HomeMy Public PortalAbout5853 SULTANA AVE_Mechanical__ COUNTY OF IAS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
ME 0508 0911160001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
[LEGAL ID: I FEES PAID I BUILDING ADDRESS: [
JTR: 5905 LT: 110 I [ 5853 SULTANA AV [
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917801841
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15387-014-007 101 PERMIT ISSUANCE FEE 27.75 [ THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
1 .102 COMPRSR < 200 KBTU 1.00 COM 27.00 [
TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 [ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
130 AIR INLETS/OUTLETS 9.00 UNI 39.15 111/16/09 SR 11/16/10
I 1 TOTAL FEES 120.90 1
(OWNER: TEL. NO: .1 IFINAL DAT FIN Y: CODE: I
WALKER WILLIAM (626) 291-2652- 1 1
15853 SULTANA AVE. I ?j/I( '
ITEMP 917801841 1 IDESCRIPTION OF WORK 14
NEW HVAC SYSTEM
(APPLICANT: TEL. NO: 1
ICOMFORT ZONE INC. - I
1144 B VALENCIA I I I
GLENDORA CA 91740 I iSPECTnr• CONDITIONS:
I I 1
[CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
ICOMFORT ZONE INC. (626) 963-8383- I
1144 B VALENCIA LIC. NO I IFAU/WALL FURNACE / I
1GLENDORA, CA 91740 760955 C20 I
COMBUSTION AIR OPENINGS INJ
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(ARCHITECT OR ENGINEER: TEL. NO: 1 (DUCT WORK I I
LIC. NO: i IAC/COMPRESSOR IJ�J i I
(THERMOSTAT 1 �1
I I IFIRE DAMPERS I I I
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ISMOKE DETECTION DEVICES I I
I iCOMMERCIAL HOOD
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]REPORT ID: DPR264 ROUTE TO: BS0508
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ell
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
d' h rely dffitjn that I have a certificate of consent to self
Nhsufe, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a crertified copy thereof(Sec. 3800, Lab. C.) 76A364C
W-d 7 CFy-818(REV. 10/81)
Policy No. CLT97i- Company j4m � 0
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDIN ANDS F
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion departments (PRINT OR TYPE ONLY) ADDRESS
Date �' _3—AJ Applicant . LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed if the work involved by ABSORPTION UNIT,BTU DISTRICT NO PROCESSE
the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM (/V. D BY
it
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. BOILER,BTU APPROVALS DATE INSPECR'S SIGNATU E
Date Applicant COMPRESSOR, BTU ROUGH 44y�9'-
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL f/2
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT D OQ
'(commencing with Section 7000)of Division 3 of the Business
AL
and Professions Code,and my license is in full force and effect.
License Number '7 7 8 Lic. Class�5®_ %P
Contractor I&II �a to
❑ I am exempt under Sec.
Plan check fee FA
FA
B.&P.C. for this reason PERMIT ISSUING FEE$ p
Date: v
l Signature TOTAL FEE
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT p
#g
I hereby affirm that I am exempt from the Contractor's License Y3
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with
ADDRESS I ( o - 2(150
wages as their sole compensation,will do the work and CITY TEL. NO.
the structure is not intended or offered for sale(Section o 0 0 2 Q 5 0
7044, Business and Professions Code). OWNER ��l G a 0 5—8 5
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS p AA 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR � J
(Sec. 3097, Civ. C.).
ADDRESS
Lender's Name
CITY . -9A TEL. NO.
Lender's Address STATE -c/ LIC.
I certify that I have read this application and state that the LICENSE NO. (p CLASS G 1
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
upo the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date