The URL can be used to link to this page

Home My Public Portal About5721 OAK AVE_Mechanical_1/30/2007_COUNTY OF IAS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0701250002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 6561 IT: 730 ON: .002 5721 OAK AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802431 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-005-005 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C 1 102 COMPEER < 100 KBTU 1.00 COM 27.00 TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 130 AIR INLETS/OUTLETS 5.00 UNI 21.75 101/30/07 JK 07/29/07 141 VENTILATION FAN 2.00 FAN 31.50 1 OWNER: TEL. N0: 1 TOTAL FEES 135.00 1F�FyL FINj �j��Y: CODE: KHAN, MR&hII25. WING K - 1 'rNlfy iIO 15721 OAK AV I 1 917802431 1 IDEEC OF WORK (TEMP (INSTALL HVAC SYSTEM FOR THE ADDITION 2 VENTILATION FANS 1 1APPLICAN T: TEL. NO: I I I ITOM O'LEARY (626) 287-0937- 1 1 15823 AGNES AVENUE 1 ISPECIAL CONDITIONS: ITEMPLE CITY CA 91780 1 1 ICONTRACTOR: TEL. N0: I JAPPROVALS DATE INSPECTOR SIGNATURE 1TOM 0•LEARY CONSTRUCTION 15823 AGNES AVENUE (626) 287-0927- LIC. NO I 1_ FURNACE I / ITEMPLE CITY, CA 91780 489354 B-1 IIFAU/WALL ! -I I COMBUSTION AIR OPENINGS I 1ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I ISAWAYA, RAMEY - 11960 SANTA ANNTA AVE. LIC. NO: IAC/COMPRESSOR (SIERRA MADRE, CA NONE I I 1 ITHERMOSTAT I 1 IFIRE DAMPERS Ii I 1 I I (SMOKE DETECTION DEVICES 1 I I !COMMERCIAL HOOD I I I ID: DPR264 ROUTE TO: BS0508 LICENSED CONTRACTOR'S DECLARATION I hereby affirmunder penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. _A r; `lfr3nd4 Cbntractor's Si ure`� / Dale OWNER -BUILDER DECLARATION I hereby affirm antler penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance; also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contmc(ors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis [or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1 am exempt under Sec. , B & P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] [31, as owner of the properly, will do the work, and the structure is not mended or offered for sale (Sec. 7044, Business and Prolessions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year at completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ I, as owner of the property, or my employees with wages as their sole compensation, will clothe work, and the structure is not intentled or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors LicenseLaw does not apply to an owner of property who builds or improves re theon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale ) ❑ I, as owner of the property, am exclusively contracting with licensed nt coractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such projects with a contractar(s) licensed pursuant to the Contractors License Law). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell -insure for workers compensation, as provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers compensation insurance carrier and policy number are: Carrier �^7tA-T �f uj, ✓� Policy Number r �) ;; L/ am/ ❑ 1 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 of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. � 30-67 Applic nt Signature Date WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE /S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LOBBYIST ORDINANCE CERTIFICATION mplete this section for permits in 1 unincCoorporated Los Angeles County only This is recertify that I, as permit applicant, am lamiliarwith the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Owner Signature Date Company Name (if employed by an entity/agency) Date JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ No ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220 Sections 220.100 through 220.140 concerning hazardous material reporting and loroblaining a permitfrom the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAOMD or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury Thal there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.) Lenders Name Lenders Address "°,Z? I certify that I have read this application and state under the penalty of perjury that the above information is correct. / agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Appl' ant m Agent �ignature > Dale