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HomeMy Public PortalAbout6404-6414 ROSEMEAD BLVD_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT • DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0211210019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEE ID BUILDING ADDRESS: ON FILE 6404 6414 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 91.7751958 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-044 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 02 COMPRSR < 100 KBTU 6.00 COM 162.00 TENANT: 08 FURNACE/HEATER <100 6.00 UNI 162.00 ISSUED ON: PROCESSED BY: PLA BY: WIRES ON: 30 AIR INLETS/OUTLETS 50.00 UNI 217.50 11/21/02 JK 05/20/03 TOTAL FEES 569.25 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CHANG; LU & RAESHIAU (626) 291-2345- 922 PARK AVENUE LZ r O L ARCADIA 91007 DESCRIPTIUN OF WORK MECHANICAL FOR FIRE DAMAGED BUILDING APPLICANT: TEL. NO: DOUG FARNIK (562) 698-0201- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DOCKSTADERS (562) 698-0201- 6727 GREENLEAF AVENUE LIC. NO FAU/WALL FURNACE WHITTIER, CA 90606 350935 C20 COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. N0: DUCT WORK H C HANSEN ENG (714) 573-0073- Z ' 17371 IRVINE LIC. NO: AC/COMPRESSOR TUSTIN CA 92780 3027 Z ��- THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 -"' WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure' or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) CE-81 C CE 818(REV. 10/81) � Policy No.!�company / f 1 Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ® Certified copy is filed with the county building in a FOR APPLICANT TO FILL.IN BUILDING // tion department. ADDRESS �� ev /U �� � (PRINT OR TYPE ONLY) 7 LOCALITY Date / Applicant rN . TYPE OF APPLIANCE OR EQUIPMENT FEE 4,1 CERTIFICATE OF EXEMPTION FROM WOR S' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. `PROCESSED BY 67 the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this. AIR HANDLING UNIT, CFM permit is issued, 1 shall not employ any person in any manner J so as to become subject to the Workers''Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE dOC� Date Applicant COMPRESSOR, BTU r� ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' / Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALI AT with comply with such provisions or this permit shall be deemed revoked. / FURNACE: FAU GRAVITY 1G� LICENSED CONTRACTORS DECLARATION Ci FLOOR - BTU I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT '(commencing with Section 7000) of Division 3 of the Business HEATER: WALL and Professions Code,and my license is in full force and effect. License Number, 0 _2 / Lic. Class •+� �6 � ® 09 Contractor a -a O ❑ I) I am exempt nder Sec. W Plan check fee CL B.BP.C. for this reason PERMIT ISSUING FEE Date: TOTAL FEE Signature F'F 3.6 A 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):' [ °,� 'J S Q ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 0 the structure is not intended or offered for sale(Section CITY TEL. tJO. 1,27 —8 D- 7044, Business and Professions Code). _ OWNER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). n ADDRESS J G or CONSTRUCTION LENDING AGENCY CITY ad `- }v TEL. NO. S -�2.6) 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.), ADDRESS Lender's Name CITY TEL. NO. /_ Lender's Address a.' ' STATE E,. c% LIC. I certify that I have read this application and state that the LICENSE NO. r�© / CLASS --2 above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authopppfffze a entatives of this County to enter up n t above ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7- Signature Of App t n r Agent Date