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HomeMy Public PortalAbout10750 GRAND AVE_Mechanical__ DEC WO-m that I have a cera cafe of APPLICATION FOR PERMIT f hereby affkm that'I have a certificate of consent to self , In r or a certificate of Worker' Compensation Insurance, HEATING - ENTILATII IR CONDITIONING p ce copy thereof (Sec. 3800, Lab. C.) 76A364C -81 B(REV. 10!81). • �/�t� ` P❑ollcyl?`975957 Company R@pt�lir- InriRmnity j� Certified copy Is hereby fumished. BUILDING AND SAFETY © Certified Gopy Is filed with the rountv 164Hding Insper FOR APPLICANT TO FILL IN BUILDING tlon department. (PRINT OR TYPE ONLY) ADDRESS 107-SO East Crind AVenue Data 11/28/88 Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF E)(E.MPTION FROM WORKERS' NEAREST COMPEWTION INSURANCE CRoss ST. (This section need not be completed If the work involved by ABSORPTION uNrT, BTU DMTRCT NO. PROCESSED BY the pwmtt Is Fdr one hundred dollars(;100)or less.) AIR HANDLING UNIT, CEM `7th V_ I certify that In the performonce of the work for which this permit Is Issued, I shall not employ 8nyrzon In any manner to as to become subject to the Workers�Compa6satlon Laws. BOILER, BTU APPROvAus DAte SGN4 RT Date Ilcpnt 1 COMPRESSOR, BTu 24,00 btu (� � ROLGH NOT] TO APPLICANT: If, after making this Certificate of VENT]LAT)ON SYSTEM FINAL Exemptjon, you should become subject to ,the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATrVE COOLER VALIDA with comply with such provisions,or this permit iholl be -deemed revoked. RJRNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION 1 FLOOR40 fu I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SLISPENDEDUNIT '(commencing with Section 7000) of Division 3 of the Business. WALL and Professions Code,and my license Is'ln full force and effect. d lice u r Ic. Class Cort a 11/28/88 O I am exempt under Sec. Plan check fee °• • B.BP.0 H for this reason' _ Date: PERMIT ISSUING FEE$ Q 13 7 Signature ^ T 30 OTAL FEE ° OWNER$IJILDER DECLARATION PLAN CHECK APPLICANT I e - 3Q50 1 hereby affirm that 1 am exempt from the Contractor's License Poo.Law for the following reason (Section 7031.5, Business and NAME Professlons Code): o •,0 3 (�5 Q ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,wIl I do the work and (.22 0�8 8 the structure Is not Intended or offered for sale(Section CTTY TEL NO. 7044, Business and Professions Code). . El1, as owner of the property, am exclusively contracting OWNER Francis Kenzy with licensed contractors to construct the project (Sec- MAIL AmRii� 10750 E. Grand tlon 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY Temple City TES. No. 444-1462- I hereby afflrm that there Is a construction lending agency for , the performance of the work for which this permit Is Issued CONTRgCTOR (Sec. 3097, Cly. C.). Lender's Name, 1350 E. Las-Tunas Drive Lender's Address CITY San Gabriel TE- No_ 286-1141 STATE . LIC I terrify that f have read this application and state that the LuNsE o. 51 CLASS C-20 above Infcrmatlon Is correct. I agree to comply with all County ordinances and State laws relating to building construction, arVkeraby authorize representatives of this ounty to enter panh antlered pro rty for In Ion pu SEE REVERSE FOR EXPLANATORY LANGUAGE -.. �/. re of App llca Agent