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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0810290005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-04BB EXT
LEGAL ID FEES PAID BUILDING ADDRESS -
ON FILE 1 1 5564 SULTANA AV
FEE DESCRIPTION QUANTITY DOM AMODNT TEMP CA 917802322
(ASSESSORINFORMATION NUMBER I NEAREST CROSS STREET LAS TUNAS -
15387-026-017 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY, Cl
102 COMPRSR < 100 KBTU 1 00 CUM 27 00 1
TENANT 08 FURNACE/HEATER <100 1 00 UNI 27 00 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TOTAL FEES 81 75 10/29/08 SR 04/27/09
OWNER TEL NO , FINAL DATE FINAL BY CODE
PICA SHARI (626) 524-3530-
5564 SULTANA AV - 1 "'L y �W
TEMP 917802322 ' - - ID I ION'OF MURK
(REPLACE FURNACE COIL S CONDENSER
(APPLICANT TEL NO
IHUMPHREYS (626) 710-6868- 1
13170 DEL VIM ST 1 (SPECIAL CONDITIONS 1
PASADENA, CA 91107
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(CONTRACTOR TEL NO I (APPROVALS DATE INSPECIUR SIGNATURE I
UNIVERSAL PLUMBING (626) 710-6868- - 1
13170 DEL VIVA ST LIC NO IFAD'LULL FURNACE
PASADENA CA 91107 386678 C16 I
COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER TEL NO _ (DUCT WORK
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LIC NO AC/COMPRESSOR
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THERMOSTAT
FIRE DAMPERS
(SMOKE DETECTION DEVICES
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I COMMERCrnr, Hoop
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IREPORT ID DPR264 ROUTE TO BS0508
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\\'ORKERS COMPENSATION DLCLARATION 76A364C
1 hereby affirm that 1 hese o certificate of consent to self
CE 818 (280)
APPLICATION FOR -PERMIT
msure or a certificate of Workers Cm'tpensano= Insurance or HEATING-VENTILATING-AIRCONDITIONING
a certified copy thereof(Sec 3900 Lab
��t_OC�r)
Policy No .04725_Company—BEAC —Ln,�(scr_
❑ Certified cops is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the taunts budding Inspection dTFOR APPLICANT TO FILL IN
Date-/- YF WBUILDING
ptl4/83- A fp
, hcant (PRINT OR TYPE ONLY) ADDRESS
5564 SULTANA
LOCALITY
'
CERTIFICATE 01 EXEMPTION 1 ROM \40R KL R5 NO TYPE OF APPLIANCE OR EQUIPMENT FEE
TEMPLE—CITY
COMPENSATION INSURANCL NEAREST � + d
(This section need not be completed if the work mrnh'ed ABSORPTION UNIT BTU CROSS ST "'�r� vgs O
b) the permit Is for One hundred dollars ($100) or less) DISTRICT NO Pnocii; f-)
I certify that in the performance of the work for which this AIR HANDLING UNIT CFM Qcc
permit is issued I shall not employ env person In any manner �• 8
so as to become subject to the Workers Compensation Laws BOILER BTU
APPROVALS DATE IN TO SSIGNATURE W
Date Applicant COMPRESSOR BTU
ROUGH N
NOTICE TO APPLICANT If after making this Certificate ofZ
Exemphbn you should become sLbject to theWorkers VENTILATION SYSTEM J(JFINAL
1 Compensation provisions of the Iabor Code you must forth EVAPORATIVE COOLER VALIDATION
1 wdh comply with such provisions or this permit shall be
deemed revoked FURNACE FAU_1--- GRAVITY__
LICENSED CONTRACTORS DECLARATION FLOOR US s +D
1 hereby affirm that 1 am licensed under provisions of Chapter HEATER SUSPENDED UNIT _
9 (commencing with Section 7000)of Drvtaon 3 of the Rust WALL
ness and Professions Code and my license Is in full force and
effect
License Number-257573— Lin CWss_C-?0
Contractor-BARNES Dao._7/14/83
❑ 1 am exempt from the heensing requirements as 1 am a
licensed architect or a registered professional engineer Plan Check fee 25%of above
acting in my Professional eapactty (Seebon 7051 Bus
mess and Professions Code) PERMIT ISSUING FEES 10 50
LIc or Reg No Date TOTAL FEE 49 75
'HOME OWNLR BUILDER DECLARATION PLAN CHECK APPLICANT
1 hereby affirm that I am exempt from the Contractors NAME
License Law for the followng reason (Section 7031 5 Bust
ness and Professions Code) - ADDRESS
❑ 1 as owner of the property will do the work and the
structure Is not Intended or offered for sale (Section CITY TEL NOS 4 8 1 S.A
7044 Business and Professions Cude) r t
❑ OWNER KEN WELLER # •'•,8
I as owner of the property, am exclusn ely cunt Noting ' } '
with licensed contractors to Construct the project MAIL 2t• • 49,7j55
(Section 7044 BUSInLSS and Professions Cade) ADDRESS j
,CONSTRUCTION LENDING AGLNCY CITY TEMPLE CITY
TEL NO - ��I• • 49,7,55
1 hLtebs affirm that there is u construction lending agency 0 8 2 6-8 s3
for the performance of the work for which this permit is CONTRACTOR BAR r,^ 1 ,
issued
Sec
Lender s Name 712
Civ C) ADDRESS W
Lenders Address CITY tipSL, TEL NO
1 certify that I have read this application and state that the STATE LIC r•
above information is correct I agree to comply with all County .61CENSE NO 257573 C
CLASS -20-
ordmam,es and State laws regulating Heating Ventilating and ,
Air Conditioning and hereby authonie representatives of this SEF. REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above mentioned property for
i nature oft( arm tee pate !r3