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HomeMy Public PortalAbout5431 BALDWIN AVE_Mechanical__ (2) COUNTY OF LOS ANGELES TEMPLE CITY 4' 050$ MEGNa.=?: %r SIT DEPARTMENT OF Pt ;L iC WORKS 9701 LAS TUNAS IME 050t3 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 9'760 PHONE: (626) 'EXT: LEGAL iw' ---- I - - _`r� PAi3 TBUILDING ADDP,ESS: -----_�j MBK: -1? PG: 72 PC: 2 I 5431 BALDWIN AV !F17 DESCRIPTION: QLJAN37ITY: UOM: Ahir:;jwT ! TEMP-CA 9178026-2-9 INFORMATION NUMBER: ; NEAREST CROSS STREET: 8588-0`19-032 ii;l P-EMI7 ISSUANCE 'EE c- THOMAS GRTD: �� LOCALITY:PAGE: 597 , CI 08 FURNACE/HEATER <100 1.00 UNI 27.00 l Ti_, t i -'.0 AL t'-. S v.7� l, ,, IED ON: PROCESSED - N - . EXPIRES Oid: 109!02/04 JK 03/01/05 IiFIN?L DATE FIN4L UY; CODE:—TEL. NO: i !iTMENE", M:NUEL (818) 309-9006- f ; RAi-DWIN AV ! I TE`? 917802625i SCRiP7 0;! OF WORK CHANGE OUT EXISTING F. c 4 ; U I ti;=',`iT: TEL. NO: '- �r '1Er (626) 357-5311- i !-C' 30 V CE;:ORY AVE i ISECIAL CONDITIONS: "' IEG";iA �CO.JRAC i1;Z — —� TES NO IAF K—i7VaL5 — �.4r;: INSPECTOR T41rF— -' !AT TR0 (626) 357-5311- MYRTLE 57-5311-MY•'.'iLE AVE LIC. NO I I F. _!WALL FURNACE -- I a10'i3O' "A C '1016 258228010 � I i i . ITiiCT CR kGINEER: TEL. NO:NO: w'i'_, WORr LIG. N0. ! IAC/C,0-`4PRESSOR } I -- - -- —- — �_. TA t SMOKE DETECTION DEViCC•Ni�_—I—.1--- ix ADDITIONAL DATA ON FILf;: ,REPORT ID: DPR264 ROUTE TO: BS0508 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT -1 hereby affirm that' I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3804, Lab. C.) 76A364C /�105113.., c 20-0046 DPW 9/88 Policy No S,�l1J lJC hereby , Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion Jepartment. ADDRESS 3 &"—)tv 1,J Ave-- /��, �i�✓,f /J�t - (PRINT OR TYPE ONLY) Date ©"� Applicant �' rte" LOCALITY 11` NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. f (This section need not be completed if the work involved by ABSORPTION UNIT, BT DISTRICT NO. PROC ED BY the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which This AIR HANDLING UNIT, CFM O� 5i �� 1.�• permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SGNATURE Date Applicant COMPRESSOR, BTU �" ID ROUGH I z NOTICE TO APPLICANT: If, after making this Certificate of �j VENTILATION SYSTEM �QLI �Gi O FINAL Exemption, you should become subject to the Workers' t/ Compensation provisions of the'Labor Code, you must forth- EVAPORATIVE COOLER N with comply with such provisions or this permit shall be deem- ed 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. 3 v r o'� CL License Number 7/-7/3 Lic. Class Contractor�F/ / /��/ Date /0 ❑ O I am exempt under Sec. Plan check fee W B.&P.C. for this reason.- H Date: PERMIT ISSUING FEE $ Z Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): F-11, //�-�zIry ,elut .- &,ld I, as owner of the property, or my employees with 1(LJ77/ C/Y 5 g- � A4CUg wages as their sole compensation,will do the work and ' �/' jTi�A TEL. NO. /� the structure is not intended or offered for sale (Section fTj� TJ � CITY WL 3307 .. . 106a75 7044, Business and Professions Code). /©� _ ❑ I, as owner of the property, am exclusively contracting OWNER ®�� /Ips (� !7 T i g � with licensed contractors to construct the project (Sec- MAIL 1 5 tion 7044, Business and Professions Code). ADDRESS iL.�AL �i_P m - CONSTRUCTION LENDING AGENCY CITY !f �� •TEL. NO. *f—j7� CHECK 1+Oc�a7� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR0121) ( , CHANGE .011 (Sec. 3097, Civ. C.) n A1�4 ��/ycy WIL ADDRESS Lender's Name /^Y/�� �I���_(')��1 1���t;G�.y 7%/ w �/�ITT/PQ� /l�0 /41 /4V CITY TEL. NO. a -. Lender's Address 1 AM 70-42 1 certifythat I have read this application and state that the STATE LIC. '�+.}+- PP LICENSE NO. �3 CLASS above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter u the bove-mentione op ty for inspction urposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A licont or Agent Dc%e ©s