HomeMy Public PortalAbout6303 GOLDEN WEST AVE_Mechanical__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT
I hereby affirm that I ha4e a certiflcate of consent to self
Insure, or a certlf catq of.Worjcers' Compensailon Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certffied'copy thereof (Sec. 3800, Lab. C.)
20.0046 DPW 9/88
Policy No Company
Certified copy Is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certlfied copy Is filed with the county building Inspec- FOR APPLICANT TO FILL INAl� W
tlon deportment. (PRINT OR TYPE ONLY)
LOCALITY
Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' QST
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed 1f the work Imrohred by ABSORPTION UNIT, BTU 11-7 NO. .
the penis Is for one hundred dollars ($10G) or'less.)
I certify that In the performance of the work for which this AIR IAfIDIJNG UNIT, ffM s
permit Is Issued, I shall not employ arty person In any manner BOILER BTU
so as to become subject to the Workers' Compensatlon Laws APPROYAIS DATE Sr'W'TUIZE
COMPRESSOR, BTU ROUGH
Date App I I ca ni
NOTICE TO APPLICANT: If, afire ng this Certificate of VENTILATION SYSTEM FINAL !�
-Exemption, ydu should become ject to the Workers'
Compensation provlslons of the labor Code, you must forth EVAPORATIVE COOLER V L y
with compI with such provisions or this permit shall be deem-
ed revoked. FURNACE: FAU
UCENSED CONTRACTORS DECLARATION BTU
I hereby affirm that I am licensed under provlslons of Chapter 9 HEATER: SUSPENDEDUNIT
(commencing with Section 7000)of Division 3 of the Business WA
and Professions Code,and my I Icense is In full force and effect.
License Number I Ic. Class SSC_. d
O
U
Contractor a OC
❑ I am exempt undef'Sec rj
Plan check fee W
B.&P.C. for this reason PERMIT ISSUING FEE $ a.
Date:
TOTAL FEE
SI g rwtu re
OWNER-BUILDER DECLARATION PLAN CITAPPLICANT
I hereby affirm that I am exempt from the Contractors License N111'.Law for the following reason (Section 7031.5, Business and N.� j
Professions Code): v
❑ I, as owner of the property, or my employees with '`CRESS A
wages as their sole compensation, will do the work and TEL NO AM,
the structure Is not Intended or offered for sale(Section CITY
7044, Business and Professions Coded OWNER
I, as owner of the property, am exclusively contracting 1 ITM
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Profewlons Code). ADDRESS TOTAL r-J' _5. 00
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
I hereby affirm that there Is a construction lending agency for CVE(Yi T•W
the performance of the work for which this permit Is Issued CONTRACTOR , a
(Sec. 3097, Clv. C.}
APID RESS DQ
ko
Lender's Name
CITY TEL NO IJ,JrrJIF t!L t 1 �,1SI,�
Landow Addross
I certify that I have read this application and state that the ��NO. U� — 19117 1 Ali 9:7
above Information Is correct. I agree to comply with all County
ordinances and State laws relating to building constructlon,
and hereby authorize repratentatives of this County to enter
upon the above-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
54 r Applicant or Agent Date mi
L
COUNTY OF LOS ANGELES TEMPLE CITY 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS HE 0508 0809170005 ✓
BUISDII7G AND SAFE'T'Y / LAND DEVSLOPmEmr TENPT.E CITY CA 91780
PBONF: (626) 265-0488 ETT:
LFAFLL ID: FEES PAID BUILDING ADDRESS:
ON FILE 6303 GOLDEN FIRST AV
FSE DESCRIPTION: QCANPITY: DOM: AMOUNT: TEMP CA 917$01421
ASSESSOR INFORMATION NTXUER: NEAREST CROSS STREET:
5383-019-001 01 PERMIT ISSUANCE FSE 27.75 THOMAS PAGE: 597 GRID: A2 L4>7J=: TEMPLE CS'I'Y, C
08 FURNA,CR/HEnTER <100 1.00 UNI 27.00
TENANT: TOTAL FEIi9 54.75 ISSUED ON: PROCESSED BY: PLAN BY: EMPIRES ON:
09/17/08 SR 03/16/09
OWNTEL. NO: FINAL DATEArI RFM0%BY: COD&:
TIA TAD LI (626) 399-4328-
6303 GOLDEN WEST AV NO
TEMP 917801421 DESCRIPTION OF WORK
CEANCE OUT FURNACE 90.000 BTU
APPLICANT: TEL. NO:
souaia AND HVAC (818) 473-4125-
7327 ELMO ST. SPECIAL CONDITIONS:
TUJUNGA, C7L 91042
CONTRACTOR: TSL. NO: APPROVALS DATE INSPECTOR SIG2ULTORE
SOTTU AND HVAC AND CONSTRUCTION, IN (818) 473-4130-
7327 RLMO ST LIC. NO FAQ %kLL FURNACE
TUJUNGA Ca 91042 696074 +
COM BU=ON AIR OPENINGS
ARCHITECT OR ENGI2UMR: TEL. 190: DUCT WORK
LIC. NO: AC/C17FPRESSOR
TH�RWSTAT
FIRE. DAMPERS
SMOKE DETECTION DEVICES
.COkMERCI.AL HOOD
I
+ ADDITIONAL DATA ON FILE
REPORT ID: DPR264 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TELE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1208060021
BUILDING AND SA= / LAND DEVELOM2C TII4PLE CITY CA 91790
PHONE: (626) 285-0488 EFT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE - 6303 GOLDEN WEST AV
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917801421
ASS&JS0R INFORY9�TION NUMBER: NEAREST CROSS $TAFFY: LOMMEN
5383-019-001 01 PERMIT ISSUANCE FEE 27.80 TBOb9L.S PAGE: 597 GRID: A2 LOCALI'T'Y: TE?ILE CITY, C
41 VE2?TIIATION FAN 1.00 FAFl 15.80
T12U+ T: TOTAL FEES 43.60 ISSUED ON: PROCESSED BY: PLAN BY:
08/06/12 SR
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
JIA TAD LI (626) 394,-4328- 1 nu
6303 GOLDEN WEST AV � � � n/
TEMP 91780-1421 DESCRIPTION OF WORK
VENFII.ATION FAN FOR BATHROOM 02 REMODEL
APPLICANT: TEL. NO:
KWOK, DOROTHY (626) 300-8818-
1139 MF.STMD9ISTER AV SPECIAL CONDITIONS:
ALFAMBRA CA 91803 -
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGbtATURE
LI, JIA T (626) 394-4328-
6303 GOLDRN NEST AVENGE LSC. NO FAU/HALL FURNACE
TEMPLE CITY, CA 91780 NONE -
C'OMBGSTION AIR OPMVZNGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
LIC. NO: AC CCZ�SOR
TF DSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
:v COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508
w _ s
'COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTI,= OF PUBLIC WORKS 9701' LAS TUNAS ME 0508 1212100034
BU=ING A19D SAFFiTY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 785-0488 ETT:
LLEGAL ID: FEES PAID BUII,DIIVG ADDRR.9S:
ON FILE 6303 GOLDEN WEST AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801421
ASSESSOR INFORMATION NUMBER: NFAREST CROSS STREET: LONGDEN
5383-019-001 01 PERMIT IgSUANCE FEE 27.80 THOfG S PAGE: 597 GRID: A7 LOCALITY: TEMPLE CITY, C
41 VENTILATION FAN 1.00 FAN 15.80
TENANT: TOTAL FEES 43.60 ISSUED ON: PROCESSED BY: PLAN BY:
12/10/12 SR
OWNER: TELNO: FINAL DATEF BY: CODE:
JTA TAO LI (626) 394-4328-
6303 GOLDEN WEST AV
TEMP 917801421 DESCRIPTION P WORK
VENTILP.TIOH FAN FOR NEW BALOOM
APPLICANT: TEL. NO:
KWOb, DOROTHY (676) 300-8818-
1139 W&ST!@7ISTER AV SPECIAL CONDITIONS:
ALHAMBRA CA 91803
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
YU ZHENG GUAN (676) 893-8533-
6154 OAK AVENi7E LSC. NO FAD WALL FURNACE
TEMPLE CITY CA 91780 713400 +
COMBUSTION AIR OPE -ENGS
ARCHITECT OR ENGINffi2: TEL{. NO: DUCT WORK
LSC. NO: _ AC/COMPRESSOR
TUER?ID=
FIRE DAMPERS
SMOKE DETECTION DEVICES
- COM 13RCTAL HJOD
+ ADDITIONAL DAIA ON FILE
REPORT ID: DPR264 ROUTE TO: BS0508