HomeMy Public PortalAbout6277 GOLDEN WEST AVE_Mechanical__ l WORKER'S COMPENSATION DECLARATION 20-ODW DPW 9 W
hereby affirm that I have a certificate of consent•to *elf Insure, APPLICATION FOR PERMIT LIME GREEN
or a oertifl2late ot.Workers Compensation Insurance, or . oertlned HEATING -.VENTILATING-AIR CONDITIONING
Loopy therocf(Seo.3800 Lab.C.)
Polcy No. Company COUNTY OF`LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy in he{eby hwnlahed.
❑ Cerffled copy is filed with the county Ilnspeotion FOR APPLICANT TO F1L L IN S _ . .
L (PFUNT OR TYPE ONLY)
Date LOCALITY 7r - C
TYPE OF APPLIANCE OR EQUIPMENT FEE
Applicant
NEAFEST
CERTIFICATE FIOMORKERS'OF E)CEM FW .
COMPENSATION INSURANCE ABgDRF oN uN T BTU
CM11a*action need not be oompleted H the work InvolvMd by the MAP PAGE PAFICIEL
permit la for one hundred dollars (!1100)o[fees) AIR HANDuNG umrr CFM
oamur No. anoces®
19erdty that In the performance of the Work for whlqh this permit
,Is Issued, I @hall not employ any pereon In any manner so as to BTU f
beoome subject to the Workers' Compensation Linn. �O
BTU D
A""OVAu an MPWrorn Mit s
Date APpk-rt VENTrLATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certlflopte of BDUGH
Exempilon,you should become subject to the Workers'Compensation EVAPOFUITNE COOL�1
provision*of the Libor Code,'you must forthwithcomply with such FINAL 17
— -T•
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
UCENSFD CONTRACTORS DECLARATION / FLOOR BTL, VALIDATION
I hereby affirm that I em licensed under provisions of Chapter O HEATER. StIBPE9DED UNIT
(commencing with Section 7000) of.Dtvtslon 3 of the Business and WAS
Profossione Code, end my Jlcenae is In,full force and effocr
a-O
Ucerre Number.am-5-�? —Llo.Class (Z^y� '
Deis pn
❑ ern exempt under Seo. Plan check fbe
B.BP.C.for this reason PERMIT ISSUING FEE 0
Dom: TOTAL FEE / 4D W
d
co
OWNER�UILDER OE(LARATION �� AN tx�ANT Z
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.6, Business and Professions
es , u
Code): r T
ElI, as Owner of the A'C 1 property, or my employees with wages ADI 'T
as their sole compensation, will do the work and the Crr1 TEL NO.E-p 3307
structure Is not Intended or offered for sale (Section 7044,
Business and Professions Code). CANNER � 1 11 GrF
❑ I, as gwner o1 the property, em exclusively contracting
with licensed contraotor@ to construct the project (Seo- ADD E88 rTOTIAL� 51 . 00 i `
tion 7044, Business and Profeeslone Code). 4 rCITY TEL NO. L4(i 1■L4I
CONSTRUCTION LENDING AGBJCY
I hereby affirm that there 1@ a construction lending a enoy for CONTRACTOR
I
he performance of the work for which this permit Is 1s@uad
(Seo. 3097, Chi.CJ.
ADDRESS ��y�rI �y� L t�
L.encWa Name Lal�4 1J—UJV 1 7/14f 7
CITY. TEL NO. �•J � �{t
(ender*Addreee STATE /J LIC. i/ 1 rtl f 7 1
I certify that I have toad this appllcatlon and state that the above LICQE NO. L CLASS•.C d +G`
hiformadon Is corracL-I agree to comply with aJl County ordlnanoee
and State lane reiadrtg to bulidtng corr Wuctlon,and herelby authorize
repreeerrtatfvee of thte County to enter upon the above-mendoned
prop* for Inspeotbn purposes, SEF REVERSE FOR E)CPLARATORY LANGUAGE
COUNTY OF LOS ANQELES TEMPLE CITY 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TU&S ME 0508 0,210160004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-04x8 EXT:
LEGAL ID: FEES PAID BUILDING
ON FILE 6277 GOLDEN WEST:AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801705
ASSESSOR INFORMATION NUM1BER: NEAREST CROSS STREET: LONGDEM
5385-021-005 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
D2 COMPRSR < 100 KBTU 1.00 CON 27.00
08 FURI(ACE/HEATER <100 1.00 UNI 27.00 ISSUED PROCESSED BY: PLAN BY: EXPIRES
30 AIR INLETS/OUTLETS 2.00 UMI 8.70 10/16/02 . JK 04/14/03 .
TOTAL FEES 90.45
OWNER: TEE. W: F1 FIRAL BY:
CHOI;DAVID AND AMY CHUNG (626) 614-9393- 9 L CODE:
!
6277 GOLDEN WEST AV
TEMP 917801705 DESCRIPTION OF WORK
MECHANICAL FOR ADDITION
APPLICANT: TEL. NO:
SAME AS OWNERDATE INSPECTOR SIGXATURE
CONTRACTOR: TEL. WF
-
SPECIAL CONDITIONS:
SAME AS OLMER - C`vr4 �
APPROVALS
LIC. NO ` '� FAU/WALL FURNACE
CONSUST
ARCHITECT OR ENGINEER: TEL. NO: wu gm
CHER, MICHAEL T (626) 288-556P.
'
, ��� �I �.-~,� ��
642 � D5&7 AVE LIC. NO.
SAM GABRIEL, CA 91776 * ;;1 _ I '1111111
7 /= •- r- i� r-- FIRE
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* ADDITIONAL DATA ON FILE
REPORT fD: DPR264 ROUTE TO: 880508