HomeMy Public PortalAbout6327 GOLDEN WEST AVE_Mechanical__ 3 \
wOR1 ill CI have'. carts DECLARATION APPLICATION FOR PERMIT
I he affirm that I have a certificate of consent to self �
insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or,a certified copy thereof (Sec. 3800, Lab. C.) 76A364C
CE-818(REV. 10/81)
Policy No. Company
Certlfied copy Is hereby fumfshed. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certffled copy Is filed,with the county building Inspec- FOR APPLICANT TO FILL IN BUILDING
tion department. (PRINT OR TYPE ONLY) ADDRESS
�i
Data Applicant
NO. TYPE OFAPPLIANCE OREQ111PMENi FEE LOCALITY
CERTIFICATE OF DSWM TION FROM WORKERS' NEAREST /
COMPENSATION INSURANCE /--eh e `e,
(This section need not be completed If the work Imrohred by ABSORPTION UNIT, BTU ok"K7 No. B
the permit Is for one hundred dollars(=100)or less.)
AIR I-IAIJDUNG UNIT, CFM
I cgrtlfy that In the performance of the work for %Vhlch this
permit Is issued, I shall not employ any n n In any manner y )
so as to become I shall of ke m Ion Laws. B04LER, BTU ` O� Aaraovnis on1E i tcPtnTttRE
Da Ilcant ROUGH /7 1
COMPRESSOR, BTU
N6fid TO APPLICANT: If, afte rtlaking IN s Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FA G MY !1
LICENSED CONTRACTORS DECLARATION BOOR —BTU O
I hereby affirm that I am licensed under provisions of Chapter 9 HEADiR: SUSPENDED UNI
'(commencing with Section 7000) of Division 3 of the Business WALL
and Professions Code,and my license Is In full force and effect. 4�4
� O
License Number Lic. Class , U
SD C9
Contractor Date O
❑ I am exempt under Sec LU
Plan check fee CL
B.BP.C_ for this reason'
Date: PERMIT ISSUING FEE $ v
Signature TOTAL FEE Q
OWNER-BUILDER DECLARATION PIAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License 10111. 6 5 9. Z A
Law for the following reason (Section 7031.5, Business and NAME LLQ y p
PrQfesalans Code): 1�1 5 T ( 0 4 T.S
w117�1 I; as owner of the property, or my employees withADDRESS &fJ
wages as their sole compensation,will do the work and / �/ e o o Q
the structure Is not Intended or offered for sale(Section CIY �L—lT �- NO. —7-5 Z 2 r E7
7044, Business and Professions Code).
OWNER
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Set- MAIL
tion 7044, Buslness and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL NO.
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is Is CONTRACTOR ,
(Sec 3097, Clv. C.).
ADDS
Lender's Name
CITY TEL NO.
Lenders Address
STATE UC.
I certify that I have read this application and state that the. LICENSE NO. (LASS
above Information Is correct. I agree to comply with all County
ordinances and State laws relating to building-construction,
and hereby authorize representatives of this County to enter
u e Cloned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
T
Slgrwture of Applicant Or Agent Date
u CODUTY OF LOS ANGELES TEMPLE CITY 9 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUTAS' ME 0308 97114.240010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE:.(818) 285-0488 EXT:
LEGAL Ip: PEES PAID BJJIL[-
ON FILE 632T GOLDEN WSSTAV .
FEE DESCRIPTION: QUANTITY: LICA: AR"T: TEKP CA 917801421
ASSESSOR ER:, NEAREST CROSS STREET:
5383-019-005 01 PERMIT ISSLMCF FEE 27.75 THOMAS PAGE: 597 -GRID: L2 "LOCALITY: TEMPLE CITY
30 AIR INLEfS/OUfLETS 2.00 U1 .8.70
TOM FEES 36.45ISSM ON: PROCESSED BY: PLAN BY: EbIRES .
04/24/97 TCOWNER: TEL. FINAL DATE F I NAL BY. CODE:
04/24/98 .
LEU SHIN-HWA•MOU LI-MIN (818) 287-5868-
6327 GOLDEN GEST AV
TEMP 917801421 -DESCRIPTION OF WMK'
EXTEND TWO DUCTS FOR NEW ADDITI
APPLICANT: TEL. NO:
SAME AS OWERCONTRACTOR: TEL. 160:
SPECIAL COlfDITIONS-
SAME AS OAPPOWKS DATE INSPECTOR SIGNA7E
WER -
' LIC. NO �^ - FALVWALL FLRK ACEARCIIITgrT OR � -
COPUAT ION
.
LIC-i NO:
THERMOSTAT
PUIEDUC tl tl ®bl-IlKs
9901KE DETECTION DEVICES
47 0
sic
REPORT ID: DPR264 ROUTE TO: RSD508