HomeMy Public PortalAbout9515 PENTLAND ST_Mechanical__ • WORYrERS COMYPNSATION DLCLAR TION 764364C
CE q18 (2 d01 APPLICATION FOR PERMIT
I h•reir' affirm that 1 have a certificate of consent to self
insure or a certificate of Workers'Compensation h,urance or HEATING-VENT ILATI NG-AIR CONDITIONING
a certified comms t iCerrCof(Sec 3800 Lab
C�)
Policy Nv'�6 O / omPnnY v-f/'f7��u/(/G� T
❑ Certified copy u hereby£urmshi.d COUNTY OF LOS ANGELES / z - BUILDING AND SAFETY
Certified cop) is filed with the county budding inspection
L! FOR APPLICANTTO FILL IN BUILDING 7 r
de�ariAment ��p�T�
Date�� 1_ffyppplmant _K ��_ (PRINT OR TYPE ONLY) ADDRESS
I LOCALITY
CLRTI EICATE Of EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EOUIPM ENT FEE
COMPENSATION INSURANCE NEAREST
(This section need not be completed if the work involved ABSORPTION UNIT BTU— CROSS ST a
by the permit is for one hundred dollars (3100) or less) 6ISTRICTNO PROLE S eY O
1 certify that in lht. performance of the work for which this AIR HANDLING UNIT CFM
permit u Issued I%hall not employ any person in any manner s � 01 0
so as to become subject to the Workers Compensation Laws BOILER BTU 0
/ (,/l/ ,� /O APPROVALS DATE INSPECTORS SIGNATURE V
Date SO
Applicant COMPRESSOR BTU_/ i—f- / W
ROUGH Z� �-
NOTICL 1`0 APPLICANT If after making this Certificate ofVENTILATION SYSTEM / ' N
L.emphon you should become subject to the Workers' FINAL Z
Compensation provisions of the Labor Code, you must forth EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked FURNACE FAU— +RAVITV
LICENSED CONTRACTORS DECLARATION / FLOOR BTU_y0_o0_0 /Q
I hereby affirm that I am licensed undLr provisions of Chapter HEATER SUSPENDED UNIT
9 (commencing with Section 7000)of Dniston 3 of the Bust WALL
nes, and Professions Code and my license is in full force and
effect
License Number �G_77�/ v Lac Class—rj
ContractoV_ _C Date -A5
❑ 1 am exempt from the licensing requirements as
licensed architect or a registered professional engineer Plan Check fee 25%Of above
actino in my'professional capacity (Section 7051 Bus
mess and Professions Code) PERMIT ISSUING FEE $ �p O i
Lic or Reg No Date TOTAL FEE 3Q SO
HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANT /' T
I hereby affirm that I am exempt from the Contractor's NAMt��'yj
License Law for the following reason (Section 7031 5 Bust
nusq 7
and Professions Code) ADDRESS 5 l � :� ) I &5A
❑ I, es owner of the property will do the work and theI I >•
structure is not Intended or offered for safe (Section CIT, )T J�-'�p,, TEL NO j�Z/ # ^• • • • 8
7044 Business and Professions Code) - OWNER NE.R C ?t•i S,u,n
❑ C en 'JO ,
I, as owner of the property am exclusively contractcontractingntcting a
atth ,licensed contractors to construct tie project MAIL i•s•s• 3 6 '�
(Section 7044 Business and Professions Code) r� r, ADDRESS i , ci
e CONSTRUCTION LENDING AGENCY w CITY TEL NO 0511 '-84
1 bathe) affirm that there roflending as a construction lagencyg agen
for the performance he work for which ethisnd Permit Is CONTRACTOR��jr paissued ` (),r+
b'llo T
Lenders Name CivC
ADDRESS `` 11 > ,�
N
Lender s AddressCITY �Ls pp TEL NO
I certify that 1 have read this application and state that the rl E
STATE yr o� LIC /'•�(
above information is correct I aL/
gree to comply with all County ICE NSE NO � / O CLASS
ordinances and Stats laws regulating Heating Ventilating and
An Conditioning, and hcreb) authorize representutiviis of this Slit REVERSE FOR EXPLANATORY LANGUAGE.
County to enter upon the abgve mentioned proper) for
m•neetmn proposes '
-Q L<__ s-moi-�V
Signature of Permittee Data
COUNTY OF LOS ANGELES TEMPLE CITY q 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ' ME 0508 1007060020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL IO FEES PASD BUILDING ADDRESS
TR 14572 LT 31 9515 TI.AND PENST
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803845
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
18590-007-020 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID S4 LOCALITY TEMPLE CITY, Cl
( 102 O _1 1 00 com 27 00
TENANT 108 FURNACE/HEATER 1001 00 UNI 27100 ISSUED ON PROCESSED BY PLAN BY
TOTAL FEES 81 80 107/06/10 SR
TOWNER TEL NO �FI�/L DATE F BY CODE
BATEMAN, ROBERT (626) 286-4745- /
9515 PENTLAND ST �� O
(TEMP 917803845 D SCRIPTION OF WORK
REPLACE THE EXISTING ROOF MOUNTED COMBO A/C 6 HEATING
CENTRAL UNIT
1APPLICANT TEL NO
ADVANCED HANDYMAN (909) 596-6868- '
11790 N WHITE AVE SPECIAL CONDITIONS
LA VERNE CA 91750
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
ADVANCED HANDYMAN (909) 596-6868-
1790 N WHITE AVE LIC NO FAO/WALL FURNACE
LA VERNE CA 91750 690496 B
COMBUSTION ASR OPENINGS
ARCHITECT OR ENGINEER TEL NO IDUCT WORK
I
I LIC NO AC/COMPRESSOR
�//�// �
THERMOSTAT 1
iFIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
I I I
I I
I I I I I
• I I I I
_ I
REPORT ID DPR264 ROUTE TO BS0508
I