HomeMy Public PortalAbout5624 / 5628 GLICKMAN AVE_Mechanical__ WORKER$'COMPENSATION I)ECLARATION 7EA384C /�
I hereby efftat I have certificate of consent to self CE-818 j2.80) A D P L IC A T I Ofd! FOR PERMIT
rnr that ti
insure, or A certlflcste of Works Com
rf' penutlonlnsursnce,o+ HEATING-VENTILATING-AIR CONDITIS,fdING LLLIII
■certlfled copy thereof(Sea, 3800, Lab. C.)
o(// ppi .Qb°7 Y ENSPL OF WAUSA�1
f0ltcq No. Company
Certified copy is h61•gby furnished. COUNTY OF LOS ANGELE��J ' U1 L 1NG AND SAFETY
® Certltled copy,is filed With the county building lnspeetion BUILDING
departm t. �/7 FOR_APPLICANT YO FILL IN' GLI
Date Applicant b.�L„-��7 L*- (PRINT OR TYPE ONLY)
ADDRESS } T,-rr��
// -LOCALITY 1'+T[� CITY
CfTTFICATE OF$X$lvfPTION FROM WORKERS Nb. TYPE OF APPLIANCE OR EQUIPMENT FEF
NEAREST
COMPENSATION INSURANCE CROS 5T d
(Thi$ aectlon steed not be completed if the work iwotyed ABSORPYIO-N UNIT,BTU
try the permit is fps one hundred dollars (3100) oL tees.) D19TRICT No. P B �}
1 certify that In the performance of the work flu which,this AIR HANDLING UNIT CFM Q
permit is Issued,7 shall not employ arty person InahY manner
to as to become subject to•the Workers' Compensation Laws. BQILEH7 BTU' Nt
. - - DATA INSPECTOR•ae '. RE
Date Applicant COMPRESSOR BTU R - LUCL
ROUGH
NOTICE TO APPLICANT: It,-after malting this Certificate of VENTILATION'§YSTEM Z
Exemptlon, you should become subject to the Wor*erV FINAL
Compensation,provisions of the Lebo{`Code,you must forth-
with
orth- /
with'cornply with. such provisions or this papnit shall be EVAPORATIVE COOLER VALID(,TION
deemed revoked. FURNACE FAU V T
LIi ENaED CONTRACTORS DECLARATION FLOOR: BT
L h'eretly affirm thaf I am licensed under,provislonz of Chdptef HEATER: SUSPENDT D UNIT
9 (ctommencing with Section 7000) of Dfvfsion.3-of the Bus]- WALL
peas and Professloryt Code. and my tfcgnse Is in full force.and
effect.
LlcenseNumbei 26509.4. 'Lic.-Class- 'C-20
Contractd' ^TRA14E ACR .Date
ElI art] 6Xempt'from the licensing retiulrements as 7 em a
Ilcens6d architect,or a registered profwdonal'engtheer Plan cheek fee 7696 of above.
i a ing in•my pro atiional capacity (Section 7051, Di
u
I inns and Profession Code).. PERMIT-ISSUING FEE $ 7 00
Llc.or'Rq.N`o. Date TOTAL F`EE
HOMIr OWNGR-BULLDER QECLARATION PLAN CHECK APP-LICANT
r
I herebyefflrm that I.asp ezdmpt fr6m, the Contractor's NAME2.5j 3 a
License Law for the following reason (Stiction 7031.5, Bw1• -
1 ness and Professlons-Code): ADDRESS #'•� r• •4 ,
1, as owger of the property,'wtll do the work wd the• '
structure. is not Intended or offered for sale ($action CITY TEL. NO.
7044, Bu$new and Professlans Code).❑ GUGLIRZMO' 'TI, JAMES
I, ■h owner of the proporty, aro ezclusitiely cgntnOWNER,,-
with licensed contractors fo eonstruct .the projoct MAIL
(Section 7044, Business and Professions Code). ADDRESS SAME 2iti -'.2-7.0 0 .
CONSTRUCTION LI;NDINta AGENCY CITY TEMP CIM, TEL. NQ. — 2;_ O O Tu
I hereby affirm that there Is a construction le6ding agency ( a a/o
for the perfotmsnee of the Work for Whleh Phis permlt Is CONTRACTOR TRAM ., 4CC
{ E Q09=80
laaued 45ec. 3097,civ.C.). (
Lender s Names ADDRESS' 20.34 N J+��t�r+v'
RD
i
Lender's A.ddreta CITY TEL N
I certify that I have read this application and state that the STATELIC.
above information Is correct.I agree to comply with all County
LICENSE N L
ordinances and Stet6 laws regulating Nesting, Ventilating arid
�C6un
toning and hereby authviize a esentattves of this SED REVERSE FOR 1 7iPLANATyBY LANGUAGE
enter upon the abov oned property Tot p poses. ,
Ignature of Permitted Da e
COUNTY OF LOS AWE F6S TE3GYLR CITY # 0508 MECHANICAL PERMIT
DEPARTF&NT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0905110006
BUILDING AND SA-= / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LE3AL ID: FEES PAID BU=INd ADDRESS:
ON FILE 5624 GLIC 14 AN AV
FEE DESCRIPTION: Qcu%. ITY: OCP[: AMOUNT: TEND CA 917802710
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: I= OAR
8586-016-003 01 PERMIT ISSUANCE FEE 27.75 TM06UL.S PAGE: 597 GRID: B3 LOCALT'I'Y: TEMPLE CITY, C
02 COIIFRHR < 100-T.BTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UTT 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
30 AIR TNLRTS/OUTLETS 10.00 UTI 43.50 05/11/09 SR 11/07/09
TOTAL FEES 115.25
OWNER: TEL. NO: F DATE FINAL, BY: CODE:
NAM, ANY (626) 823-7968- ^
5624 GLIC121 AN AV ill
TEMP 917802710 DESCRIPTION CIE WORK
INSTALL AIR CONDITIONING AND HEATING SYSTEM
APPLICANT: TEL. NO:
KYM CONSTRUCTION (626) 575-0843-
9625 ALPACA ST. 9PPCIAL CONDITIONS:.
S. EL MONTE CA -
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR 9IGNIT=
TAI HEATING AND A, C (626) 575-0843-
9625 ALPACA LSC. NO FAU/MALL FURNACE
SOUTH EL MOMTE, CA 91733 506659
COMBUSTION AIR OPENINGS
ARCHITECT OR E4011 R: TEL. NO: DUCT MORN
LIC. NO: AC/COMPRFSSOR �+ M
THERMDSTAT
FIRS DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
i
a
REPORT ID: DPR264 ROUTE TO: M0508