HomeMy Public PortalAbout9831 WENDON ST_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0105230002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: BUILDING ADDRESS:
TR: 11386 LT: 2 BL: A 9831 WENDON ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801727
ASSESSOR IO NEAREST CROSS STREET: OLDEN WEST
5385-022-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27,00
30 AIR INLETS/OUTLETS 3.00 UNI 13.05 THMO ON: PROCESSED B EXPIRES ON:
TOTAL FEES 67.80 05/23/01 UT 11/19/01
OWNER: TEL. NO: FINAL PATEINAL BY: CODE:
MALCYNSKI TIMOTHY D;SUSAN (626) 286-1755-
9831 WENDON ST ®�
TEMP 917801727 DES V
0RK
RENEW PERMIT FOR BEDRM, BATHRM, LAUNDRYRM, & UPGRADE EXIST
APPLICANT: 0:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. 0:
SAME AS OWNER APPROVALS DAT INSPECTOR SIGNATURE
- �`�i� �C E .':
LIC. NO =r FURNACE
ti COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. 0: C OR
LIC. NO: _ AC/COMPRESSOR
THERMOSTAT
r FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
` moi'.,,`,•,•� lI -'- - - I ~
REPORT ID: DPR264 ROUTE TO: BS0508
•WORKERS'COMPENSATION DECLARATION APPLICATION F O R PERMIT
w'I.liereby affirm that I hhve a certificate of consent to self
insure, ar a certificpte of Workers'Compensation Insurance, HEATING —VENTILATING - AIR CONDITIONING
a or a certified copy thereof(Sec. 3800, Lob. C.) 76A364C
CE-818(REV. 10/81)
Policy No. e Company Certified copy is hereby furnished, COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified co y g ' p FOR APPLICANT TO FILL IN BUILDING �3• !�,
copy is filed with the count building inspec- ADDRESS /
tion department. (PRINT OR TYPE ONLY)
Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. 6esl d wiS-
(This section need not be completed if the work involved,by ABSORPTION UNIT,BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars($100)or less.) t
I certify that in the performance of the work for which thi AIR HANDLING UNIT,CFM
permit is issued, I shall not employ any on in an man
so as to become subject to the War s'/amp Obi BOILER,BTU APPROVALS DATE INS C R'S SIGNATU
1 , pplicant COMPRESSOR, BTU TQ 4�C ROUGH
- �`'"�l /
•Date/
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth EVAPORATIVE COOLER AVATIONI
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000)of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
O
License Number Lic. Class ® u
Contractor Date O
❑ I am exempt under Sec. a
Plan check fee H
BAP.C. for this reason' PERMIT ISSUING FEE$ S
Date: A
TOTAL FEE
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
133.8A
I hereby affirm that I am exempt from the Contractor's License yy� ® # 0 0 0 0 o.
Law for the following reason (Section 7031.5, Business and NAME f / tICI. 7 )���
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS �p� D s I n . 2S75
wages as their sole compensation,will do the work and =
thestructure is not intended or offered for sale(Section CITY ' `ir1 �� TEL. NO. Pl����2-17� 0 0 0 2 5 7 5.'
7044, Business and Professions Code).
OWNER cij� cis 4J :I 216 -88
❑ I, as owner of the property, am exclusively contracting v
with licensed contractors to construct the project (Sec MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
I hereby affirm that there is a construction lending agency for.
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.).
ADDRESS
Lender's Name.
n
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 t comply with all County
ordinances and State laws relatin o building construction,
and he;4y out nz repr a es of th' County to enter
upo abo.- tion
rty pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign Pure of Applicant or Agent Date