HomeMy Public PortalAbout10227 GREEN ST_Mechanical__ Wk>RKETrS COQ1Pe4SAnON
loate of to 20-0040 MM04C /� APPLICATION FOR PERMIT'
LIME GREEN
I hereby rrsr the#I have s certificate oT consent to self Insure, 78A3s4C
oRe to of-Worker's Compensation Insurance, or a certified HF-AnNG'-VENT11�i TING-AIR CONDMONING.
Loopy t}rereof(Seo.5800 Lao.C.) ' • - ,
PnoBcy Np•' P Corn p" COUNTY OF LAS G DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
I Certf!W copy Is hereby hanbhed.
BUUNNG
❑ Certified copy Is flied with the county bulId!hg Inep•otlon- FOR APPLICANT TQ FILL IN MISS O 2 dk�—
.(PR?NT OR TYPE ONLY)
ate APPrrt G�
1 OCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
IAN
NEAREST
CERTIFICATE;QF EXEMPTION FROA4 WORKERS' CF09BST. ��f✓InJ
COMPENSATION INSURANCE A139DWTIONUMT BTU
.(This sebt)on need not,be completed n the wort tnvolred by the MW BOOK g 'PAaE ` PARCEL
perdrlt Is for onrhundreddolhrs(8100)or 4 .) NRFANDUNG CFM osmacTr+o rnoI : ; Ery
I oef-d y that In the performshce of the work for which this pertntt .
Is Issued, I s6all not employ any person In any manner to do to BTUm
beooe subject to the Workers'Compenbgtfon Laws
COMP OR F XRI
Date 4 �Z l ( App"MLFI✓ VEM�ATION SYSTEM
APPROVALS.' D+re esia+ruw
NOTICE TO APPLIrfANT: If, atter making this Certificate of P404"
Exemption,you Should become subject to the Workers' Compensation
provlstofH oI tha Labor Code, you must.fortflwfth,compiy whh such EvAPORAT[vE COOLER F1lLAL �_•'
provlslpps or this permit•hall be deemed revoked. FURNACE FAU _ ( lAyrTY-
L)Cf3NSED coNTRACToRs DECLARATION FLOOR . BTU O Y1�17DN4TION
I hereby affirm that I am Iloensed under provislons of Chapter 9 BUSPE NOF=)_.UNIT C
(commencing with S•btlon 7000)of Division 3 of the Business lnd HEATER
WALLProfsitWorts Code;and my Roan"Is In full foroe'end effect �+
Lbwwe+Number Lb.C{eae O
Contra" Dery t.
ACCT:* r
❑ I.em ex"under Seo. Plain check fee _ = '� 97.30
B-. P.C.for this rsaeon PERMIT ISSUING fEE>E r7 1 ITE115 Q
TOTALE TCTAL7-_.3
CHECK. .9.7.W d
rs
PLAN CHECK APPLICANT ry rakes
OWN'1--51-1I LDER DECLARAT40NZ
n
t�
I hereby affirm that I am exempt from the Contractors Lloanae Law NAME
for the following reason (Section 7031.15, 13*ness and Professions. .
•) A11RE88 O zz O t: 2/-, .
I,as owner of the property, or my employees with wages ��r7
'as their sole compensation, will do the work and the Cr.I' TEL NO. ��� Lr11r 1 11t11•�1'
structure Is not Intended or bttered for sale{Section X044, ID22 12 _
Business and Professions Code). OWNER
❑ 1, as ownet of the property, dnf exclusively contracting L
with licensed contractors to oonstrpot the project•(Seo- _
tion 7044, Business and Professlons Code).
CONSTRUCTION LENDING rGi CY Ury TEL NO:'
I hereby affirm that there Is a construction lending agency for CONTRACTOR
the performance of the work for which thls permit Pe Issued
(Seo.3097,Ctv.C.). r
ADDRESS
Lenders Name _ SIT1
Lenders Address STATE INC.
I oentty that I have read this application and state that the above tJOBNBE'tNO: CLA88
brfamaifori Is correct. I agree to-ompty with all County ordlilarwee
and Stale laws refOng to bLdUng=%sftLcdbn,and hereby aubxAze _
representatives of thii County to enter upon the above4nen(ioned '
prope for In Ion pure ,gam F tVEh8E FOR bTLAHATORY LANGUAGE +
L
X
SIGNATURE of AF I rArE1
' f
t ,
i
COU(Tf OF LOS 11NGELES TN PLE•C7 TT 0 0508 Mel:HANIC�L PERMIT
DEPARTMENT OF PUBLIC YORXS 9077 LAS TL AS ME 0508 9�AODOT
-BUILDING AND SAFETY / LAND DtWLOPPENT TEMPLE CITY CA
y PHOME: (818) 255-0488 EXT:
LEGAL ID; FEES PAIDWILDING ADDRESS:
Olt FI LE - 5227 GREEN ST
FEE bESCRIPTIOM: O�IANTITT: LION: AMOUNT: EMP G 917803337
r EAREST CROSS STREET: BALDWIN
8585,005-016 01 PERMIT ISSLKKE .FEE 27.75T}10NAS PAGE: 591 GRID: B4 LQGLITT: TEMPLE CITY
02 COMPkSR < 100 K@IC�TU 1.00 COM 27:DO 4
08 FURN�ICE/HEATER <100 1.00 UNI 2y.Q0. : PROCESSED BY: PLAN BY: IOES ON:
30 AIR INLETSJOUTLETS 8.00 UMI 34.80 /25/97 GT, (25.
TOTAL FEES 116.55
OWNER: TEL. NO: FINAL C�TE FI
CHEM LINDA CODE:
51457 MYRTUS AV l
TEMP 917800000 ffE=ipTlUN- OF WORK
REPLACFNG EXISTING HEATING "STEM AND ALR COMDITIOMG
APPLICANT ' 4
T i L AIR�COMbITIONING INC. (626) 279-5858- SPEcrAb'
T i L AIR CONDITIONING, INC. (626.) 270-5x58- 0i'
10699 HELIC. NO ^ G�
EL FIONTE, CA G 91717,31 733167 C20 � (_1✓1IA
COMBUS�ION AIR OPENINGS,
. I LA
N 0: ® .�
LIC. NO: `
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WL FIRE UkVMS
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REPORT ID: DPR264 ROUTE TO: RSD508