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Home My Public Portal About5132 BARELA AVE_Mechanical__ WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 LIME GREEN 76A364C I hereby affirm that I have a certificate of consent to self insure, APPLICATION FOR PERMIT or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) "d Policy N 3CIS-0NO%(- mpany C1 A ik - COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. . E[—.G BUILDING dertartm nt y is filed with the county �building inspection FOR APPLICANT INTOR TYPE TO IN ADDRESS Date ` Applicant `� NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY /� CERTIFICATE OF EXEMPTION FROM WORKERS' / y/ C ROSS ST.T. 1 A In,F LLA COMPENSATION INSURANCE ABSORPTION UNIT,BTU This section need not be completed if the work involved b ASSESSOR ( P Y the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person,in any manner so, as to BOILER,BTU become subject to the Workers'Compensation Laws. l A:2 COMPRESSOR,BTU Mcu APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH `� ' Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER FINAL 12- provisions of the Labor Code, you must forthwith comply with such „_- — provisions or this permit shall be deemed revoked. / FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION ! FLOOR BTU 210000 ®d VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and WALL f Professions Code,and my license is in full force and effect. 7 ��GA-Vo- c�ZZo 0 License Number�" Lic.Class C- Contractor (I\-A"5 Date 1 ❑ . I am exempt under Sec. Plan Check fee IIX: B.&P.C.for this reason PERMIT ISSUING FEE$ � ®� � Date: TOTAL FEE 3-100 � Signature PLAN CHECK APPLICANT N OWNER-BUILDER DECLARATION _ Z I hereby affirm that I am exempt from the Contractor's License Law NAMEr for the following reason (Section 7031.5, Business and Professions y,"'1I 1 '5=A Code): ADDRESS ., ❑ 1, as owner of the property, or my employees with wages 1 F I L!IZ as their sole compensation, will do the work and the CITY l t TEL.NO.25 -/_( _`g7( """[: amt structure is not intended or offered for sale (Section 7044, \ V i AL Business and Professions Code). OWNER EJI, as owner of the property, am exclusively contracting MAIL allll with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for ,CONTRACTOR j-jIA+911—f_s1�E) -r: the performance of the work for which this permit Is issued . . " ,� R.. (Sec.3097,CIV.C.). E 3 Gf.,3 S }"it ' 31- ADDRESS `�� k-r ey � Lender's Name CITY TEL.NO.• Lender's Address STATE LIC. l I certify that I have read this application and state that the above 16.LICENSE NO. CLASS 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 upon the abov -mentioned property for insp tion purosds. _ ` SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APP(CANT OR AGENT DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0205090004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 15683 LT: 49 5132 BARELA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803846 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BLACKLEY/CAMELLIA 8589-011-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY _ 08 FURNACE/HEATER <100 1.00 UNI 27.00 TENANT: .__ _ 30 AIR INLETS/OUTLEIS 8.00 UNI 34.80 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 89.55 05/09/02 JK 11/05/02 OWNER TEL. NO: FINAL DATE FINAL BY: CODE: PHAMMY D;KATHERINE LAN 5132 - 75' dy-z 5132 BARELA AV TEMP 917803846 DESCRIPTION OF WORK MECHANICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: AP VACS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO FAU ALL FURNACE Z � . --------- I-C OMBUSTION 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