The URL can be used to link to this page

Home My Public Portal About5732 GOLDEN WEST AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby offrrm that I have a certificate of consenr'to self Insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING CE-818 or a certified copy thereof (Sec 3800, Lab C ) CE 818(REV 10/81) Policy No Company Certified copy is hereby furnished COUNTY-OF LOS ANGELES BUILDING AND SAFETY - /� --11 ❑ Certified copy is filed with the county building i spec- FOR APPLICANT TO FILL IN BUILDING ADDRESS JT ] CIO�U�+�w 2 '� tion departme — (PRINT OR TYPE ONLY) 1 Dat -Appllcari LOCALITY o� i G 1 1 fell IF NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST l• J CERTIFICATE OF COMPENSATION I FROM WORKERS' CROSS ST G cs f d ien uU e b f' ' LAST U S COMPENSATION INSURANCE (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY the permit is for one hundred dollars (:100)or less.) AIR HANDLING UNIT, CFM I 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 become subject-to the Workers'Compensation Laws BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE i Date Applicant COMPRESSOR, BTU ROUGH NOTICE,TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL 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 FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I"am licensed under provisions of Chapter 9 HEATER SUSPENDE UNIT S (commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license Is in full force and effect - O License Number Llc Class OC Contractor Date ❑ I am exempt under Sec d Plan check fee H B&P C for this reason Z ' PERMIT ISSUING FEE $ Date ,Signature TOTAL FEE I OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT M c e l L 'L — 21 9 0 3.9 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and NAME 1 �G , , # o 0 o o o 8 Professions Code) ❑ I, as owner of the property, or my employees with ADDRESS 4_3n a 2 0 o 3 Q 5 0 wages as their sole compensation, will do the work and I CITY Cm TEL NO `7 3 the structure Is not intended or offered for sale(Section o"0 0 3 Q 5 0 OWNER 7044, Business and Professions Code) f -fy 'El /CJ.�I e / !To 5 I, as owner of'the property,'am exclusively contracting ,� 2 � 7-84 with —8G- with licensed contractors to construct the project (Sec- MAIL ADDRES73 a (?,PA iAJC,5 tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY CITY GV�i C TEL NO j hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued CONTRACTOR (Sec 3097, Civ C ) ADDRESS0 N�s L Lender's Name - CITY C, TEL NO'� 3 000, Lender's Address STATE LIC _ I certify that I have read this application and state that the LICENSE NO — (0 73 CLASS l above information Is correct I agree to comply with all County ordinances and State jaws relating to building construction, and hereby authorize representatives of this County to enter upo the abov -mentlone operty for inspection purposes SEE REVERSE FOR.EXPLANATORY LANGUAGE nature of Applicant or Agent Date - - - 1 ., COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1102020006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ITR: 6561 LT: 456 5732 GOLDEN WEST AV 1 IFEE DESCRIPTION. QUANTITY UOM AMOUNT TEMP CA 917802503 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 1 18587-028-018 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID- A3 LOCALITY. TEMPLE CITY, Cl 1 102 COMPRSR < 100 KBTU 2 00 COM 54 00 1 TENANT 108 FURNACE/HEATER <100 1 00 UNI 27 00 JISSUED ON PROCESSED BY PLAN BY 1 130 AIR INLETS/OUTLETS 6 00 UNI 26.10 102/02/11 SR 135 AHU < 2000 CFM 2 00 AHU 25.70 I OWNER TEL NO I TOTAL FEES 160.60 IFINAL DATE FINAL BY CODE ICAMPOS, RICARDO (626) 286-3915- I It�� ( t <(v n(� 15732 GOLDEN WEST AV I / /� ` < \1Y/ TEMP 917802503 I ES IPTION OF WORK INEW INSTALLATION OF FAU AND AC + 2 DUCTLESS AIR HANDLER AND - 11 CONDENSER (MINI SPLIT SYSTEM DUAL) 1APPLICANT - TEL NO I ICORZO, ANDREW (951) 538-1595- I I 15027 WYCHE CT. I (SPECIAL CONDITIONS 1 SAN BERNARDINO 92407 I I I I I ICONTRACTOR TEL NO: I (APPROVALS DATE INSPECTOR SIGNATURE INORTON AIR HEATING AND A, C (951) 538-1595- I 15027 WYCHE ST LIC NO iFAU/WALL FURNACE ISAN BERNARDINO, CA 92407 819746 C20 '( COMBUSTION AIR OPENINGS (ARCHITECT OR ENGINEER TEL NO 1 IDUCT WORK I LIC NO JAC/COMPRESSOR I I I ITHERMOSTAT I (FIRE DAMPERS I _ (SMOKE DETECTION DEVICES ICOMMERCIAL HOOD I I I I I I I I I I I I I I I I I 1 I I I I 1I I I I REPORT ID DPR264 ROUTE TO BSO508 I I I I