNATURE W
Date Applicant COMPRESSOR BTU_(LQI-�.4 /� ROUGH �/�8 �..1•- y
NOTICE TO APPLICANT If atter making this Certificate of VENTILATION SYSTEM / FINAL •�t7' 6l' ?
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth EVAPORATIVE COOLER - VALIDATION
with comply with such provisions or this permit shall be
deemed'revokcd FURNACE FAU AVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTI _ S Pvo= 0
I hereby affirm that 1 am licensed under provisions of Chapter HEATER SUSPENDED UNIT �I,J
9 (commencing with Section 7000) of Division 3 of the Bust WALL
ness and Professions Code and my license IS in full force and _
effect /
License Numbe,3 ��
Lie Class x
ContractZ (.,. -o ZAL NN 119De�a
1 am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 'j5%of above
acting in my professional capacity (Section 7051 Bus
mess and Professions Code) - PERMIT ISSUING FEES �� SO
Lie or Reg No Date /TOTAL FEE Yd SQ -
HOMF OWNER BUILDER DECLARATION PLAN CHECK a.PPLICANT.('j 3,�OGRLJ4 N'AP T ,
1 hereby affirm that 1 am exempt from the Contractors i NAME ,- a (/2 A/- S L( I�2,5 9.9,Q
License Law for the following reason (Section 7031 5 Bust
ness and Professions Code) ADDRESS I i
8
I as owner of the property, will do the work and the �.. , i• i
structure Is not mtended or offered for sale (Section ) CITY TEL NO ��/S�7 •2 •I• (( QlSQ
7044 Business and Professions Code) /� j / �a I '
❑ OWNER ,s/zs _ I / C.. 0' 1 ^� i 4Q,F)
I, as owner of the property am exclusively contracting �,/E/ l-e .1� I� ' • Q•Q I
with licensed contractors to construct the project MAIL '—(,,S I p �/ r���00'8;-"813i ,
(Section 7044, Business and Professions Code) ADDRESS �,/ 0•6
TEL NO i
CONSTRUCTION LENDING AGENCY len CITY-T5•/ti�((C C j /`
I hereby affirm that there is a construction lending agency (tom• /- -
for the performance of the work for which this permit is CONTRACTOR GlnfO Zf}LNNRYZ-90 '
issued (Sec 3097 Civ C ) v ( '
Lenders Name - ADDRESS - 1,��
Lender's Address - CITY -jio`- 71 � TEL NO �1 �r S'� 72 ± '
I certify that 1 have read this application and state that the STATE t` -a •L _
above Information Is correct I agree to comply with all County LICENSE NO 6 C012 CLASS
ordinances and State latus regulating Heating Ventilating and I
Air Conditioning and hereby authortzc represcntatives of this SEE REVERSE FOR LXPLANATORY LANGUAGE
County to enter upon the above mentioned property for ,
iris - on purptf,E7 + r 1 -
__a �
_ign
at.
of Permittee Date _ _ _ _ Y_ - _ - s
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1102220014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
(LEGAL ID FEES PAID BUILDING ADDRESS
ITR 13613 LT 72 5451 PARMERTON AV
(FEE DESCRIPTION QUANTITY GUM AMOUNT TEMP CA 917803506
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
8573-005-033 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY Cl
(TENANT 102 COMPRSR, 1 100 KBTU 2 00 COM 54 00
108 FURNACE/HEATER 1100 2 00 UNI 54 00 ISSUED ON PROCESSED BY PLAN BY
TOTAL FEES 135 80 02/22/11 SR
IOWNER TEL NO (FINAL DATE FINAL BY CODE
CLEMAN JOHN DONNA (626) 443-8633-
15451 PARMERTON AV
TEMP 917803506 SCRI PTION OF WORK li
CHANGE OUT EQUIPMENT 6 DUCTING 6 ADD 1 SYSTEM
APPLICANT TEL NO
(ANDERSON DAMN (909) 730-1482-
16750 TOPAZ STREET (SPECIAL CONDITIONS
(ALTA LOMA CA 91701
I I I
ICONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE
ISOUTH COAST AIR (909) 730-1482-
6750 'TOPAZ STREET LIC NO (FAG/WALL FURNACE C
(ALTA LOMA CA 91701 879675 �l
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER TEL NO I I❑QCT WORK I I
LIC NO IAC/COMPRESSOR f L�
1 (THERMOSTAT ' rt
(FIRE DAMPERS
SMOKF DETECTION DEVICES
COh44ERCTnr HOOD
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REPORT ID DPR264 ROUTE TO DS0508