HomeMy Public PortalAbout5332-5334-5336-5338-5340 VILLAGE CIRCLE DR_Mechanical__ 76 A364- CE 818- 5-73
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR-CONDITIONING
COUNTY OF LOS ANGELES A DRESG ( �JS2 .�'� 3
DEPARTMENT OF COUNTY ENGINEER V513
BUILDING AND SAFETY DIVISION LOCALITY S3�O yZ'Vt/
NEAREST
CROSS ST. �+
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL -
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS B
CITY TEL. NO. (j0'y
. ABSORPTION UNIT, BTU
CONTRACT?
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU Sl(P 0 - STATE /SS�I CLASS �O
Lr - LICENSE NO.
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE `` PROCESSED BY
EVAPORATIVE COOLER �J ��.r�y'!
FURNACE: FAU K GVITY INSPECTION RECORD
lD FLOOR BTU a
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL
9-
a.
O
c.D
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F-
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Plan check fee 25% of above. See reverse. z
PERMIT ISSUING FEE S 0
TOTAL FEE —IVO
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE.OF THE STATE OF_qIFORNIA.
SIGNATUREPERMIT VALIDATION CK. M.O. CASH
OF PERMITTEE )3L!"''L't
PLAN CHECK VALIDATION CK. M.O. CASH
1 5 7'r; EB `ji 4 1 o 9 4.5 0 &96
WORKER'S COMPENSATION DECLARATION 2o-004IIDPW 9l89 APPL.ICATI®N FOR PERMIT LIME GREEN
I hereby affirm that 1 have a certificate of consent to self insure, 76A964C ,r
.
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof Sec.3Wlompanyz4o��
Policy No COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
�ertified copy is filed with the couppp��tyyy building inspection FOR APPLICANT TO FILL IN BUILDING
degflrtm nt. � �9 (PRINT OR TYPE ONLY)
Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS
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($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU '�� G � ,
become subject to the Workers'Compensation Laws. r,¢iJ�/
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER A i
provisions of the Labor Code,you must forthwith comply with suchFINAL
provisions or this permit shall be deemed revoked. r, FURNACE: FAU ITY J- a VALIDATION
LICENSED CONTRACTORS DECLARATION \ FLOOR BTU S
I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED UNIT
:
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force an—d�effZ/,�qA4
e
License Number��/L-✓ Lic.Class
�N
�(�
Contractor N /d: M a'�Dr to
r_1I am exempt under Sec. Plan check fee G
B.&P.C.for this reason PERMIT ISSUING FEE$ 1 7, k
Date: TOTAL FEE !ld p O V U
Signature �_ ACCT.Ir v
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT `=t'7 L O o lift
I hereby affirm that I am exempt from the Contractor's License Law NAME 1 ITEMS
for the following reason(Section 7031.5, Business and Professions _ h q �ry
Coe): ADDRESS TOTAL �o 00
I, as owner of the property, or my employees with wages G � 48Mas their sole compensation, will do the work and the CITY TEL.NO. '-1
structure is not intended or offered for sale(Section 7044, L - CHNIGE .00
Business and Professions Code). OWNER r'
❑ 1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- ADAIL
DRESS G /� 09MI-M01 2/ 1/$3
tion 7044,Business and Professions Code). /
CONSTRUCTION LENDING AGENCY CITY TEL.NO / 794.5.E 1 PMS12-7
I hereby affirm that there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued
(Sec.3097,Civ.C.).
ADDRESS
Lender's Name
CITY TEL.NO. �r
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. s'7 CLASS
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
TmgE7
upon the bove- entioned
SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNA RE A LICANT OR AGENT DATE
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1210220008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
ITR: 29602 IT: 3 UN: 74 1 1 5342 VILLAGE CIRCLE DR 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917803360 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18585-001-144 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
102 COMPRSR < 100 KBTU 1.00 COM 27.00
ITENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 IISSUED ON: PROCESSED BY: PLAN BY: I
I 130 AIR INLETS/OUTLETS 1.00 UNI 4.40 110/22/12 SR [
I TOTAL FEES 86.20 1 1
(OWNER: TEL. NO: 1 IFINAL DATE FINAL BY: CODE:
IMALDONADO FRANCINE (626) 482-2104- II
15342 VILLAGE CIRCLE I I `
ITEMP 917803360 1 IDESCRIPTION OF WORK
I I IA/C - FURNACE, DUCT CHANGE OUT 1
I
1APPLICANT: TEL. NO: I I I
ICONTRERAS, CARRA (626) 286-3157-
14931 N ENCINITA AVE I ISP CIAL CONDITIONS: 1
ITEMPLE CITY CA 91780 1 1 1
I I Iebar
[CONTRACTOR: TEL. NO: 1 1AP RO S DAT INS TOR SIGNATURE
[CONNOR AIR CONDITIONING AND (626) 286-3157-
IREFRIGETATOR INC LIC. NO 1 IFAU/WALL FURNACE I I I
14931 N ENCINITA AVENUE 4037351 1 1 I I
1TEMPLE CITY CA 91780 1 1CON.BUSTION AIR OPENINGS-1-1
I
1ARCHITECT OR ENGINEER: TEL. NO: - 1 1DUCT WORK I-
'
I I
LIC. NO: 1 1AC'�COMPRESSOR I I [
I THERMOSTAT 1
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IFIRE DAMPERS I I I
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I I ISMOKE DETECTION DEVICES I 1 I
COMMERCIAL HOOD
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I IREPORT ID: DPR264 ROUTE TO: BS0508 I I I I
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