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Home My Public Portal About5751 RIO HONDO AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0302210011 y 43UILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 1 UN: .003 5751 RIO HONDO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802433 ASSESSOR IN 85875003-006 FORMATO R. NEAREST CROSS STREET: WORKMAN 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 PROCESSED 8 . 30 AIR INLETS/OUTLETS 3.00 UNI 13.05 02/21/03 JK 08/20/03 41 VENTILATION FAN 1.00 FAN 15.75 OWNER: TEL. NO: TOTAL FEES 110.55 FINAL DATE FI AL BY: CODE: ANDREWS DANIEL P (626) 285-3651- 5751 RIO HONDO AV TEMP 917802433 D5SCRIPTION OF WORK NEW HVAC SYSTEM APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNA URE SAME AS OWNER - LIC. NOFAU/WALL FURNACE COMBUST IO AIR OPENINGS ARCHITECT OR 8NGIN98R: 0: DUCT WORK LIC. NO: AC/COMPRESSOR ER TA FIRE DAMPERS SMOKE DETECTION DEVICES CO ERC A HOOD REPORT ID: DPR264 ROUTE TO: BS0508 OVORKER'S COMPENSATION DECLARATION 20A 64 DPW 9199 APPLICATION FOR PERMIT LIME GREEN ■ 78A364C I hereby affirm thut I have a certificate of consent to self Insure, or a%certiticate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No.% Company COUNTY OF LOS ANGELES DEPT OF PulruC WOKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. In ❑ Certified copy is filed with the count building Inspection FOR APPLICANT TO FILL IN BUILDING y(`s l f��/� department. y g (PRINT OR TYPE ONLY) ADDRESS /�7 sr 9 i ' aq . r/ Date Applicant LOCALITY 'X ; /l 6 e NO. TYPE OF APPLIANCE OR EQUIPMENT FEE f CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ABSORPTION UNIT BTU ASSESSOORR (This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to BOILER,BTU �� Jj become sub'ect to the Workers'Compensation J� - Q - �i7 COMPRESSOR,BTU !4 ate APPROVALS DATE INSPECTOR'S SIGNATURE DApplicant VENTILATION SYSTEM NOTIC; 'O APPLICANT: If, after making this Cel fi ate of ROUGH Exemption,you should become subject to the Workers'Co nsation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAUGRAVj.Ty-_ ypLIDATION LICENSED CONTRACTORS DECLARATION FLOOR -BTU. ,7" �� I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number /� Lic.ClassQ5 _1_I'-_' s l , i I: 0 9' > �,. T/Y7'fl /✓ l 11 o yl C Contractor Date -G I am exempt under Sec. Plan check fee a B.&P.C.for this reason PERMIT ISSUING FEE$ g,LQ H Date: TOTAL FEE U SignaturePLAN CHECK APPLICANT I j'I AL '$'06 G 05 u OWNER-BUILDER DECLARATIONa 6 I hereby affirm that I am exempt from the Contractor's License Law NAME CHE%iK slk for the following reason (Section 7031.5, Business and Professions Code): L•I E )hi__ •t`- ADDRESS ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. i structure is not intended or offered for sale(Section 7044, -'-- I-�j- 'its� •' Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL / with licensed contractors to construct the project (Sec- ADDRESS A?/O tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 1CITY: TEL.NO. Liv hereby affirm that there is a construction lending agency for gyp/ C he performance of the work for which this permit Is issued ONTRACTOR 0 (Sec.3097,Civ.C.). ADDRESS,L �sY • Lender's Name CITY n ��0 Lender's Address ff I certify that I have read this application and state that the above LICENSE No. CF s�39 L G CLCASS Q information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned 4.,..AO1rA. ins p ti pur sea. SEE REVERSE FOR EXPLANATORY LANGUAGE PPLICANT OR AGENT DATE