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Home My Public Portal About9069 RANCHO REAL RD_Mechanical_9/11/1996_ME 0508 9609100027 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECAkiICAL PERMIT;"y • DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ,ME, 5A8_46091Q0027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID (—BUILDING DING ADDR SS,- TR: 11218 LT: 20 BL: B 9069-RAA HO REAP6 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: _..EMP-CA 91-7803031- ASSESSOR INFORMATION MB R: NEAREST CROSS STREET: SULTANA 5388-002-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY 02 COMPRSR < 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: 20 FIREPLACE < 100 KBTU 1.00 APL 27.00 09/11/96 TC 09/10/97 30 AIR INLETS/OUTLETS 4.00 UNI 17.40 OWNER: TEL. NO: TOTAL FEES 126.15 FINAL DATE FINAL BY, CODE: WONG KIM H;WING S (818) 286-4036- 9069 RANCHO REAL RD 1 TEMP 917803031 DESCRIPTION OF WORK NEW ADDITION AND ALTERATION APPLI TEL. NO: SAME AS OWNER - &�LES C SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: � ' �® APPROVALS DATE INS TOR SIGNATURE SAME AS OWNER - f� LIC. NO C FURNACE - ® I COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: - DUCT WOR LIC. NO: AC/COMPRESSOR _ THERMOSTAT uro O F U C Wn-� 'd C-�fS FIRE DAMPERS SMOKE DETECTION DEVICES O 0 Q � 1 J P", COMMERCIAL HOOD \ / ❑ �, ®� � 9e REPORT ID: DPR264 ROUTE TO: BS0508 - -WORkEPS'tOMPENSATION DECLARATION APPLICATION FOR PERMIT bereby;ffi-rm that I have a certificate of consent to self ji,sure, ora certificate of Workers'Compensation Insurance, HEATING - VENTILATING - Alli CONDITIONING or a cejfified copy thereof(Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby fur is ❑ Certified copy is filed i the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRES Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIF TE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE - CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED the permit is for one hundred dollars ($100)or less.) lam'^ AIR HANDLING UNIT,CFM I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner BOILER,BTU so as to become subject to the Workers'Com ensation Laws. APPROVALS DATEI PECTOR'S SIGNATURE 6COMPRESSOR, BTU �T ZL ROUGH Date 9fV.-,licant NOTICE TOA LICANT: If, after making this Certificate f VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' I ;:�Mel I I ,9— k Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VA IDA with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR —BTU — I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division.3 of the Business WALL and Professions Code,and my license is in full force and effect. O License Number L' Class , Contractor Date ❑ I am exempt under S tu Plan check fee B.&P.C. for this r son PERMIT ISSUING FEE$ � C31,6A Date: TOTAL FEE _PIC 8 Signature o 0 0 0 0 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's LicensePO. I o o 3 0,5 0 Law for the following reason (Section 7031.5, Business and NAME Prgfessions Code): P(1. xtJ 1, as owner of the property, or my employees with ADDRESS o 0 0 3 Q 5 0 wages as their sole compensation,will do the work and CITY TEL. NO. 07.29-88 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). OWNER (tN S k/�,) 9/1J 7 ❑ I, as owner of the property, am exclusively contracting MAIL / //�� 1-1 A with licensed contractors to construct the project (Sec- ADDRESS G I(,/fJ ( Ku�`J1J tion 7044, Business and Professions Code). _ CONSTRUCTION LENDING AGENCY CITY N, �L� TEL. NO. 6— C I hereby affirm that there is a construction lending agency for I the performance of the work for which this permit is issued CONTRACTOR / (Sec. 3097, Civ. C.). ADDRESS 0 Lender's Name CITY E.' Lender's Address STATELIC. I certify that I have read this application and state that the LICENSE NO. CLASS above information is rrect. ee to comply with all County ordinances and Stat I rel to building construction, and hereby t r' a res t ves of this County to enter upon the en ' ned pr rty fo nspectio p� SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of Applicant r Agent Date