HomeMy Public PortalAbout9231 WEDGEWOOD ST_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1012140011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 7485 IT: 16 I I 9231 WEDGEWOOD ST
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 917802437 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18588-001-018 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
1 109 FURNACE 101 500 KBTU 1.00 UNI 52.20 I 1
I
TENANT: TOTAL FEES 80.00 ISSUED ON: PROCESSED BY: PLAN BY:
12/14/10 SR 1
1OWNER: TEL. NO: I (FINAL DATE FINAL BY: CODE: I
IGRAINGER WILLIAM ( 1 1 b 1
9231 WEDGEWOOD ST 1 1 - 1
ITEMP 917802437 1
DESCRIPTION OF WORK
1 I WALL FURNACE 25,000 B.T.U. I
1APPLICANT: TEL. NO: I I
IWUKMIR, NICK (626) 442-2148- I 1 I )
�11500 RAMONA BLVD. 1 ISPECIAL CONDITIONS: 1
EL MONTE CA i 1
ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
IWUKMIR, JAMES (626) 442-2148- 1 1 I
111500 RAMONA BLVD LIC. NO IFAU/WALL FURNACE I I I
IEL MONTE CA 91731 285626C20 1 I I I I
I ICOMBUSTION AIR OPENINGS I I I
(ARCHITECT OR ENGINEER: TEL. NO: I (DUCT WORK I I 1
I LIC. NO: i 1AC/COMPRESSOR I
(THERMOSTAT I I
I, IFIRS DAMPERS I 1 1
ISMOKE DETECTION DEVICES I I I
ICOMMERCIAL HOOD I I 1
I I I I I
I 1 I I 1 I
I I I I I I
I I I I I
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I I I I I I
IMPORT ID: DPR264 ROUTE TO: BS0508 I I I
I I I I I I
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
I hereby ahitm 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.) 76A364C
CE-818(REV. 10/81)
Policy No. Company
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ZSfw•-SD 5L
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department. ADDRESS 1.3 1 Z7r [.T/ RWVV,1
(PRINT OR TYPE ONLY)
Date Applicant LOCALITY 1-< 61
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE 1
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST ( /
COMPENSATION INSURANCE CROSS ST. ti en t I't; I t S S aio[V�D
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. LPR7BY
the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM O i
I certify that in the performance of the work for which this c (J
permit is issued, I shall not employ any person in any manner BOILER,BTU
so as to become subject to the Workers'Compensation Laws. APPROVALS DATE INSPECTOR'S SIGN TURE
p c
Date 4P^1 /-9- Applicant Il�aYN K. Grai7laZr COMPRESSOR,BTU ROUGH
NOTICE TO APPLICANT: If, after making this Certificate off VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDAT ON
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR •—BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000)of Division 3 of the Business - WALL 9,
and Professions Code,and my license is in full force and effect.
O
License Number Lic. Class ® V
t?L
Contractor Date
❑ V
w
I am exempt under Sec. Plan check fee
N
B.&P.C. for this reason'
Date:
PERMIT ISSUING FEE$
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
Professions Code):
2011, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and CITY TEL. NO.
the structure is not intended or offered for sale(Section
7044, Business and Professions Code).
OWNER �72a4A
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS # o o e o 0 8
CONSTRUCTION LENDING AGENCY CITY TEL. NO. I a -.2(150
1 hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR ® .o 0 0 2 a 5
(Sec. 3097, Civ. C.).
ADDRESS .0619-87
Lender's Name
CITY TEL. NO.
Lender's Address
STATE LIC.
I certify that I have read this application and state that the LICENSE NO. 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 the above-mentio d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date