HomeMy Public PortalAbout5707 ROWLAND AVE_Mechanical__ DEC
TION
WORKERS'
that
I have a cerci cafe of corse APPLICATION FOR PERMIT
�,hereby e6ffirm 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, Lob. C.) 76A364C
❑ rT�iP/lan
y awd- - I ,t( y D� � CE-818(REV. 10/81)
Policy No
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is hereby furnished.
Certified copy is file ith the county building inspec- FOR APPLICANT TO FILL IN BUILDING r—
tion epar enc. % (� ADDRESS D l�)
/ C/ �/-!� (PRINT OR TYPE ONLY)
Dote pp ican�"� LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKE ' NEAREST
COMPENSATION INSURANCE CROSS ST. U�
ABSORPTION UNIT, BTU DISTRICT NO PROCESS y
(This section need not be completed if the work involved by >g
the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT, CFM .�
I certify that in the performance of the work for which this �� • U1
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 INSP O 'S SIGNATURE
Date Applicant / COMPRESSOR, BTU v�� !� 6 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 VAIIiIJATION
with comply with such provisions or this permit shall be l
deemed revoked. FURNACE: FAU G ITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU if
DDD
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 WALL
and Professions Code,and my license is in full force and effect. r �� S 0 ,//
License Number Lic. Class Lill[ �'(lX ► V
LJO
Contractor Date O
❑ 1 am exempt under c. U
W
Plan check fee d
N
B.&P.C. for this reason PERMIT ISSUING FEES D Z
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 ;�(3U 4 65
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS .,J07 N, 4(,JL,6(70 C
wages as their sole compensation,will do the work and /
the structure is not intended or offered for sale(Section CITY !� day TEL. NO. b r
7044, Business and Professions Code).
E387CIC�R
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- ' L
tion 7044, Business and Professions Code). AD9RZSS
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTORr pop-
Lender's
Lender's Name
(Sec. 3097, Civ. C.).
ADDRESS ?V ,93
"T S
Lender's Address
CITY /V1)/V1) s.._a its TEL. NO.
c
STATE •rt y LIC.
I certify that I have read this application and state that the LICENSE NO. �Ud�e7 CLASS
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 thea ve-mention rql erty for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of ArVant or Agent Date
• •COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1302060030
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID 1 BIIILDING ADDRESS: I
ITR: 6561 LT: 401 1 I 5707 ROWLAND AV I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917502617
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LIVE OAK
18587-029-003 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI
I 141 VENTILATION FAN 2.00 FAN 31.60 1
(TENANT: I TOTAL FEES 59.40 11SSUED ON: PROCESSED BY: PLAN BY: 1
I 1 102/07/13 SR
OWNER: TEL. NO:
TRIEU, MAI 1FINAL DATE FINAL BY: CODE:
(626) 315-6902- d-(3 1 '�/�() I
15707 ROWLAND AV �� ��(( I
TEMP 917802617 IDESCRIPTION OF WORK 14
I I 12 VENTILATION FANS
(APPLICANT: TEL. NO: 1 I I
ILO, GILBERT (626) 234-4118- 1 I I
12200 S FREMONT AVE 1 ISPECIAL CONDITIONS: 1
IALHAMBRA CA 91803 I I
I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IG & YONG CONSTRUCTION INC (626) 234-4118- I 1 I
12200 S FREMONT AVE #200 LIC. NO I IFAU/WALL FURNACE I I I
IALHAMBRA CA 91803 795058 1 1 I I I
I I (COMBUSTION AIR OPENINGS I I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 DUCT WORK I
I - I
LIC. NO: 1 IAC/COMPRESSOR I I I
I I (THERMOSTAT I I I
I I (FIRE DAMPERS I I
I I (SMOKE DETECTION DEVICES I I I
I I (COMMERCIAL HOOD 1 I I
1 7 I
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IREPORT ID: DPR264 ROUTE TO: BS0508 I I I I
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