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Home My Public Portal About5405 ROSEMEAD BLVD_Mechanical__ WORKERS; I have' cerci DECLARATION APPLICATION FOR PERMIT I hereby af�irm that I have'a certificate of consent to self inskire,c-r ater'tificate of Workers' Compensation Insurance, 1. HEATING - VENTILATING - AIR CONDITIONING ora certified copy thereof(Sec.. 3800, Lab, C.) 76A364C r p i , CE-818(REV. 10/81) C��CifD Company 16��12 j e t Policy No.k1 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 /� f tion department. ADDRESS i (PRINT OR TYPE ONLY) DateA lica LOCALITY App NO. TYPE OF APPLIANCE OR,EQUIPMENT FEE ' CERTIFICATE OF EXEM TIO FROM WO KERS' NEAREST COMPENSATIO NSURANCE' CROSS ST. �Kp �CUf (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PRocesseD BY the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM C/ 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'Compensation Laws. APPROVALS DATE IN CTOR'S SIGNAT RE Date Applicant _2 COMPRESSOR, BTU ' G'}2 C!del�` w ROUGH Ir NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM /)/� FINAL Exemption, you should become subject to the Workers' i Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALID N with comply with .such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU V 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. ;6 4 5.5 A License Number Lic. Class f � - 22575 V �T�GlC c� , ® 225,75 Contractor /V61611C. 4111_ Date 2� � jZ s --&2' rpt f 0202-87 u ❑ I am exempt under-Sec. LU Plan check fee. B.&P.C. for This reason PERMIT ISSUING FEE $ Z Date: Signature TOTAL FEE 5 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): El 1, as owner of the property, or 'my employees with ADDRESS �/�'L. Yy`C N{zCc . wages as their sole compensation,will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section . 12M 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting ,3 Ale J CrtrC1 13 �( --1TC_!�3jA with licensed contractors to construct the project (Sec- L. tion 7044, Business and Profess ions'Code). ADDRESS D SyaC `tom CONSTRUCTION LENDING AGENCY CITY. OW TEL. NO. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR %T �,1 ► (Sec. 3097, Civ. C.). 7Gl�- Y•Zt /�/C°j µ _ . Lender's Name ADDRESS � ' Lender's Address CITY � f r'a! TEL. NO. C. ��'�Ca% C% , STATE LIC. I certify that I have read this application and state that the LICENSE NO. %� .j CLA55 above 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 e abo m tied property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / 2 2 OT t5ig"n cure of Applican or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1301070004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: 5405 ROSEMEAD BL ON FILE __1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 SGAB CA 917762212 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY 15388-024-064 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl I _130 AIR INLETS/OUTLETS 10.00 UNI 44.00 TENANT: i TOTAL FEES 71.80 JISSUED ON: PROCESSED BY: PLAN BY: IBYUN / 00-BOOK KOREAN BBQ YONG-BOK I 101/07/13 SR 1 OWNER: TEL. NO: ( IFINAL DATE FIN/AL BY: CODE: M ENTERPRISES 11 11222 7 FLYNN ROAD #301 I ,I CAMARILLO, CA 93012 JDESC9IPTIOfT OF WORK - (ADD 10 AIR INLETS (APPLICANT: TEL. NO: IYONG HO SEO (213) 368-0204- 13700 WILSHIRE BLVD (SPECIAL CONDITIONS: ILOS ANGELES CA 90010 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IYONG HO SEO (213) 368-0204- 1 1 13700 WILSHIRE BLVD #427 LIC. NO IFAU/WALL FURNACE ILOS ANGELES CA 90010 954470 1 1 I COMBUSTION AIR OPENINGS (ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK I I -I I LIC. NO: 1AC/COMPRESSOR ITHERMOSTAT IFIRE DAMPERS - ISMOKE DETECTION DEVICES I CO6M9ERCIAL HOOD 1 I II � II I I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 IREPORT ID: DPR264 ROUTE TO: BS0508 r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPAR%MENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1207050005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID ( BUILDING.ADDRESS: I ON FILE I 5405 ROSEMEAD BL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762212 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY 1 15388-024-064 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl I 104 COMPRSSOR > 500 KBTU 1.00 COM 131.00 I 1 (TENANT: 119 BOILER > 500 KBTU 1.00 BOI 131.00 (ISSUED ON: PROCESSED BY: PLAN BY: I IBYUN / 00-BOOK KOREAN BBQ YONG-BOK 143 COMM KITCHEN HOOD 1.00 HOO 65.40 110/15/12 SR I 1 170 PC INDIV COMM HOOD 1.00 HOO 252.90 1 1 (OWNER: TEL. NO: I TOTAL FEES 608.10 IFINAL DATE FIN BY: CODE: 1 A & M ENTERPRISES I 11227 FLYNN ROAD #301 ICAMARILLO, CA 93012 1 ID2SCRIJTION OF WORK 1 i IME FOR T.I. FOR EXISTING RESTAURANT NO ALTERATION ON ADA 1 (APPLIED (E) RESTROOM (E) CHANGING ROOM & (E) KITCHEN 1 (APPLICANT: TEL. NO: IEDDIE NOH (213) 383-8328- 1 13450 WILSHIRE BLVD. ISPECIAL CONDITIONS ILOS ANGELES CA 90010 I I I I I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IYONG HO SEO (213) 368-0204- I I 13700 WILSHIRE BLVD. #427 LIC. NO IFAU/WALL FURNACE 1 ILOS ANGELES, CA 90010 954470-B I 1 I (COMBUSTION AIR OPENINGS 1 1 (ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK 1 I 1CORBEL ARCHITECTS INC. (213) 739-9902-3 1 1 13450 WILSHIRE BLVD. SUITE 1000 LIC. N0: I lAC/COMPRESSOR 1 I I ILOS ANGELES, CA 90010 C23320 I I I I ITHERMOSTAT I I I I I f I I IFIRE DAMPERS I 1 I I I I I I 1 ISMOKE DETECTION DEVICES 1 I I I I I I I (COMMERCIAL HOOD 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR264 ROUTE TO: 2S0508 1 1 I I I I I I