HomeMy Public PortalAbout5632 PERSIMMON AVE_Mechanical__ COUNTY OF LOS ANGELES I TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1007260003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
1 PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 13935 LT: 31 I I 5632 PERSIMMON AV I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802808 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18573-010-007 1101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
I 102 COMPRSR < 100 KBTU 1.00 COM 27.00 I_ I
TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 ISSU2D ON: PROCESSED BY: PLAN BY: I
I TOTAL FEES 81.80 107/25/10 SR I
I � I
(OWNER: TEL. N0: iF TE FIN BY: CODE: I
ISTANLEY, JOHN (626) 446-0543- I
15632 PERSIMMON AV 1
ITEMP 917802808 I r8 - ID SCR PTION OF WORK
IREPI CE FURNACE 70,000 BTU 80% AFUE & A/C 3 TON 16 SEER INISAME LOCATIONS(APPLICANT: TEL. NO:(ERIC JACOBY (818) 735-1876-15858 DOVETAIL DR. ISPECIAL CONDITIONS:
AGOURA HILLS 91301
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1CONTRACTOR: TEL. NO: I � V ' Q (APPROVALS DATE INSPECTOR SIGNATURE I
ISERVICE CHAMPIONS (818) 735-7876- I
122911 SAVI RANCH PKWY LIC. NO i ` 1FAU/1'1ALL FURNACE I I I
YORDA LINDA, CA 92887 799170 I (((
i (COMBUSTION AIR OPENINGS I I I
1ARCHITECT OR ENGINEER: TEL. N0: IDUCT WORK
LIC. NO: I IAC/COMPRESSOR I I
I iTHERMOSTAT I I 1
FIRE DAMPERS I I
ISMOKE DETECTION DEVICES I I I
ICOMMERCIAL HOOD
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REPORT ID: DPR264 ROUTE TO: BS0508
I I I
ION
WORKER'S I have
a certificate
of consent to 20-0046 DPW PW9/89 APPLICATION FOR PERMIT LOGO GREM
I hereby affirl:that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATIN`U-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN ADDRES ���
department. (PRINT OR TYPE ONLY) 32—
Date ApplicantLOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSSST. ` f ye, 0
ABSORPTION UNIT,BTU ASSESSOR LL!/
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Comp n tin CN§. ®
-s /r��'� COMPRESSOR,BTU
Date O A licant •rte APPROVALS DATE INSP R'S SIGNATURE
PP VENTILATION SYSTEM
NOTICh TO AP LICANT: If, after nakVng thistificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAUG AVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VA ID TION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect. -C°' L
1 /.cJ 6 S / - .5
License Number ✓ LID.Class �
"ALIF
r•
l�[LIF i2,Um&�teD S >
4
Contractor ate Ili i AL -� I � `c
Plan check fee �., _ ;
❑ I am exempt under Sec. I EE�:r i€j t T D
B.&P.C.for this reason PERMIT ISSUING FEE$ f/
CHANGE
,c
F
Date: TOTAL FEE u
Signature PLAN CHECK APPLICANT flzl:_I(I--ij l l; 1i 10/'"r'r U_
OWNER-BUILDER DECLARATION
"�f-+ •i x' n a. 6
I hereby affirm that I am exempt from the Contractor's License Law NAME "'='r'? i A I 7 li=tis:•
for the following reason (Section 7031.5, Business and Professions
Code): ADDRESS
❑ 1, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). OWNER TC/"
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS S16_3Z_
tion 7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY m TElO
I hereby affirm that there is a construction lendingagencyfor ,p�j rO /• JI��.T- ,
the performance of the work for which this permit Is issued CONTRACTOR (� ` ` /e I¢
(Sec.3097,Civ.C.).
ADDRESS
Lender's Name �f
CITY 1 17
_55V
LE
A
Lender's Address v
I certify that I have read this application and state that the above IL CENSE NO. Z CLLASS C—
information is ca t. I agree to comply with all County ordinances
and State ws r Ila ng t uild• construction,and hereby authorize
rep a en iv e of his ty o enter upon t e above-mentioned
pr y r! sp cti r s SEE REVERSE FOR EXPLANATORY LANGUAGE
s—
SI AT OF L NT AGENT ATE