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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1401220010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE I I 5807 ROSEMEAD BL I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 91780 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
15397-012-043 IOW P.C. FEE $109.35 MIN 0.00 164.10 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI
I 101 PERMIT ISSUANCE FEE 27.80 I
ITENANT: 140 EVAPORATION COOLERS 2.00 UNI 43.80 ISSUED ON: PROCESSED BY: PLAN BY: 1
1CHUAN'S RESTAURANT 141 VENTILATION FAN 2.00 FAN 31.60 105/13/14 SR I
I 143 COMM KITCHEN HOOD 2.00 HOO 130.80 1
(OWNER: TEL. NO: I TOTAL FEES 398.10 IFINAL DATE FI CODE:
ICHEN, QU (626) 616-5089- 1 I
13042 SYCAMORE AVENUE I1
ILA CRESENTA CA 91214 1 IDE CR PTION OF WORK
I 1 ITENANT IMPROVEMENT - MECHANICAL FOR CHUAN'S RESTAURANT 1
(APPLICANT: TEL. NO: 1 I I
IZHANG, BINGYING (626) 570-9978-
119 S ATLANTIC BLVD 1 ISPECIAL CONDITIONS: 1
IMONTEREY PARK 91754 1 I
]CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE 1
IJY CONSTRUCTION GROUP INC. (626) 332-6789- 1 1 I
11214 E EDNA PLACE LIC. NO 1 IFAU/WALL FURNACE I I I
ICOVINA CA 91724 963661 1 1 1 I I
I 1 ICOMBUSTION AIR OPENINGS I I I
ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK 1
(DRP INC. (626) 570-9978- ] 1 I
11119 S. ATLANTIC BLVD. #119 LIC. NO: I IAC/COMPRESSOR I I I
IMONTEREY PARK, CA 91754 NONE
I I ITHERMOSTAT I ]
IFIRE DAMPERS I I
I � I
SMOKE DETECTION DEVICES I I
I I ICOMMERCIAL HOOD 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
1 ] I I I I
I I I I I I
I IREPORT ID: DPR264 ROUTE TO: BS0508 I I I ]
I I I I I I
WORKER'S COMPENSATION
certificate
of consent to 7BA34fiDPW9le9 APPLICATION FOR PERMIT LI E GREEN.
I hereby-affirm that I have a certificate of consent to self insure, 7tiA384C
or a celtificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.)
Policy No./2012-3 Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy hereby furnished. If
❑
FOR APPLICANT TO FILL IN BUILDING Certified copy is tiled with the county building Inspection (PRINT OR TYPE ONLY) ADDRESS � _.�•-� ��
departmen. +f
Date Z LJ
Applicant LOCALITY
NO91 If . TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM--/--
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws. lC-2.tc1
COMPRESSOR,BTU / DDD. Q
APPROVALS DATE INSPECTOR'S SIGNATURE
Date `� Applicant � VENTILATION SYSTEM 20
NOTICE APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation �- EVAPORATIVE COOLER J � FINAL
provisions of the Labor Code,you must forthwith comply with such
provisions or this permit shall be deemed revoked. FURNACE: FAU—GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU /D0,OOO B'a VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license Is in full force and effect. ./6
License Number 46 LID.Class _ ,may C >
d C"+ cf � � Doo iLE"fl J � C
Contractor � Date � p ���' �
❑ I am exempt under Sec. Plan Check fee moi" • 1/ D
B.&P.C.for this reason PERMIT ISSUING FEe$ AI �� I
Date: TOTAL FEE 3 a
Signature 1414"
U,
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT �
1 hereby affirm that I am exempt from the Contractor's License Law NAME ► �:
for the following reason(Section 7031.5, Business and Professions
e): ADDRESS f,
4r1:
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). OWNER
❑ `
I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS — On,
tion
--- r,:.•
tion 7044,Business and Professions Code). p -
CONSTRUCTION LENDING AGENCY C T p'� z f
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit Is issued CONTRACTOR �� S`. �� �C/fI , , tip_ %s}f`°:;-'
(Sec.3097,Civ.C.).
ADDRESS 2 ���� E_�.`�C`_f. i f1 7
Lender's Nam f ^ `G,
CITY TEL.NO. /�v�Q.
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. f Y(J CLASS
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
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGENT DATE '