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HomeMy Public PortalAbout9917 LAS TUNAS DR_Mechanical__ WORKER'S COMPENSATION DECLARATION . 20-0046 DPW 9/88 - N FOR PERMIT LIME .:GREEN ,I herebfirmyafthat'I'have a certiflcateof consent'to self Insure, 76A364C• APPLICATIO,i or a certificate of•Worker's Compensation Insurance, or a certified HEATING %VENTILATING-;AIR CONDITIONING- t copy thereof(Sec 3800 Lab C) r Policy No Company r' COUNTY`OF LOS ANGELES DEPT'OFr•PUBL-I'C WORKS BUILDING AND SAFETY DIV.Y•' t ❑,- ❑, Ce:ihed-copy is'here,tiy-furnish; ed rrCertrfled copy'Is fled.wi•th the county abudding inspection .. Ff OR APPLICANT TO FILL IN ;• ,BUILDING , '•�J /'`' �•� �' � ADDRESS ' / /, L'�✓ �� `v department ,(PRINT OR TYPE ONLY) LOCALITY` Date Apphcant NO TYPE,OF APPLIANCE OR EQUIPMENT-, !' ' ' FEE t z NEAREST " CERTIFICATE OF EXEMPTION-FROM WORKERSte,• CROSS ST 'COMPENSATION.INSURANCE h ABSORPTION UNIT,BTU This section need not be com letedrif the work'Irivolved b the• ASSESSOR (, P Y- +'a• MAP BOOK PAGE, PARCEL permib is for one hundred dollars'($1110)or less') AIR;HANDLING•UNIT,CFM v` - p - DISTRICT NO PROCESSED BY I certify that In the performance of the work for whlch'thls permit t ,x'"•. '; Is-Issued, I 'shall,not employ any person m ny man er,so as to_' BOILER become subiect.to'the Workers'bompens Laws �, _ COMPRESSOR,BTU _�APPROVALS DATE •�• INSPECTOR'S SIGNATURE 'Date' Z` Apphcant e VENTILATION SYSTEM _ NOTICE O A PL'IC'ANT if, after making the e'rtiflcate ro a ROUGH ' Exerriptiori,,you shouldbecome sutilecteto_the Wor s'•Compensate n EVAPORATIVE COOLER p�ovlslons'of`the`Labor,Code,you must forthwrt comply with ch," o'` FINAL- Ss proveslons,or this permit shall-be deemed revoked FURNACE AU GRAVITY •^ - - y.. •�' -I LICENSED CONTRACTORS DECLARATION FLOOR BTU' { VAI-(DATION- I hereby affirm that,l am licensed under,provisions of Chapter'9, SUSPENDED• F UNIT ;'�• I -(commencing,with Section 7000pof Droisiorn3 of the Business and HEATER' WALL' Professions Cotle,and my license Is in full force and effect L cense Number Gc Classy "` ;, 1'^3}E GI'i_ "� i t _TAL X76 056. Contractor.�� C%L'/moi/¢/'Date �I Y • Plan check fee U 10 I,am exempt under Sec i Q B&P C for this reason w ",'PERMIT ISSUING FEE$ ; ` f— ` Date J/3. TOTAL FEE. 51 14 i 7 Signature �` tt " ri NER-BUILDER,D RATION PLAN,CHECK APPLICANT d`, t'•' j�7 f t ___Z Lhereby,aff;r"n that I am exempt fro 'the Contractor's cense•Law NAMES' i ,.for the,foliowing reason,(Section 7031 5, Business a Professions Code) ADDRESS41 ❑ ,I,•as owner of�the.property, or,my employees wnth4wages t` ','p - ` ! ,• _ gas their sole compensation,` will do the work and the CITY '!J;`�� TEL N(Oil? J/, ;,3' } 'structure Is not intended or offered for sale (Section 7044, ^' Business and Professions Code) OWNER; ❑'t 1,as owner:of,the property, am.exclusively cgntracting MAIL 'with licensed contractors-to construct the pro)ect.(Sec- ADDRESS - tion 7044, Business and Professions Code) CITY� �I/�j7� TEC NO —Y • ` CONSTRUCTION LENDING AGENCY I hereby'afflrm that there Is-a con'structeon lending'agency for, CONTRACTOR the'performance of the work for which this permit Is'Issued /l�/ ;� (Sec 3097, Civ C) 13se:.; ADDRESS,• �.�"' ,/'� 'G!'//�C%� /v,' '_, ,'- - - wx .•• '. " Lentler's'Nanie _ tr.. _ 'A K. CITY y:G� f'�1�7� C/ <Z✓s'�STS3/; l _ - I Lender's Address - STATEr 2 � LIC- - u certefy'that,I have read fhis'applecateomand'state that the above LICENSE NO- 3-1) ,:Ga3` CLASS information es-correct I adree to comply with all County ordinances - "=and Via,�i� ting ifdeng construction,and hereby authorize'reprth C my to enterupon.the above-mentioned'r0 10 OSeS _ Yp p -SEE REVERSE FOR EXPLANATORY LANGUAGE 3 •I', -i ' •zw OR GENT SIGNATURE OF APPLICANT DATE', - ^ , 1 • ".r^ - �.4 v. + ' y • J COUNTY OF LOS ANGELES' TEMPLE CITY' # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC IrORKS 9701. LAS TUNAS ME 0508 9911290017 _ BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL-ID: , FEES PAIDBUILDING ADDRESS. TR: 09285 _ .99.17,LAS-,TUNAS DR' JAI FEE'.DESCRIPTION: _ `AMOUNT-: -TEMP`'CA'91780SY: ASSESSOR 0 _ - - '—NEAREST CROSS STREET: r , 8587-031-026 01 PERMIT ISSUANCE FEE' G 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY" 02 COMPRSR < 100 KBTU _ 6.00 COM 162.00 1 .A T: 30 AIR IN11-1TS/OUTLETS 28.00 UNI 121.80 ISSUED ON: PROCESSED BY: PLA9 BY: EXPIRES ON: TOTAL FEES 311.55 11/29/99 UT 05/27/00 (OWNER: TEL. NO: I FINAL DATE FIN" BYl?r CODE: A AND G LTD LIABILITY CO _� 162 CONSTITUTION DR. w J IMENLj PARK, LA DESCRIPTION OF WORK I REPLACE EXISTING AIR CONDITIONING UNITS l i ,APPI-IrANT: TEL. NO: GARMAGARM INTERNATIONAL, INC 8491 SUNSET BLVD. SPECIAL CONDITIONS: LOS ANGELES, CA S C® CONTRACTOR: TEL. NO: ®�3 ��a ADPROVALS DATE INSPECTOR SIGNATURE GARMAGARM INTERTIONA.L INC. (323) 650-7155- DBA GAMA CENTERAL OEAT Fx A/C LIC. NO , U/WALL FURNACE 8491 SUNSET BLVD. STE. 126 445484 LOS ANGELES, CA 90069 © COMBUSTION AIR OPENINGS ARCHITECT OR NGINEER: TEL. NO: DUCT WORK LIC. N0: � 1111111 AC/COMPRESSOR --1 , THER OSTAT q I�. D (� ("D n /1 G lK 8 FIRE DAMPERS � U IIL� \1VI/11\JI/ IIJ,'U� SMOKE DETECTION DEVICES C 0 COMMERCIAL HOOD �.� Q ❑ FT-*{ 0 ®5 48��c 0 �0 %3epvice��aq REPORT ID: DPR264 ROUTE TO: BS0508