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HomeMy Public PortalAbout10903 GRAND AVE_Mechanical__ - WORKER'S COMPENSATION ate of consent to �WefW APPLICATION FOR PERMIT LIME GREEN. > I hetrsby efflgn that I have • certificate of consent to Ball Insure, Oc q certlflcate of Worksri Compensatlon Insuranoe, or a oertlfled HEATING'-VENTILATING-.AJR CONDITIONING Copy t7iereof(8ea.3800 Lab. C.) I�o�1 lNo. terry COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING ANP SAFETY DIV. Certtfled copy Is hereby hmishad. ❑ Certified copy is filed with the county buSd Q Ira pectlon FOR APPLICANT TO FILL IN ERJ o AVP depart—L (PRINT OR TYPE ONLY) LOCALITYDate Apparrt llo No. TYPE of APPLwJCE OR EQUIPMENT FEE CERTIFICATE OF IDOE APTION FROM'WORKS N COMPENSATIOSU N INSURANCE ABSORPTION umT BTU n (This section need not be oompleted if the stork Invgtvod try the MAP BOO!( �J PAOE19 PAAC✓3 QIV permit Is for one hundred dollars($100)or lesa.)' ,UR HANDLING UNIT CFY DarrrQT No. PAODa••m ey I oerttfy that In the performance of the work for which this permit � ' �� to Issued, I shall not employ any person In any manner @o as to BTU become subject to the Workers'Compenaatlon Laws. ,,yy r COM BTU nPPaouus DATE P Psorous sa7MlA T Data "Icarrt NOTICE TO APPLICANT: If, after making.thle Certltloate of ROUGH Exemption,you should beoome"act to the Workers' Compensation EvAPoqATrA COOL provisions of the Labor Code, you must forthwith comply with such FINAL provision or this permit shall be deemed revoked. FURNACE . FAU0 LICENEIE �D CONT ACTORS DECLAFLATFLOOR BTL o VALIDATION I hereby affirm that I am licensed under provision@ of Chapter B HEATEFt 8tWENDED UNIT (commencing with Section 7000) of Dlvlslon 3 of the Business and WALL Professions Code, aand�my license/to In full force and effect. L1Oerre Number �/S� `.�7-- Lia Ctow ` a. Convaotnr DMt�� .•I .7 8 m ❑ I am axe54 under Sec PIflf1 CheClc f96 - B.hP.C.for this reason PERMIT ISSUING FEE .�4, ITO Data: A09= ff t TOTAL FEE TC l` jyl PLMI CHECK APPLICANT rACN.;. 141.1'7 Z UILDER DECLARATION I hereby affirm that I am exempt from the Contractors Lloenss Law ///D a - /, ' 6 -for the follaMng reason (Section 7031. , Business and Professions N /7 f I� 'J/�/mal Code): ADDRESS © 6! 4,UD F-1I,'a owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL NO. structure la not Intended or offered for sale (Section 7044, L .r�ci �... Buslneee and ProfeeNona Code). OWNER F-1 I, as owner o1 the property, am exclusively contracting PAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Profesolons Code). CITY TEL NO. CONSTRUCTION LENDING AGENCY I herebyy affirm that there Is a cbnotructlon lending a enoy fbr ' I he performance of the work for which this permit le leeued(sec.3097,ON. C.). AWRE88 d Lel cavil /r Lender.Name _ Lender@ Addrea. CITY �s 0/� 33 NO. -3f 8TATE LIC. I certify that I have read this a"I{oailon and state that the above LlCEilBE NO. L CLA88 't7 hformeflort Is convoL I agree to comply with all County ordlnancee and Shade laws retattng to bulding constructbn,and her9by eudwrtze representatives of this County to enter upon the above me-n6onad property for InspedUon purposes. SEF REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ATMGE=Z TEMPLE CTT7 ¢ 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORTS 9701 LAS TUNAS ME 0508 1202160004 BUILDING AND SAFETY / LAND DE'VELAPMENT TEWLS CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADO6LB9S: TR: 11497 LTi 16 BL: A UN: .002 10903 GRAND AV FEE DESCR=ON. QUANTITY: DON. ANCONT: TEMP CA 917803552 ABSE990R INFORMATION NABER: NEAREST CROSS STREET: 8574-008-018 01 PERMIT ISSUANCE FEE 27.80 THOH S PAGE: 597 GRID: D4 LOCALITY: T3)SPL3 CITY, C 30 ASR TNT ETS/OUTLE'T5 2.00 UNI 8.70 TELT: 41 VENTILATION FAN 1.00 FAN 15.80 ISSUED ON: PROCESSED BY: PLAN BY: 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 02/16/12 SR - TOTAL FESS 79.30 OWNER: TEL. NO: F ` FINAL BY: � CODE: MOON CHIN (626) 283-0710- �� 10903 GRAND AV TEW 917803552 DESCRIPTION OF STORE ALTERATION OF HIT T DUCT SYSTEM, 2 AIR INLETS AND 1 VENTSLAT ION FAN FOR NRN BEDROOM AND BATF5 000H APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR 9IGN[XTURR SAME AS OWNER TSC. NO FAD KKLL FU� COMBUSTION ASR OP4NINGS . ARCFQTSCT OR E29GT 1FrRR: TEL. NO: DUCT WORT BOPADIL.LA, GABRIEL (626) 510-0617- 725 E. WALNUT ST. LIC. NO: AC/CCM� PASADENA, CA 91101 NONE TLUKRICeTAT FIRE DAMPERS SMDEE DETECTION DEVICES CC&JGRCIAL HOOD REPORT ID: DPR264 ROUTS TO: B90508 ' - J