HomeMy Public PortalAbout9734 WEDGEWOOD ST - Mechanical cz
7GA364EICE-81SA)-9/77 APPI.I TION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST. r
ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT,CFM MAIL.
ADDRESS Li
y BOILER,BTU
COMPRESSOR,BTUQCT �
'3 S� CONTRACTOR 1.1,Z67 X
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL.NO. ?jct 9 79,1
FURNACE: FAU-Y_GRAVITY STATE yy LIC.
FLOOR BTU LICENSE NO. 1 CLASS
HEATER: SUSPENDED UNIT— DISTRICT NO. GROUP ZONE PR SSED BY
A. WALL Q
x
INSPECTION RECO
u
at
Plan check fee 25% of above.
Lu
PERMIT ISSUING FEE$_ $A
TOTAL FEE lq .
PLAN CHECK APPLICANT
NAME l�v
ADDRESS
CITY TEL.NOW>0 3:2
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES ANb LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
I HEREBY CERTIFY THAT I .AM NOT ACTING IN VIOLATION OF. APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION 3—OF THE BUSINES AND 0FESSIONAL CODE ROUGH
OF THE STATE OF CAl}rNIA.
SIGNATURE /L [,j//'/ FINAL �� / � �`"•^ �J
OF PERMITTE
10
PLAN CHECK VALIDATION CK., M.O. CASH PERMIT VALI ATI CK. M.O. CASH
9 2 '1 til1.t;, b 41
®5
WORKERS'COMPENSATION DECLARATION APPLICATION ' FOR PERMIT
f
I hereby'affirm tkat 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 COUNTY OF LOS ANGELES / BUILDING AND SAFETY
Certified copy is hereby furnished..
❑ Certified copy is filed with the county-building inspec- FOR APPLICANT TO FILL IN BUILDING (( �
tion department. (PRINT OR TYPE ONLY) ADDRESS
OF-7 3
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' CNEAREST
ROSS ST.
COMPENSATION INSURANCE I
(This section need not be completed if the work involved by ABSORPTION UNIT,BTU ' DISTRICT NO. PROCESSED B
the permit is for one hundred dollars($100)or less.) I AIR HANDLING UNIT,CFM
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner BOILERBTU
so as to become subject to the Workers'Compensation ,laws. APPROVALS DAiT INSPECTOR'S SIGNATURE
Date f�Z ' I1 Applicant I COMPRESSOR,BTU �/ O l ROUGH � � r�.-�—'►+
NOTICE TO APPLICANT: If, after making this Certific a of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Wo ers'
Compensation provisions of the Labor Code, you must forth- I' EVAPORATIVE COOLER VALIDATION
with comply with such .provisions or this permit shall be
deemed revoked. FURNACE: FAU G ITY
LICENSED CONTRACTORS DECLARATION I FLOOR JBTI 1 0 '
I hereby affirm that I am licensed under provisions of Chapter,9 HEATER: SUSPENDED—UNIT—
'(commencing
USPENDED UNIT'(commencing with Section 7000) of Division 3 of the Business - WALL
and Professions Code,and my license is in full force and effect:
License Number Lic. Class
,I Ik
Contractor Date O
❑ LU
I am exempt under Sec. LU•
Plan check fee EL
B.BP.IC. for this reason' it l
PERMIT'ISSUING FEE$ Q U Z
' Dare: .
Signature. . - TOTAL FEE Q ,
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 I NAME
PP fessions Code): -
I q-•� r
I, as owner of the property, or my employees with ADDRESS 1 ! LL EaCig V4 pra 13 :J c
1
wages as their•sole compensation;will do the work and 1
the structure is not intended or offered'for sale(Section CITY'—r In ^ C f TEL.NO, 3
7044, Business and Professions Code). ^'0
I OWNER � ,
❑ I, as owner of the property, am exclusively contracting , :IF o 0 0 0 0
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS) o 0 3 0.5 0' .
CONSTRUCTION LENDING AGENCY CITY ' : .. EL. NO. ' ��
I hereby affirm that there is a construction lending agency.for �'0 5 C:r
the performance of th work for whi h this—permit ermit is issued CONTRACTOR
c 1 7-82
(Sec. $097, Civ. C.).
ADDRESS
Lender's Name
e ®^ �, CITY TEL. NO.
Lender's Address iJ
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 :I
ordinances and State laws relating to building construction, '
and hereby authorize rp1property
tives of this County to enter. ;I
I u n the pb e- tiofor inspection purposes. t SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Ag Dote
v
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1005120001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
ITR: 11131 IT: 7 I 1 9734 WEDGEWOOD ST ]
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802535
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GOLDEN WEST
18588-010-001 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I 141 VENTILATION FAN 1.00 FAN 15.75 I I
ITENANT: I TOTAL FEES 43.50 ISSUED ON: PROCESSED BY: PLAN BY: 1
I I 105/12/10 SR
(OWNER: TEL. NO: 1 FIZIAL DATE FINAL BY: CODE:
LFII, JENNIFER JILIN ( 1 I /W�
19734 WEDGEWOOD ST I I I
ITEMP 917802535 1 1DtPtCRIPTION OF WORK I
I I (VENTILATION FAN FOR BATHROOM REMODEL
1APPLICANT: TEL. NO: 1 I I
ISAME AS OWNER
ISPECIAL CONDITIONS: 1
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
(SAME AS OWNER _ I
LIC. NO i IFAU/WALL FURNACE I I I
I ICOMBUSTION AIR OPENINGS 1 I I
(ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK I I 1
LIC. NO: 1 JAC/COMPRESSOR I I
1 I ]THERMOSTAT I I 1
1 (FIRE DAMPERS I I I
SMOKE DETECTION DEVICES ] I I
I ] (COMMERCIAL HOOD
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IREPORT ID: DPR264 ROUTE TO: BS0508 I ] I
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