HomeMy Public PortalAbout5534 HALLOWELL AVE_Mechanical__ Wti O� ERS'COMPENSATLON'DECLARATION CEA 818 (2-80) A P P� CAT 0 O N FOR PE R vl(� T
I'hereby'affirm that I hWe a certificate of consent to self
insure. or a certificate of Workers'C'bmpensation Insurance,o'r -I�>sa 7TI�Cy-bIE�YIL�IYI�G-Alkd COQ®ITIOWB��
a certified copy-ihereof(Sec.3800,,Lab. C.) .
Policy N -company COUNTY OF LOS ANGELES. BUILDING AND SAFETY`
Certifiedtified copy is hereby furnished. - -
'D. Certified copy is filed with the county building inspection BUILDING /j_
department. FOR APPLICANT TO FILL IN 7
Date Applicant (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. . •TYPE OF-APPLIANCE OR-EQUIPMENT FEE ��1 _
COMPENSATION INSURANCE NEAREST /-- C '
(This section need not be completed if the work.involved ABSORPTION UNIT, BTU CROSS ST. (.I (C , a0
by the permit is for one hundred dollars ($100) or less.) DISTRICT N0. . PROCESS v ev U
[ certify that in'-the performance of the work for which this AIR FI'ANDLING UNIT,CFM a
permit is issued, I shall not employ any person in any manner < </ O
so'as to become subject to the Workers"Compensation Laws. I.BOILER, BTU
APPROVALS DATE INSPECTOR'ssiGN - RE W
Date Applicant COMPRESSOR BTU �.W a
ROUGH
NOTICE TO APPLICANT: If, after making-this Certificate of VENTILATION SYSTEM' Z
Exemption, you should become subject to the Workers' FINAL'
Compensation provisions of the Labor Code, ybu must forth- ' EVAPORATIVE.COOLER AL DATIO
with comply with such provisions or this permit shall be
deemed revoked. • '
FURNACE: FAUVIT_ Y� iqr
LICENSED CONTRACTORS DECLARATION FLOOR:' BTU � (�(J
I hereby affirrn•that I am,licensed under provisions'of Chapter HEATER:. SUSPENDED UNIT '
9 (commencing with Section 7000) of Division 3 of the Busi- WALL
ness,and Professions Code, and my license is in full force and -
'effect. '
License Number Lic. Class'
Contractor Date
0 I am exempt from the licensing'requirements as-I.8m'2
licensed architect or a 'registered professional engineer Plan•Check fee 25%of above.
acting in my professional capacity:(Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE $
Lic.or keg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
[ hereby affirm that I am exempt from- the Contractor's NAME T � I(/3_ l(�V-�
License Law for the following reason (Section 7031.5, Busi- b I
ness and Professions Code): ADDRESS V.
1 as owner of the property, will,do the work and the 7 ANT."y
CITY j(�� TEL. NO.. Z.� �y -+
structure is not intended -or offered for sale (Section �� � Ct� �7� (� �_ } { .�11, I_t
+'7044, Business-and-Professions Code).
OWNER I EMS
• I, as owner of.the property, am exclusively contracting � - � '
with licensed' -contractors to construct the project MAIL -3 I-( -30 d -3
(Section 7044., Business and Professions Code).. ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL.NO. ICE�ECK .71J.5r_!
I hereby affirm that there is a construction lending agency414-1 GE
for the performance of the work for which this. permii is CONTRACTOR'
issued(Sec. 3097.Civ.C.).
Lender's Name ADDRESS "
Lender's Addressiti!3tE- i 3[i 4/ 5/8'
CITY , TEL.NO.
I certify that I'have read this application and state that theSTATE LIC. I •iil
' above information is correct. I agree to comply with all County- LICENSE NO. CLASS
ordinances and State laws regulating Heating;.Ventilating and
Air'Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned property for
inspection purposes.
Signature of Permittee Date.
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0903040003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
s
PHONE: (626) 285-0488 EXT -
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: '
ITR: 12392 IT: 12 1 1 5534 HALLOWELL AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT 1 ' ARCD CA 910078417 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18586-013-018 101 PERMIT•ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, Cl
1 103 COMPRSR 101 500 KBTU 1.00 COM 52.20 I
ITENANT: 109 FURNACE 101 500 KBTU 1.00 UNI 52.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
I 1 TOTAL FEES 132.15 103/04/09 SR 08/31/09 I
1 I I I
OWNER: TEL. NO: IFINAL DA FIN Y: CODE:
IZHENG, ANNIE - (626) 731-3633- q An
- -
I
15534 HALLOWELL AV I
(ARCD 910078417 - I 1 ESCR PTI N OF WORK I
1REPLACEMENT'A/C PACKAGED GAS/ELECTRIC 4 TONS 13 SEER ON I
IROOT TOP (E) ELECTRIC, GAS PIPE AND AIR PLENUM CONNECTED I
(APPLICANT: TEL. NO: I I
ILIN (626) 641-5387- I
1702 E. FOOTHILL BL. ISPECIAL CONDITIONS: 1
, 1GLENDORA, CA 91741
ICONTRACTOR• TEL. NO: 1APPROVALS. DATE INSPECTOR SIGNATURE 1
IPACIFIC AIR (626) 641-5387- 1 1 1
1702 E. FOOTHILL BLVD. LIC. NO I IFAU/WALL FURNACE I 1
GLENDORA. CA 91741 668675 C20 II 1
I I ICOMBUSTION AIR OPENINGS I 1 1
1ARCHITECT OR ENGINEER• - TEL. NO: 1 IDUCT WORK I 1
I LIC. NO: 1 1AC/COMPRESSOR I
I I ITHERMOSTAT I I
I I IFIRE DAMPERS I I
ISMOKE DETECTION DEVICES 1 I
I I ICOMMERCIAL HOOD I I I
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IREPORT ID: DPR264 ROUTE TO- BS0508
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