HomeMy Public PortalAbout4923 GOLDEN WEST AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY f 0508 MIECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TLNAS ME 0508 0110230008
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BUILDING AND SAFETY / LAND DEVELOPME](T TEMPLE CITY CA 917M PHONE: (626) 285-0488 EXT:
LEGOU •
FEM PAID ERJI LD
TR: -5342LT: 6 BL: .001 4923 GOLDEN WEST AV
FEE DESCRIPTION: QWTITY: UOM: AMOUNT: TEMP CA 917803938
ASSESSOR INFORMATIONNUMBER:.. NEAREST CROSS STREET: LOWER AZUSA
85897019-001 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 IIID: A5 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 2.00 LMI 8.70
TOTAL FEES 36.45 ISSUED ON: BY: EXPIRES ON:
10/23/01 JK 04/21/02
OWN ER TEL. NO: FIML DATE F I NALL BY:
TRU(NG•ANTNOMY (626) 673-1236-
4923 66(B6 WEST AV'
TEMP 917803938 DESCRIPTION OF WORK
DUCTS FOR ADDITION.
APPLICANT: TEL. NO:
SME AS OWNERCON -
SPECIAL CON51TIONS:
- TR. S P�yGELES co APPROVALS DATE INSPECTOR SIGNATURE-
SAME AS OWNER
LIC. NO FAUIUALL FURNACE
WANG, NICK (626) 300-893
1815 AZALEA DR LIC. 111111
r ALHAMBRA-,CA . 91801 NONE
THERNDgrAT
U"MO� WOR��
+LMOERCIAL RW-
.4-7 ❑
0
b 7 �o
Service T�►et
REPORT ID: DPR264 ROUTE TO: BS0508
"'°RKER'Baffirm '�A'c°"° "R""°" �004°DPW
°1BD APPLICATION FOR PERMIT LIME GREEN
I herby arm that I have,■ oertlTlaate of consent to self Insure,
or■ceritfloate of Worker's Compensation Insuranoa, or a oertffled HEATING -VENTILATING A1R CONDITIONING
copy thereof(8@4,3800 Lab.C.)
Pay' P�t�'V11�IcrSot�I,�ery�C efw---p COUNTY OF LAOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certffled,00py Is hereby fumbt»d.
LSY Cerdfled copy to fIW with the o«mty bulk N Inapectbn FOR APPLICANT TO FILL IN 9u
L (PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OF APPLLANCE OR EQUIPMt3lT F�
CERTIFICATE OF E�IPT)ON FROM WORKERS' NEARESTTI
00088 ST.
COMPENSATION INSURANCE A88ownON UNfT BTU ASSESSOR
(This seotlon need not be completed If the work Invotved by the MAP BOOK PAGE PARCEL
permtt Lo for ons hundred dollars(111100)or Tess.) NA KA?� UNIT q31
orTrsor wo. arro001ee00 BY
I certify that In the performanoe of the work for which this permit
Is Issued, I shall not employ any person In'any manner so as to I gpt BTU
become subject to the Workers'Cpmpenaatlon La". o
BTU
Aamovv.s wTZ 1A0WtorreMNATURe
Date APp k VENT1LATK>N SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH 12
Exemption,you should become sub)ect to the Workers'Compeiwrion EVAPORATIVE COOLER
provlsbns of the Labor Code, you must forthwith comply with such FIINA
provlslons or this permit shall be deemed revoked. FURNACE FAu VfTY T�
LICENSED CORS DECLARATION FLOOR BTU �M/� q f b VALIDATION
ell
I hereby affirm that I amt Iloenaed under provisions of Chapter 9 9LWE 1DED UNrr
(commencing with Ssctton 7000) of DhAslon 3 of the Business and REAT� WALL—
Professions
ALL Professions Code,and my license Is In full force and affect-
License
ffectLicense Number t� v I�Ct_LkL Claes
ACCT.T
ContraotnrV-%6c--p rs1 S!'f Dale 5^Z�g3 33b,7 75ji S
El Plan check fee
I em exeR,pt under sec 1..ITEli5
& P.C.for thls reason PERMIT ISSUING FEE i TI3TAL 75- 45
Dole: TOTAL.FEE — , 5 a
' PLAN q-IE�1(APPLICANT �{�y,� •�y
OWNER-Bt1imm DECLARATYON ►r1 AHGE -OCI
I hereby aftlrm that I am exempt from the Contractor's License Lar NAUE
for the following reason (Sectlon-7031.6, Business and Professions
Code): ADDRESS
El I, as owner of 4he property, or My employees with wages e��t �i t:r1?
as their sole compensation, will do the work and the ClT1 TEL NO. 7747 1 Lh7
structure Is not Intended or offered for sale (Sectlon 7044,
Business and.Profeaslons Code). OWNER
❑ I, as owner of the property, ■m exclusively contracting JL
with licensed contractors to construct the project (Seo- =:tES$
tion 7044, Quelnees and Prafesslons.Code).
CITY NO.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending ■penoy for CONTRACTOR
the performance of�the work for which this permlt Is'lasued - -
(Seo.3097,Ctv.C.):- _
ADDRESS
Landers Name
TEL NO —�!� (�
Larders Address STATE LIC. lX�
I oertHy that I have reed this appiloatlon and state that the above LKAaM NO. Ct188
krformatlon Is oorrect. I agree to comply with all County crdLnanoea
and State fawn reb&6g to bullding oonatnxdw,and hereby authortze
representatives of this County to enter upon the above-merftloned
property for Inspection purpoeee. SEE REVERSE POR PTLMATORY LAMGUAGE
DATE