HomeMy Public PortalAbout5144 ARDEN DR_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C p no no p p o P 2 o n/�
I hereby affirm that I have a certificate of cons(. -sel 4 CE-x$18 (2-80) Q I� 11� LL,0� U V U LS UVtl��
insure, or a certificate of Workers'Compensation Insurance,or XEATONG-VENTILATING-AOR CONDITIONIf`G
a certified copy thereof(Sec. 3800,Lab CC.)
Policy-N _ Com pany_� COUNTY OF LOS ANGELES �r � BUILDONG AND SAFETY
Cer-ified copy is hereby furnished.
Certified copy is filed with the county building inspection BUILDING
dApar ment. � FOR APPLICANT TO FILL IN ADDRESS
Datei �(�/ ApplicantGE�SiiCo (PRINT OR TYPE ONLY)
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
COMPENSATION INSURANCE NEAREST
CROSS ST. d
(Phis section need not be completed if the worn involved ABSORPTION UNIT, BTU _ — O
by the permit is for ore hundred doK ars ($100) Or less.) DISTRICT NO. P ESSED Y U
I certify that in the performance of the work for which this I AIR HANDLING UNIT,CFM /��/ Ir
permit is issued, I shall not employ any person in any manner S AVO O
so as to become subject to the Workers' Compensation Laws. BOILER, BTU
APPROVALS DATE INSPECTOR'S SIGNATURE IU
Date Applicant COMPRESSOR,BTU— _— _ _� ROUGH - y
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation'provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR: hTU"a- —2
I hereby affirm that I am licensed under provisions of Chapter HEATER: Q111SPENIUED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL
ness and Professions Code, and my license is in full force and y Z Z G 6 9;'&8 A
effect.
License Number�!�1l� Lie.Class_ /
o o`0 0 0 8
Contract or�j�'G '/�r� Date� �/tea_ " 2,° - 38.50
I am exempt from the licensing requirements as I am a olo o 3 a 5 0=
U
licensed architect or a registered professional engineer Plan check fee 25%of above. '
acting in my professional capacity (Section 7051, Bus- 10,-1 9P 8 2
iness and Professions Code). PERMIT ISSUING FEE$ S
Lic,or Reg.No. Date J TOTAL FEE �(1
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from- the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
0 1, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section CITY nTEL. NO.
7044, Business and Professions Code).
I, as owner of the property, am exclusively contracting OWNER /6 �d�� /�s #Y Q o 8
with licensed contractors to construct the project MAIL (' — ( S o 73 50
(Section 7044, Business and Professioas Code). ADDRESS �.
CITY �'*_/ '— TEL.NO. ° ° 3 3.5 0'0x
2
CONSTRUCTION LENDING AGENCY C _1
�'(
I hereby affirm that there is a construction lending agency CONTRACTOR 1 1 9t'82
for the performance of the work for which this permit is �j�/jjt//L �_
issued(Sec. 3097,Civ.C.).
Lender's Name ADDRESS
Lender's Address CITY a TEL.No _�^
I certifythat I have read this application and state that the
Pp STATE i LIC.
above information is correct.I agree to comply with all County LICENSE NO. CC SS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
Countv to enter upon the abrve-mentioned property for
in� .c .on purpose� �
/�
signature of Permittee D.-e
i
t
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0102260033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 15874 LT: 12 5144 ARDEN DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803315
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA
8585-019-012 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/NEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 81.75 02/26/01 UT 08/25/01
OWNER: TEL. NO: FINALTE FINAL B CODE:
PHOTOS SUZANNE N (818) 442-1384- `�� 2-00
5144 ARDEN DR T
TEMP 917803315 DESCR! TION OF WOR
CHANGE OUT OF FAU UNIT AN ADD CO ENSOR - NO NEW DUCT WORK
APPLICANT: TEL. NO:
AIR TECH HEATING & AIR (626) 795-8880-
204 S. ROSEMEAD BL SPECIAL CONDITIONS:
PASADENA
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
AIR TECH HEATING AND AIR CONDITIONI (626) 795-8880-
204 S ROSEMEAD BLVD LIC. NO FAU/WALL FURNACE
PASADENA, CA 91107 541161/C20
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
LIC. NO: AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508