HomeMy Public PortalAbout5832 MUSCATEL AVE_Mechanical__ TION
AR consent to Self APPLICATION FOR' PERMIT.
nsationlnsurance,
ab. C.) HEATING•- VENTILATING - AIR CONDITIONING
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Fairmont I ICE-818(REV. 10/81) f
furnished. ; ' COUNTY OF LOS ANGELES ,I C BUILDING AND SAFETY
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ed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
� •^ (PRINT OR TYPE ONLY) ADDRESS 5832 Muscatel, ,Avenue
Applicant Pluffmrls S NO. TYPE OF APPLIANCE OR EQUIPMENT FEE. LOCALITY Temple City
Jam`?CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. �
(This section need not be completed If the work involved by ABSORPTION UNIT,BTU' DISTRICT NO.. PROCESSED Y
the permit is for one hundred dollars($100)or less.)
AIR HANDLING UNIT,CFM
a .V
I certify that in the performnce of the work for.which this :� 'i '
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant 1 COMPRESSOR,BTU An,nnn s ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL ev
Exemption, you should become subject to the Workers' '
Compensation provisions of the Labor Code, you must forth,- EVAPORATIVE'COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. I 1 FURNACE: FAU_XG46VIU(O� /
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT /MY
(commencing with Section 7000).of Divisioh 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
License Number 3R2,451 Lic. ClasP?n14{4- - U
Plummer's q� ► 0
Contractor Dafe,]Jt�1•y ��•r
❑ I am exempt under Sec. }+ti--- ( us
I Plan check fee
B.&P.C. for this reason' ' PERMIT ISSUING FEE$ 0
Date: �
m
Signature
TOTAL FEE
OWNER-BUILDER DECLARATION PLAN CHECK'APPLICANT ,
I hereby affirm that I am exempt from the Contractor's License , r'(! 1 A
Law for the following reason (Section 7031.5, Business and NAME
Professions Code): . 1 . r,' o a o o a .8
El1, as owner of the property,•or''my�employees with ADDRESS
wages as their.sole.comgensation,will do the work'and a•a 310. 0
the structure is not intended or offered for sale(Section CITY TEL. NO.
::. � 7 n 0
7044, Business and Profess ians,Code).
' OWNER I
El .. ;
I, as owner of the property,am exclusively.contracting 11:7 C —2 4
with licensed contractors to construct the project (Sec: �IiREss 5832 Muscatel Avenue
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY Temple City TEL.No. 287=0012
I hereby offirm'that there is a construction lending agency fob ;
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.). PlurrmeT'S Ht & Air Cond.I
ADDRESS 346 So. Motor Avenue
Lender's Name. CITY Azusa TEL. NO. 334-4939
Lender's Address
I certify that I have read this application and state that the STATE LICENSE NO. 382451 CLASS - C20144
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives,of this County to enter
UP907he, bove- io d property for inspection purposes. -SEE REVERSE FOR EXPLANATORY LANGUAGE
Dote
gnoture of Applicant or Agent