HomeMy Public PortalAbout10749 FREER ST_Mechanical__ WORKER'S COMPENSATION DECLARATION 20.0046 DPW 9/89
76A364C
e?� LIME GREEN,
• I hby 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) ^"
Policy No = -Company COUNTY OF LOS,ANGELES DEPT-OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
❑' Certified co is filed with the count bwldin 'Ins ection FOR APPLICANT.TO FILL IN BUILDING =`
departmentPY. , Y g P (PRINT OR TYPE-ONLY) ADDRESS Ia7 •�
Lf 66
OCALITY "
Date Applicant NO- TYPE OF APPLIANCE OR EQUIPMENT -FEE
CERTIFICATE OF'EXEMPTION FROM WORKERS' NEARESTCROSS;ST. '
COMPENSATION INSURANCE; ABSORPTION UNIT,BTU
This sb action need not be completed if the work involved
ASSESSOR,
`• ( P Y the ",. MAP BOOK PAGE. PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM - - -
DISTRICT NO PROCESSED BY
I certify that In the performance of the work for which this permit
Is issued, I shall not•employ"any person In any,mann o' BOILER,BTU '
become subject to the Workers' Compensation L
/Iw�J COMPRESSOR,BTU Ad Cb
DateC2' — licant APPROVALS DATE INSPECTOR'S SIGNATURE
PP VENTILATION SYSTEM
NOTICE TO APPLICANT: If, afte making t s rtificate of ROUGH
Exemption, you should become subject to the-Wor .Compensation EVAPORATIVE COOLER
-•provisions of-the Labor Code, you must forthwith comply with such FINAL
provisions,or this permit shall-be deemed revoked. FURNACE•• FAU GR ITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU D 41 f
O. VALIDATION '-
�u
I hereby affirm that I'am licensed under provisions of Chapter9 HEATER: SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and WALL
` Professions Code,and my,license is in full force and effect
License Number Lia Class �~ -0
Contractorra.
DC /�TFG Date ��� ' L O
' I am exempt under Sec. Plan Check fee 'ACCT..
Q
B.&P.C.for this reason PERMIT ISSUING_FEE$ 707 l'-
102.75
O-eDate: 2 TOTAL FEE 7 1 ITEI'iS w
Signature :'
OWNER-BUIL DECLARATION PLAN CHECK APPLICANT- 'WTAL x,02 ®nn 7__f (n
1-hereby affirm that I am exempt from the Contractor's License Law NAME �. ECK 102.7=' Z
for the following reason (Section 7031 5, Business and;Professions , tS p1
Code)- ;- ADDRESS " • . ' - CHANGE - -•1��1
❑ I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL,NO. 0000-0, I
structure Is not Intended or offered for sale (Section 7044, l�l1 7l ib/ "
Business and Professions Code). OWNER t ii ^'
❑ I, as owner of the property, am exclusively.contracting MAIL p 8202• AM11:ice
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044;Business and Professions Code) �- {'•✓'s
'CONSTRUCTION LENDING AGENCY CITY TEL.NO. �l
I,hereby affirm that there Is a construction lending agency,for y'
the performance of the work for which this permit Is CONTRACTOR Issued C i4j/�t ,-•. i. _ _ .. _-
(Sec 3097,Civ.C.).
ADDRESS Je
44,t,
Lender's Name
CITY Q TEL NO �O./2 11=26,
Lender's Address STA .� /�
I certify that I have read this application and state that the above LICENSE NO. " CLASS l_'�"�10
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 above-mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ,
SIGNATURE OF APPLICANT OR AGENT DATE
COUNTY OF LOS ANGELES TEMPLE CITY 4' 0508 MECHANICAL PERMIT
_ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0406210013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13613 LT: 30 10749 FREER ST
ASSESSOR INFCRMPTION NUMBER:
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803533
NEAREST CROSS STREET: EL MONTE AVE.
8573-005-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS-PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C f
O8 FURNACE/HEATER <100 1-.00 UNI 27.00
TENANT: TOTAL FEES 54.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
06/21/04 JK 12/18/04
OWNER: TEL. NO: FINAL AIE FINAL BY: CODE:
LUONG/FUNG, CHARLES/VIKKY (626) 279-7585-
10749 FREER ST
TEMP 917803533 DESCRIPTION OF WORK
INSTALL 1 WAL! HEATER
APPLICANT: TEL. NO:
HOANG (626) 673-6996-
SPECIAL CONDITIONS:
CONTRACTOR: TEI_ NO: APPROVALS �- DATE INSPECTOR SIGNATURE
LUONG/FUNG, CHARLES/VIKKY (626) 272-9248-
10749 FREER ST. LIC. NO FAU/WALL FURNACE
TEMPLE CITY, CA 91780 NONE _I_
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER.: TEL. NO: DUCT P_0?'_K___
HOANG, KEVIN (626) 675-6996-
1820 S. CORDOVA ST. LIC. NO: AC/COl'4PTESSGR -
ALHAMBRA, CA 91801 NONE
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
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REPORT ID: DPR264 ROUTE TO: BS0508 --I
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