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Home My Public Portal About6355 GOLDEN WEST AVE_MECHANICAL__TEMPLE CITY PERMIT NO. M16-188 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 6355 Golden West Avenue, Temple City, Parcel: 5383-018-029 California 91780 Permit No: M16-188 Type: Mechanical Subtype: Subtype: Residential Description: New roof mount 4 ton package unit Special Air Handler 0 Conditions: over Issue Date: 07-20-2016 Expire Date: 01-16-2017 Extension: Extension: Permit expires on date shown if: 1) work does not commence or 2) work is suspended or abandoned, or 3) applicant fails to obtain code required inspection. Damper Alteration Contacts UP ]REOa-2-17 Owner Celenia 6355 Golden West Avenue, Temple City, California (626) 287-3227 Emanuelli 91780 Applicant Tom Robinson 3150 East Birch Street, Brea, California 92821 (714) 777-7777 Contractor Around the Clock Heating 7216 Varna Avenue, Los Angeles, California (800) 434-9277 650364 A/C 91605 Mechanical Details Compressor/ Furnace 2 /Etc up to 100k BTU Appliance Vent 0 Ventilation Fan 0 Compressor/Furnace 0 Compressor/ Furnace 0 /Etc 100-500k BTU /Etc over 500k BTU Air Handler up to 0 2,000 CFM Ventilation System 0 Fees Total Plan Check Fees $0.00 Permit Fees $120.24 Mechanical Inspections Air Handier 2-10,000 0 CFM Kitchen Hood/Spray 0 Booth Approval Date Inspector Thermostat FAU/Wall Furnace Fire Dampers Combustion Air Openings Smoke Detectors Duct Work Commercial Hood AC/Compressor FINAL Air 10 OR Floor 0 Inlet/Outlet Area Qty Air Handler 0 Evaporative 0 over Cooler 10,000 CFM Fire 0 Duct 0 Damper Alteration 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 U 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.). U 1, 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 Contrh or pursuant.to the Contractors' State License Law). L) 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 priori to completioq of the improvements covered by this permit, 1 CAnnot legally sdll 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,//www.leginfo.ca.cqvltalaw.htmi. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION JOB ADDRESS I hereby affirm under penalty of perjury that I am licensed under LOCALITY 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. HAZARDOUS MATERIAL DECLARATION (°ao �C� 3 Will the applicant or future building occupant handle a hazardous Licensee Class C5`6 C 5`6 License No, material or a mixture containing a hazardous material equal to or Date /ldi� Contractor Signatur greater than the amount specified on the hazardous materials _fir information guide? WORKERS' COMPENSATION DECLARATION Yes ❑ No ❑ WAilkNING: 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. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this perk is issued. Policy No. 4I have and will maintain workers' 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 insurancecomer and policy numb arm : owb :: C I.1/a,Y.K-uJQ;{fuI— AiYMt mfXc l 1 r I 7 Cartier Policy Number Expiration Dilto i o K "A41Z_ ell 751-4-873 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 Signature of Applicant 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 appli lien prose Applicant (Print Name) Applicant Sign Company Name Date Will the intended use of the building by the applicant or future building occupant require a perk 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 for obtaining a perk from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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. Sign ufa of Propqgy,wnEFor Authorized Agent Date