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Home My Public Portal About5200, 5202, 5204 ROSEMEAD BLVD_Mechanical__ 76A364e GE-8IS IREV.6/78) - oS APPLI ION FOR PERMIT HEATING -VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES.: BUILDING AND SAFETY FOR APPLICANT TO-FILL IN BUILDING 'J (PRINT OR TYPE ONLY) ADDRESS, ��. /�4®' a. ._ LOCALITY NO. TYPE OF.APPLIANCE OR EQUIPMENT' FEE NEAREST CROSS ST. ABSORPTION UNIT, BTU / /�JJ'�,� �.��•,,� / OVVNER� 4/7/-,?-& G /�ll�`y' �• / AIR HANDLING UNIT,CFM MAIL ADDRESS � � .BOILER,BTU CITYV44jIlj-r W/)f�PJEL.Nyl� COMPRESSOR,BTU CONTRACTOR s ! L -T l� VENTILATION SYSTEM e �•� ' ADDRESS �:syyam� �f EVAPORATIVE COOLER CITY TEL.NO. FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU DU ��- LICENSE NO.-:;50 CLASS HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE' WALL ROUGH /z o a; FINAL -� INSPECTION RECORD � Plan check fee 25% of above. Lu PERMIT ISSUING FEE$ 17 TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK,VALIDATION, NAME ADDRESS - CITY - TEL.NO. - - /' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND �'U.S 3,4 A STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL # o,0 0 0 (.� ORDINANCES AND LAWS R GULATING HEATINPIN LATING, AIR - coNDlnowric. PERMIT VALIDATION 2 p.220,00 I HEREBY'CERTIFY T AT I AM NOT TOLATION OF , " . .CHAPTER 9, DIVISION 3, F THE'BUSINE NDIONAL CPD S OF THE STATE OF CALIF NIA. -• o o.2 2.0,0'0�y . SIGNATURE OF"PERMITTEE O'S 2 3!-.7 9 DISTRICT NO. - P ESSE Y - ION DECLARATI WORKER'S I have a'ceSATate of consent to ;6A34DPW 9,89 APPLICATION FOR PERMIT r I hereby,affirm that I have a certificate of consent to self insure, �� `�Ili' L� or a certificate of worker's Compensation Insurance, or a certified HEATING-VENTILATING -AIR CONDITIONING NN copy thereof(Sec.3800 Lab�C.) , i- Policy No. � 'CoMID nya A-k E� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ❑ BUILDING _ Certified copy is filed with the county'building' spe tion FOR APPLICANT TO FILL IN ADDRESS department. (PRINT OR TYPE ONLY) Date Applican NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. ' COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involved by the SSOR ASAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PR CESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers' Compensation Laws. p1 ti COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH 6 ��'� ec ` Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL _ provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. 50n License Number (A-7 q-(---Z— Lic.Class 9 ' Contractor SyDa-teµL ' GCT, U ❑ I am exempt under Sec. Plan Check fee cc B.&P.C.for this reason PERMIT ISSUING FEE$ '� 0 3303 77.70 O Date: /-7 7 i ITEMS v TOTAL FEE l`j CLU L Signature TOTAL 7-7. 70 co OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT co CHECK. 77.70 I hereby affirm that I am exempt from the Contractor's License Law NAME , 1Y� for the following reason (Section 7031.5, Business and Professions Cf1tlPt 00000 Code): ADDRESS ❑ I, as owner of the property, or my employees with wages tft11t�1 f1t� 7 t�l1 p as their sole compensation, will do the work and the CITY TEL.NO. 0000-0001 7/ 12/ 5 structure is not intended or offered for sale (Section 7044, 1 AM 8 :09 Business.and Professions Code). OWNER 2245 ❑ I, as owner of the property, am exclusively contracting MAIL v` with licensed contractors to construct the project (Sec- ADDRESS o tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY CS TEL.NO. I'herpeby affirm that there is'a construction lending agency for ONTRACTOR , the performance of the work for which this permit Is issued (Sec.3097,Civ. C.).' ADDRESS Lender's Name CITY y TEL.NO. Lender's Address STATE " tIC. certify that I have read this application and state that the above LICENSE NO. �j CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize repre entatives of this County to enter upon the above-mentioned p ty f r inp ct'on pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE G..Jr�J�. ATUR OF PPLICANT OR AG _DAfE I r Y�JO IRS;tha COMPENSATION DECLARATION APPLICATION FOR PERMIT I .hereby affitm4 that I have a certificate of consent to self itisure,rora certificate of Workers' Compensation Insurance, .HEATING - VENTILATING - AIR CONDITIONING nr a certified copy thereof c 3800 Lab. C.) 76A364C a 3 3 p CE-818(REV 10/81) Policy Noi1/ � Comjny�I CEJ 2AI 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 BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS � !� ) Date l/� 7Applicant - 4F �h�� LOCALITY NO, TYPE OF APPLIANCE OR EQUIPMENT FEE - CERTIFICATE OF EXEMP I FROM W RKERS' NEAREST COMPENSATION INSURANC CROSS ST. ABSORPTION UNIT, BTU DISTRICT NO. PR ESSED 8 (This section need not be completed if the work involved by _ C the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM W 7� I certify that in the performance of the work for which this Jc 1J permit is issued, I shall not employ any person in any manner BOILER, BTU so as to become subject to the Workers'Compensation Laws. ,q //1 APPROVALS DATE SPS OR'S SIGNATURE Date Applicant COMPRESSOR, BTU -311 i eV& (/ ROUGH =�.; �f NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' r Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER // l)� VALIDAT " N with comply with such provisions or this permit shall be V vv((((((!!!!!! deemed revoked. FURNACE: EAU GRAVITY 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. CL z844,6� O License Number Lic. Class�� , #,o o o o;o U I 3 Contractor ate f� O' o,o la 0 O ❑ m o 030,507 UJ I am exempt under Sec. Plan check fee 11,3 0-8 7 � _ H B.&P.C. for this reason" PERMIT ISSUING FEE $ Date: Signature TOTAL FEE ` OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 7044, Business and Professions Code). ❑ OWNER.r I, as owner of the property, am exclusively contracting . with licensed contractors to construct the project (Sec- MAIL tion 7044, Business-and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CIT TE N .. I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR 7 Gfi (Sec. 3097, Civ. C.). ADDRE j Lender's Name CIT /' t TEL NO Lender's Address v I certifythat I have read this application and state that the STATE ,fir LIC. pp LICENSE NO. 'T CLASS r - above information is correct. I agree to.comply with all County ordinances and State laws relating to building construction, and hereby author' resentatives of this County to enter upon the abov e on d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatureof Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0212300017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 5200 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY 41 VENTILATION FAN 1.00 FAN 15.75 TENANT: TOTAL FEES 43.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: OLYMPIA 05/22/03 JK 11/18/03 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- 2700 MONTEREY RD SMAR 911081730 DESCRIPTION OF WORK T.I.- ADD RESTRM;NEW STOREFRONT;REMOVE EXISTING STAIRCASE DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 653-0409- 2207 W MERCED SPECIAL CONDITIONS: WEST COVINA 91790 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO FAU/WALL FURNACE HEMET, CA 92544 429636 A COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 COUNTY OF .LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0212300017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 5200 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596. GRID: .HS _ LOCALITY: TEMPLE CITY 41 VENTILATION FAN 1.00 FAN 15.75 TENANT: TOTAL FEES 43.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: OLYMPIA 05/22/03 JK 11/18/03 OWNER: TEL. NO: FINAL DATE FINA BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- ' 2700 MONTEREY RD i�Z `T SMAR 911081730 DESCRIPTION OF WORK T.I.- ADD RESTRM;NEW STOREFRONT;REMOVE EXISTING STAIRCASE DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 653-0409- 2207 W MERCED SPECIAL CONDITIONS: WEST COVINA 91790 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO FAU/WALL FURNACE HEMET, CA 92544 429636 A COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508