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Home My Public Portal About5033 GLICKMAN AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0309260001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 10821 LT: 6 BL: C 5033 GLICKMAN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804023 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8585-013-019 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/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 30 AIR INLETS/OUTLETS 3.00 UNI 13.05 09/26/03 JK 03/24/04 TOTAL FEES 94.80 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: LIN; SUSAN (626) 825-9398- 5033 GLICKMAN AV / J TEMP 917804023 DESCRIPTION OF WORK HVAC SYSTEM FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO - 'i;=r FAU/WALL FURNACE COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. N0: - - - DUCT WORK .i LIC. N0: ' � ------ AC/COMPRESSOR __.:_-� I �� - ;� ; THERMOSTAT - FIRE DAMPERS SMOKE DETECTION DEVICES - COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508 WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 76A364C APPLICATION FOR PERMIT LIME GREEN I hereby affirm that I have a certificate of consent to self insure, or a certificate of WoNer's Compe !onr�m �_ or a certified HEATING-VENTILATING-AIR CONDITIONING copy th�Jjreof Sec. 3800 ab. C.) bPolicy NbCompany COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnishe . r BUILDING -� Certifi copy is filed with the Dorf t ilding inspection FOR APPLICANT TO FILL IN ADDRESS D(�3 j r d y (PRINT OR TYPE ONLY) LOCALI- Date Applican NO. TYPE�01`APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM ORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO._ PROCESSED BY L certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU d become subject to the Workers' Compensation Laws. COMPRESSOR,BTU • APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should became subject to the Workers'Compensation EVAPORATIVE COO ER provisions of the Labor Code, you must forthwith comply with such FINAL `41 �! provisions or this permit shall be deemed revoked. FURNACE: CITY VALIDATI N LICENSED CONTRACTORS DECLARATION FLOOR l I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT— (commencing NIT(commencing with Section 7000) of Division 3 of the Business and WALL Professions Code, and my license is in full force and effect. License Number Lia Cla s - f [� i 31 r r•r jF_11'2„ 01,11Contractor Date -�/ s r�5- ❑ I am exempt under Sec. Plan Check fee t_,HE K y§J, „_EI,a: B.&P.C.for this reason PERMIT ISSUING FEE$ !'1 AN` 11='• Date: TOTAL FEE 0- Signature PLAN CHECK APPLICANT i,`101:)0`-101J1:j -s. j ;'`" Cn OWNER-BUILDER DECLARATION Z _.- I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages , as their sole compensation, will do the work and the CITY ,r TEL.NO. structure is not intended or offered for sale (Section 7044, f Business and Professions Code). OWNER ❑ 1, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY L TEL. s I hereby affirm that there is a construction lending agency for CONTRACTOR the (Secperformance of the work for which this permit Is issued .3097,Civ.C.). �/ ADDRES ✓ / l Lender's Name CITY TEL. O Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. CLASS information is cneela- I agree to comply with all County ordinances and State laws to building construction,and hereby authorize represent 1v Sounty to enter upon a abov -mentioned property fo io p r bses. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGEN DATE