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Home My Public Portal About5329 DUPUY CIRCLE_MECHANICAL_2/25/2016_ (2)COUNTY OF LOS ANGELES TEMPLE CITY CONTRACTOR: # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS (714) 514-9426- BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 ANAHEIM CA 92807 PHONE: (626) 285-0488 EXT: TEL. LEGAL ID: LEE, PETER FEES PAID ON FILE LIC. NO: ROSEMEAD CA 91770 1FEE DESCRIPTION: QUANTITY: VOM: ASSESSOR INFORMATION NUMBER: 1 8590-005-019 101 PERMIT ISSUANCE FEE 102 REFRIG COMP < 100 KB 2.00 COM TENANT: 08 FURNACE/HEATER c 100 2.00 UNI 30 AIR INLETS/OUTLETS 16.00 IN/ SINGLE REGISTER FANS 5.00 FAN OWNER: TEL. NO: I41 TOTAL FEES OLIVE STREET GROUP LLC. (714) 863-9192- 265 W NAOMI AVE ARCADIA CA 91007 BAKER, SCOTT 155 N WADE CIRCLE ANAHEIM CA 92807 (714) 514-9426- CONTRACTOR: TEL. NO: 20TH CENTURY AIR, INC. (714) 514-9426- 155 N WADE CIRCLE LIC. NO ANAHEIM CA 92807 511598 ARCHITECT OR ENGINEER: TEL. NO: LEE, PETER (626) 280-9000- 8748 E VALLEY BLVD SUITE L LIC. NO: ROSEMEAD CA 91770 511598 PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 12) WORK IS SUSPENDED OR ABANDONED, OR 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION R ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 MECHANICAL PERMIT ME 0508 1602160048 null INU ADD"by : 5329 DUPUY LN AMOUNT:l TEMP CA 917503131 NEAREST CROSS STREET: CLOVERLY 34.40 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 67.40 1 67.40 11SSUED ON: PROCESSED BY: PLAN BY: 84.80 102/25/16 SR 99.00 1 353.00 1FINAL DATE FINAL : i CODE: INSTALL TWO HVAC SYSTEMS FOR NEW SINGLE FAMILY DWELLING SPECIAL CONDITIONS: THERMOSTAT 1FIRE DAMPERS L SMOKE DETECTION DEVICES � 1 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 1, 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 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 Contr9ctor pursuant to the Contractors' State License Law). U I am exemi4t 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 completiory of the improvements covered by this permit, Icannot 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://www.leginfo.ca.ciov/calaw.htm]. 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 Cllaas/,,sr_w License No. t-lIt�� -L 7f Date � -r Contractor Signature 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? WORKERS' COMPENSATION DECLARATION Yes ❑ WAi3NING: 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 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 (SCARMD)? 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 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. Ppficy No. ❑ Notification letter sent to AQMD and/or EPA n I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for ❑ 1 declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. ,ibo�ieq ortl6�nsetip` inepce ie an n er ar : / p /i Carrier F�, f t/C 'Policy Number prration Date O (AECLARATION 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 ?-2SA Signature ofpirant 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 Lender's Address By my signature below, I certify to,each of the following: I am the property owner or authorized to act on the property owner's 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 Property Owner , horized Agent Date 2$��