HomeMy Public PortalAbout4851 FIESTA AVE_Mechanical_5/21/2015_ (2)360 E. FIRST STREET
TUSTIN CA 92780
EDMOND HANK KWONG (714) 293-1576-
360 E FIRST STREET #500 LIC. NO
TUSTIN CA 92780 756780
ARUH1'1'ECI' UK ENGINEER: TEL. N0:
DABS STRUCTURAL ENGINEERS (949) 295-7943-
1931 NEWPORT BEACH BLVD LIC. NO:
COSTA MESA, CA 92627 74200
# 0508 MECHANICAL PERMIT
ME 0508 1505210017
RRP RT Tn- nPR26a Rnn ' gym. nancna
BUILDING ADDRESS:
4851 FIESTA AV
AMOUNT: TEMP CA 917803815
NEAREST CROSS STREET: LOWER AZUSA
27.80 THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY
104.40 1
104.40 ISSUED ON: PROCESSED BY: PLAN BY:
52.20 05/21/15 SR
48.40
25.80 �FI TE
77.80 r
110.60
551.40 DSS IO OP WOR.
INSTALL TWO HVAC S'
COMMERCIAL HOOD
FOR A NEW SINGLE FAMILY DWELLING
SIGNATURE
COUNTY OF LOS ANGELES`
TEMPLE CITY
DEPARTANT OF PUBLIC WOKS
9701 LAS TUNAS
BUILDING AND SAFETY / LAND DEVELOPMENT
TEMPLE CITY CA
91780
PHONE: (626) 285-0488 EXT;
LEGAL ID:
FEES PAID
TR: 11454
LT: 34
FEE DESCRIPTION:
QUANTITY: DOM:
ASSESSOR INFORMATION NUMBER:
8590-020-020
O1 PERMIT ISSUANCE FEE
03 COMPRSR 101 500 EBTU
09 FURNACE 101 500 KBTU
2.00 COM
2.00 UNI
TENANT:
21 FIREPLACE 101 - 500
1.00 APL
130 AIR INLETS/OUTLETS
132 APPL VENT (OTHER)
11.00 UNI
2.00 UNI
OWNER: TEL. NO:
KWONG, DAVID
(818) 269-3868-
136 AHU 2001-10000 CFM
2.00 AHU
4845 FIESTA AV
141 VENTILATION FAN
7.00 FAN
TEMP 917803815
TOTAL FEES
APPLICANT: TEL. N0:
KWONG, ED
(714) 293-1576-
360 E. FIRST STREET
TUSTIN CA 92780
EDMOND HANK KWONG (714) 293-1576-
360 E FIRST STREET #500 LIC. NO
TUSTIN CA 92780 756780
ARUH1'1'ECI' UK ENGINEER: TEL. N0:
DABS STRUCTURAL ENGINEERS (949) 295-7943-
1931 NEWPORT BEACH BLVD LIC. NO:
COSTA MESA, CA 92627 74200
# 0508 MECHANICAL PERMIT
ME 0508 1505210017
RRP RT Tn- nPR26a Rnn ' gym. nancna
BUILDING ADDRESS:
4851 FIESTA AV
AMOUNT: TEMP CA 917803815
NEAREST CROSS STREET: LOWER AZUSA
27.80 THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY
104.40 1
104.40 ISSUED ON: PROCESSED BY: PLAN BY:
52.20 05/21/15 SR
48.40
25.80 �FI TE
77.80 r
110.60
551.40 DSS IO OP WOR.
INSTALL TWO HVAC S'
COMMERCIAL HOOD
FOR A NEW SINGLE FAMILY DWELLING
SIGNATURE
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the reason(s) Indicated
below by the checkmark(s) I have placed next to the applicable
item(s) (Section 7031.5, Business and Professions Code): Any
city or county that requires a permit to construct, alter, Improve,
demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions
Code) or that he or she is exempt from licensure and the basis
for 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).):
U I, as owner of the property, or my employees with wages as
their sole compensation, will do (/)all of or (_) portions of the
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of
property who, through employees' or personal effort, builds or
improves the property, provided that the 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 it was not built or
improved for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with
licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License
Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a
licensed Con" ctor pursuant.to the Contractors' State License
Law).
U I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signature below I acknowledge that, except for my
personal residence in which I must have resided for at least
one year prior) to completioq of the Improvements covered by
this permit, I c4nnot legally sell a structure that I have built as an
owner -builder If it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable
law, Section 7044 of the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: htto:/Avww.leginfo.ca.aov/calaw.htmi.
Date:
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty 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 License No. _% sp❑ `�
Date *t ->Contractor Signature
WORKERS' COMPENSATION DEC TION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
COVERAGE IS 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.
JOB ADDRE S
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
modiflcation 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
I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements
declarations: under the Los Angeles County Code Title 2, Chapter 220,
1 have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous
insure for workers' compensation, issued by the Director of material reporting and for obtaining a permit from the SCAQMD.
Industrial Relations as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION
is issued.
TPoljcy No. El Notification letter sent to AQMD and/or EPA
I have and will maintain workers' compensation
Insurance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not
the performance of the work for which this permit is issued. My applicable to addressed project.
work rs' omp rlsati Ins j]nccee caller and policy number are: �,/
Carder Po��l'Icy um ei Expire— D V 7S DECLARATION REGARDING CONSTRUCTION LENDING
AGENCY
Name of Agent Phone Number
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 become subject to the workers' compensation laws of
California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions
Sa I rs
Signature of Applioan Date
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated Los Angeles County only
This is to certify that I, as permit applicant, am familiar with 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
Company Name Date
I hereby affirm under penalty of perjury that there is a
Construction lending agency for the performance of the work for
which this permit is Issued (Section 3097, Civil Code).
Lender's Name
Lenders Address
By my signature below, I certify to,each of the following:
I am the property owner or authorized to act on the
property owners behalf.
I have read this application and the information I have
provided is correct.
I agree to, comply with all applicable city and county
ordinances and state laws relating to building
construction.
I authorize representatives of this county to enter the
above -identified property for inspection purposes.
Signature of Ppnperty Owner or Authorized Agent
Date 5 J S