HomeMy Public PortalAbout6012 RENO AVE_Mechanical__ WORKERS' I have
[a%3 4,RAT4.e*11.t`y � •'�' r r APPLICATION �OR PERMIT
I hereby affirm that I have a'certifcafa of eofiert to,�lf �
insure, or a certificate of Workers'Compens5tion InsC ande, I E-818 HEATING - VENTILATING AIR CONDITIONING
or a certified copy thereof(Sec. 3800, L-ab_. C.) C ,
'j CE 818(REV. 10/81)
Policy No. Company ,
Certified copy is hereby furnished. ti COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- 11 FOR APPLICANT TO FILL IN BUILDING
tion department. tl ADDRESS �,� S�
(PRINT OR TYPE ONLY) .
Date ' 'ApplicantLOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE s
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST ®
COMPENSATION INSURANCE CROSS ST. �AeQmPr
(This section need not be completed If the work involved by 1 ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars($100)or less.) 1
I certify thatti the performance of the work for which this ` AIR HANDLING UNIT,CFM
permit is is.1-1 shall not employ any person in any manner '
so as to become S jest to the Workers'Compensation Laws.' 1� BOILER,BTU APPROVALS DATE INSPECTOR'S SIGNATURE
�-
Date Applicant COMPRESSOR,BTU ROUGH —y
'• - -G-�T
NOTICE TO APPLICANT: If, after making this Certificate of 1, VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers' o
Compensation provisions of the Labor'Code, you must forth- (I VAPO AT VALIDATION
with comply with such provisions or this permit shall be I AP
deemed revoked. FURNACE: FAUGR IT
LICENSED CONTRACTORS DECLARATION FLOOR BTU ;?
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000)of Dtvtsiorn 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
W
License Number Ltc. Class , U
:I OS
Contractor Date
❑ I am exempt under Sec. 1LU
Plan check fee H
B.BP.C. for this reason PERMIT ISSUING FEE$ z
Date: '
Signature TOTAL FEE
OWNER-BUILDER DECLARATION I PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License -1
Law for the following reason (Section 7031.5, Business and NAME �` U ��� , �, A
Professions Code): �e
�q/�-
1, as owner of the property, or my employees with ADDRESS ok'L `�• `''o o n n o
wages as their sole compensation,will do the work and4 0
the structure is not intended or offered for sale(Section CITY TEL.NO. ° ° ,5 v�
7044, Business and Professions Code). r n o (I- (j �C- •
I
❑ OWNER I,as owner of the property,am exclusively contracting , t_a )'0 91—8
with licensed contractors to construct the project (Sec- �L
tion 7044, Business and Professions Code). ADDRESS Ot I VN �-� 0 5®
Y, CONSTRUCTION LENDING AGENCY CITY7%' IN EL. NO. ' S� `J f
I hereby affirm that there is a construction lending agency for
` the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.). tSL
ADDRESS
Lender's,Name
CITY TEL. NO.
Lender's Address
I certif that'I have read this application and state that the STATE LIC.
y pp LICENSE NO. CLASS
` above Information is correct. I agree to comply with.all County r
ordinances and State laws relating to building construction,
.and hereby authorize representatives of this County to enter I
Rn the above-mentioned pert or Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature ofd p Itcant or Agent
Dat
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1011230005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS: 1
]TR: 5904 IT: 144 UN: ,002 6012 RENO AV
I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801530
1ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
5384-017-009 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
] 141 VENTILATION FAN 2.00 FAN 31.60
]TENANT: I TOTAL FEES 59.40 ISSUED ON: PROCESSED BY: PLAN BY:
111/23/10 SR
]OWNER: TEL. NO: ZZAL DATE FINAL BY: CODE:
]BRIAN, JIANG (626) 236-0672-
16 012
36-0672-]6012 RENO AV
TEMP 917801530 JD2SCRIPTIOS OF WORK
VENTILATION FANS FOR BATHRO MS REMODEL
]APPLICANT: TEL. NO: I
]CHAN, SIMON (626) 318-9839-
15334 N. BURTON AVE. I SPECIAL CONDITIONS:
]SAN GABRIEL CA 91776
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
]JIANG, BRIAN (626) 236-0672- I I I
150 ALICE ST. #F LIC. NO IFAU/WALL FURNACE I I
IARCADIA, CA 91006 NONE I I I
ICOMBUSTION AIR OPENINGS I ]
(ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK I I ]
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LIC. NO: I IAC/COMPRESSOR 1 1 I
ITHERMOSTAT I
(FIRE DAMPERS
1 ISMOKE DETECTION DEVICES
]COMMERCIAL HOOD
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1 IREPORT ID: DPR264 ROUTE TO: BS0508 ]
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