HomeMy Public PortalAbout6042 PRIMROSE AVE_Mechanical_2/24/2016_ME 0508 1602240018COUNTY OF IAS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LzI lU:
TR: 6561 LT: 261 UN: .002
ASSESSOR INFORMATION NUMBER:
5385-013-020
OMER:
TEL.
NO:
TIEN NHIEU LUONG;YAU JIE JUE
-
6042 PRIMROSE AV
FEE DESCRIPTION:
QUANTITY:
TEMP 917802033
AMOUNT:I
TEMP CA 917802033
APPLICANT:
TEL.
NO:
BUI, RICHARD
(626) 548-9719-
13812 GOLDEN WEST ST
34.40
WESTMINISTER 92683
THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
02 REFRIG COMP < 100 KB
1.00
COM
CONTRACTOR:
TEL.
NO:
AV CONSTRUCTION CO.
(626)
548-9719-
13812 GOLDEN WEST STREET #200
33.70
LIC. NO
WESTMINISTER CA 92683
20 FIREPLACE < 100 KBTU
746394
APL
33.70
ARCHITECT OR ENGINEER:
TEL.
NO:
TMC ENGINEERS
(714)
829-5053-
9542 PACIFIC
LIC. NO:
ANAHEIM CA 92804
5.00
72324
PERMIT EXPIRES 180 DAYS IF
1) WORK DOES NOT COMMERCE, OR
2) WORK IS SUSPENDED OR ABANDONED, OR
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
TEMPLE CITY # 0508 MECHANICAL PERMIT
9701 LAS TUNAS ME 0508 1602240018
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ID: DPR264 ROUTE TO: ES0508
INSTALL KVAC SYSTEM FOR NEW SINGLE FAMILY DWELLING
SPECIAL CONDITIONS:
COMBUSTION AIR OPENINGS
DUCT WORK
AC/COMPRESSOR
6042 PRIMROSE AV UNIT A
FEE DESCRIPTION:
QUANTITY:
DOM:
AMOUNT:I
TEMP CA 917802033
NEAREST CROSS STREET:
O1 PERMIT ISSUANCE FEE
34.40
THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
02 REFRIG COMP < 100 KB
1.00
COM
33.70
OB FURNACE/HEATER < 100
1.00
UNI
33.70
JISSUED ON: PROCESSED BY: PLAN BY:
20 FIREPLACE < 100 KBTU
1.00
APL
33.70
02/24/16 SR
30 AIR INLETS/OUTLETS
10.00
IN/
53.00
41 SINGLE REGISTER FANS
5.00
FAN
99.00
FINAL I/AT�_ CODE:
FINAL
TOTAL FEES
287.50
l %
ID: DPR264 ROUTE TO: ES0508
INSTALL KVAC SYSTEM FOR NEW SINGLE FAMILY DWELLING
SPECIAL CONDITIONS:
COMBUSTION AIR OPENINGS
DUCT WORK
AC/COMPRESSOR
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 (J) 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.).
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 Contra or pursuant.to the Contractors' State License
Law).
(_): 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 priorlto completion, of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owns ff 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.lecinfo.ca.00v/calaw.html.
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. a
License Class License No.I
7 /
DatekOREZRS'
ontractor Signature
COMPENSATION
WAF:NING: 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
ATTORNEYS 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 permit
is issued.
Policy No.
I 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 insurance carrier and policy number are:
Cartier Policy Number Expiration Date
Name of Agent Phone Number
I certify that, in the performance of the work for which this
p rmit is issued, I shall not employ any person in any manner
s as to become s ject to the workers' compensation laws of
C lifomia, and a that, if I should become subject to the
r rs' c 5�laatfitocn provisions ofSection 3700 of the Labor
I h omply with those provisions
n
U 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
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 specfied on the hazardous materials
information guide?
Yes ❑ N o ❑
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 (SCAQMD)? See permitting checklist for guidelines.
Yes ❑
1 have read the hazardous materials information guide and the
SCAQMO 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.
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
1 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
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.
1 authorize re entatives of this county to enter the
above-idenY �e,ftfor_rspection purposes.
Signature of Ff4perty 0*6r or)4uthodzed Agent
Company Name Date Date