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Home My Public Portal About6154 BURTON AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C APPLICATION Ip py p� 1� 1� PERMIT 4 I hereby affirm that I have a certificate of consent to self CE -818 (2-60) A P Ir L IC A 1 I O 1 tl Ir O R Y- E If`G M I 1 insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800, Lab. C.) Policy No. Company ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspection APPLICANT TO FILL IN BUILDING department. FOR APLADDRESS Date Applicant (PRINT OR TYPE ONLY) LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST CROSS ST. d (TRIS section need not be completed If the work involved ABSORPTION UNIT, BTU O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO._ PROCESsID By U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ///{� 2 m permit is issued,I shalt not employ any person in anyanner 0 ,so as to become subject to the Workers' Compensation Laws. BOILER, BTU ' APPROVALS DATE INSPECTOR'S SIGNATURE W � Date7 V"$SApplican[ _ _ COMPRESSOR, BTU IROUGH NOTICE TO APPLICANT: If, af4��.fffmaking this Certificate of VENTILATION SYSTEM FINAL 4-4Z 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: FAV GAVIT LICENSED CONTRACTORS DECLARATION FLOOR: BTU_ .OR ��« s I hereby affirm that I am licensed under prdvisions of Chapter HEATER: SUSPENDED 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 effect. License Number-aql(, /- Lic.Class 4 0 ContractoR � e-,S- ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus iness and Professions Code). PERMIT ISSUING FEE $ /® Lie.or Reg.No. Date TOTAL FEE l HOMEOWNER-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- nessand•Professions Code): ADDRESS ❑ I, as owner of the property, will do the work and the 0 z ) •7 3.r6 A structure is not intended or offered for sale (Section CITY TEL.NO. , 7044, Business and Professions Code). # o o`s•e e ❑ I, as owner of the property, am exclusively contracting OWNER Qri�� Ito s 2 0.'5 0 with licensed contractors to construct the project MAIL Y-' —L-�r�/ �—� ,2 5 ,O (Section 7044, Business and Professions Code). ADDRESS ro`e e 0 0 z CONSTRUCTION LENDING AGENCY CITYS'r.�� r TEL. NO. r�r` I hereby affirm that there is a construction lending agency -.CXA Atm A505-831 for the performance of the work for which this permit is CONTRACTOR issued (Sec.3097.Civ.C.). _ Lender's Name ADDRESS 9�Ee?, Qr Lender's Address CITY /+ TEL. NO. 1 certify that I have read this application and state that the STATE LIC. above information is correct. I agree to comply with all County LICENSE NO. 9� CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE _ County to enter upon the above-rWritioned property for ' - ection rposes. Sig ore of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY k 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS ME 0508 1306100010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: IFEES PAID I BUILDING ADDRESS: (TR: 29475 LT: 10 1 6154 BURTON AV N I (FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( SCAB CA 917752653 [ ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5386-007-071 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY CAI 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 1 (TENANT: TOTAL FEES 54.80 JISSUED ON: PROCESSED BY: PLAN BY: 1 106/10/13 SR I OWNER: TEL. NO: I IFINAL DATE FINAL By: CODE: 1VENA (626) 782-2550- 6154 6154 BURTONAVE 917801 TEMP 9ll80175641 IDE$CRIPTTIO OF WORK ki (ALTERATION OF EXIST DUCT SYSTEM (APPLICANT: TEL. NO: ITAN YEW K (626) 257-8900- 16703 N GOLDEN WEST (SPECIAL CONDITIONS: IARCADIA CA I I I lCONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE POLYVISION LAND CORP (626) 257-8900- 1 1 16703 N GOLDEN WEST LIC. NO 1 IFAU/WALL FURNACE 1 IARCADIA CA 91007 NONE I COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK 1 / 1 LIC. NO: 1AC/COMPRESSOR I [THERMOSTAT IFIRE DAMPERS I I I 111 ISMOKE DETECTION DEVICES I , COPPIERCIAL HOOD I I I 111 I 111 I I I I 11 111 I I I I 11 I I I I I I I I I I I I 1111 11111 111 I I I I I 11 11 IREPORT ID: DPR264 ROUTE TO: BS0508 I