HomeMy Public PortalAbout5355 PERSIMMON AVE_Mechanical__ • COUNTY OF IAS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0703220004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
]TR: 13613 LT: 41 1 5355 PERSIMMON AV
]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802802
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: FREER
18573-003-016 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
1 130 AIR INLETS/OUTLETS 1.00 UNI 4.35 I
TENANT: 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 59.10 103/22/07 JK 09/18/07
OWNER: TEL. NO: FLT DATE FINAL 8Y: CODE:
1BESERRA SALVADOR;IRENE TRS (626) 444-8056- s
15355 PERSIMMON AV
TEMP 917802802 1DE RIPT ON WORK
ALTERATION OF EXIST DUCT SYSTEM
APPLICANT: TEL. NO:
1BESERRA (626) 444-8056- 1
15355 N. PERIMMON AVE ISPECIAL CONDITIONS:
TEMPLE CITY CA 91780
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CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE
]BESERRA, SALVADOR (626) 444-8056- 1 1
15355 N. PERSIMMON AVENUE LIC. NO FAU/WALL FURNACE
TEMPLE CITY, CA 91780 NONE
ICOMBUSTION AIR OPENINGS I I I
(ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I I I
(ARAGON, BOB (626) 444-4075- I I 1-1 I
112053 REDSTONE STREET LIC. NO: I IAC/COMPRESSOR I I I
EL MONTE, CA NONE
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]THERMOSTAT I I
I IFIRE DAMPERS I I
I I I I ! I
I I ISMOKE DETECTION DEVICES 1 1
I ICOMMERCIAL HOOD 1
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I I I I ! I
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1 ]REPORT ID: DPR264 ROUTE TO: BS0508 I I I
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WORKERS'COMPENSATION DECLARATION CEA 86 8C(z 80) APPLICATION FOR P lid ftp I\/_] T
I hereby affirm that I have a' certificate of consent to self I I�f1�If`C II Cf tl
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec.3800,Lab.C.)
Policy No. Company—
Certified
ompany Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
i
Certified copy is filed with the county building inspection BUILDING ��
department. FOR APPLICANT TO FILL IN
Date Applicant (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE P
COMPENSATION INSURANCE NEAREST
(This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. � 0
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSEDAY T V
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM / O� cc
permit is issued, I shall not employ any person in any manner O
so as to aecome subject to the Workers'Compensation Laws. BOILER,BTU I-_
APPROVALS DATE INSPECTOR'S SIGNATURE W
Date Applicant COMPRESSOR,BTU ROUGH y
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Z
Exemption, you should become subject to the Workers' 12-1-89 62
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this -permit shall be EVAPORATIVE COOLER VALIDATION
deemed revoked. / FURNACE: FAU A. GRAVITY
LICENSED CONTRACTORS DECLARATION / FLOOR: BTU 9rd9t, 91,712
I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL
ness and Professions Code, and.my license is in full force and
effect.
License Number Lic.Class
Contractor Date
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer . Plan Check fee 25%of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE$
Lic,or Reg.No. Date. TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that 1 am exempt from- the Contractor's NAME ;P3 1 29 A
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS o o o o 4 1
i, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section CITY TEL. NO. 2 o o 27. Ll
7044,Business and Professions Code).
❑ OWNER ° o - 27. 0020:
I, as owner of the property, am exclusively contracting �--
with licensed contractors to construct the project MAIL l 1. 19-80
(Section 7044,Business and Professions Code). ADDRESS r—' S , IIAO��
CONSTRUCTION LENDING AGENCY TEL.NO. _
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR
issued Tec.3097,Civ.C.). ,tt
Lender s Name ADDRESS
Lender's Address CITY TEL.NO.
I certify that I have read this application and state that the STATE LIC. P
above information is correct.I agree to comply with all County LICENSE NO. CLASS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to Pon the above-mentioned property for I
p tion ur
%6_ _ r�/&— yen
Signature of Permittee Date