HomeMy Public PortalAbout5735 RIO HONDO AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0304150003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL • E PAID BUILDING S:
TR: 6561LT: 1 UN: .002 5735 RIO HONDO AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802433
INFORMATIONNUMBER: NEAREST CROSS STREET: LIVE OAK
8587-003-011 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 3.00 UNI 13.05
TENANT: TOTAL FEES 40.80 ISSUED ON: PROCESSED B : PLAN BY: P .
05/19/03 JK 11/15/03 .
OWNER: TEL. 0: FINAL DATE FINAL BY: CODE:
573WAN5;RIONJUN HONDO (626) 337-1863- &^ZO_0 3 /
TEMPLE CITY 0 0
MECHANICAL FOR ADDITION
APPLICANT:
NICK TIMKO (909) 392-8287-
4095 N FRUIT ST #809 SPECIAL CONDITIONS:
LA VERNE
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
NICK'S REMODELING (909) 392-8287-
4095 N FRUIT STREET LIC. NO F R C
SPACE 809 409663 B
LA VERNE, CA 91750 COMBUSTION AIR OPENINGS
ARCHITECT0 NG E TEL. NO: DUCT WORK ,
LIC. NO: AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
f
REPORT ID: DPR264 ROUTE TO: BS0508
WpRKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
r .sr,he,+ Ff'rrm that I have a certificate of consent to self
insure,-or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
ci,;;�,a certified copy thereof(Sec. 3800, Lob. C.) 76A364C
CE-818(REV. 10/81)
Policy No. Company
0 Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec-, FOR APPLICANT TO FILL IN BUILDINAld
G
tion department. (PRINT OR TYPE ONLY) ADDRESS 6-76r
A116 a
Date' Applicant LOCALITY fanfmo&
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE 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 BV
the permit Is for one hundred dollars($100)or less.) / AIR HANDLING UNIT,CFM 4CO Q
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner BOILERBTU
so as to become subject to the Workers'Compensation Laws. , APPROVALS DATE NS ECTOR'S SIGNA RE
De 1✓llf Applicant COMPRESSOR,BTU Tc+r�d ;� ROUGH
at
NoTid TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption; you should become'subjecf to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATIO
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU G VITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am.licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000)•of Division 3 of the Business - WALL
and Professions Code,and my license is in full force and effect.
r 0
License Number Lic. Class ® U
Contractor Date
❑ I am exempt under Sec. AU
Plan check fee w
BAP.C. for this reason PERMIT ISSUING FEE$
Date:
Signature• TOTAL FEE
;28822A
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License # o o a o 0 8
Law for the following reason (Section 7031.5, Business and NAME
Professions Code): 1 0 040.50
ADDRESS P
I, as owner of the property, or my employees with a 76 S
wages as their sole compensation,will do the work and 0 0 0 4 Q 5 G U
the structure is not intended or offered for sale(Section CITY lt
61TEL. NO.eZ8rBse
7044, Business and Professions Code).
OWNER 0L22 $$
❑ 1, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY TEL. N .
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.). IV
' ADDRESS
Lender's Name
CITY TEL. NO.
Lender's Address
STATE LIC.
I certify that I have read this application and state that the LICENSE NO. CLASS
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby au orize representatives of this County to enter
upon the.ab mentioned property for inspectio purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date