HomeMy Public PortalAbout5636 PAL MAL AVE_Mechanical__ �i-^ i y . , . ,' r .• - ' ' + ��e arm +•)" �;� ••� •Y�a , 1 ,
a WORKER S COMPENSATION DECLARATION~, 20-OW DPW 9/09 E'
I h _r ahr "that I have a certificate of consent to-self insure' ,7 APPLICATION' FOR PERMIT LIME GREEN,, [J
t orla certificate of Worker siCorripensstion Insurance or a certified,^ ' -` '_ "';HEATING`yVENTIL'ATING - AIR CONDITIONING - ^• ( " 'I I
copy,,�heraol(Sec•3000 Lab C) A' ' = 'Jr"t, """'• LI
QK�2q 2940,7 w+" .3 �C/ rf
chic o L - Company,I + COUNTY OF'LOS ANGELES v " DEPT OF PUBLIC WORKS':' ',,, BUILDING AND SAFETY DIV
° srtifiatl copy is hereby furnished > •I
lbp ceNhed wpy is filedrwrtn ins c ty bu,d rg in pecuon r.y; z FOR APPLICANT TO FILL IN
BUILDING •S-�3� n , `+', F 9 '�s
i p [f de)pe_rtment H.! - ) k, _ r q •: a-(PRINT OR TYPE ONLY) - - . ADDRESS
i�Dela "/�11 • ApPlmant • w ' . + LOCALITY '['r i t r. �.tA - r,•,Y41tt r
,NO TYPE OF APPLIANCE OR EQUIPMENT' FEE ,° `
e.. •,._� - , - NEAREST
y r �CERTIFICATE OF EXEMPTION FROM WORKERS A 1 {,' , �,+ x . CROSS ST -
1 COMPENSATION INSURANCE ' ,• _ ABSORPTION UNIT BTU
>• r' �'4 ASSESSOR •f1.S i a' let I
•' (Thu,secbontnsedinot be completatl rf ilia work,InvolveE�bY ih.' ,` + u ^ MAP BOOK' . "' •, PAGE ' iPARCEL yria r
�perrmit is for one hundred dollars(3100)or less)r� ,- T �`.
-�- ,• , v`y- AIR HANDLING UNIT CFM De'MICT ra ,Y„ ezr..[
I certaly that in thVperformance of the work for which thisrpermn -_'L f e '�- -F" ;ai•x"r, �%• * ,t is issued I shall,nut employ en`y"person in,eny mann-errs-6-as ao'es - BOILER BTU + �1 +'j `r '�� 0 '- +, _
become subject to the Workers Compens lion Laws y�¢ ' N s „ SO
' COMPRESSOR'BTU
'` "�.�1 r •'+•.° r• . ,onC,.Ae . _ r. " _ •avrnv,u.e` - wTa �- w iictoas`aivuTws J V.e"
Date Applicant ' VENTILATION SYSTEM = -�
NOTICE'TO APPLICANT 1041ter making this Certificate of- - ROUGH j. w '� ' �^p' ' "t'u,r'.t' ' + ' 1 '• +
!Exemption tycu should become subject lo,lhe'Workers Comlleneanon' "y "' _ rb -
~ EVAPORATIVE COOLER
s .provisions oftthe Labor Code lyow must foMhwrth,comply with 5uch, FINAL'S Y _ '? &w? r^•1r ' ti
r• provisions or,lhis permit shell be deemed revoked -,. •+^ gg FURNACE FAU O,RAVITY " •'4r
�> 0.I +LICENSEDCONTRACTORSDECLARATION iY A•. FLOOR BTU • <'d -{t` °r VALIDATION
hereby,affirm that+I am,l iceneaE untler,provieione of Ahepter!9 ., SUSPENDED UNR_ 4 +jOr. ` In ��' C" A,+ u"ty' f
(coin memm�B with Section 7000]oP Division 3 of the Buslaese end ' :� HEATER WAIL O ✓ , , , ) r4i x ^ p " »'h" + It•+
P rofession s,Code and my license is in full lorce and effect"`- 1' ,y - y, •1 ¢ `. �,�#. _ or,', wt
n r 41✓j� r ff x Y - A) 4�.)+, k
License Number�U� 7 A7'/ 7 C 4 Lic Clens J Y�t „ �."- , -Iia+• b ! ` i ' +" T 1✓x f I".''"}+.y �A
At3,O�-/.2 , rtla4.
Conirecto
ate �:� • + �l - y `"'a• �; '+ � y�r# O
❑ am exempt under Sec '+I + Plan check fee • „ . .Ic �,- �;x5 a +•� t - ni •mss l (,
I _ _ 'te- - "! _ Yrq
B 8P C'for this reason '} ^` •+"^ .{7 , - ' PERMIT ISSUING FEES �... .; 'yT: "4`�.j'�Yom• • s ,5
+ Date TOTAL FEE , O ,W
Signature _ �- 4 + i tx •;m t> . W
PLAIN APPLICANT q 111,.
OWNER BUILDER DECLARATION " "" - ' a 'Til YY` I A t< • �r +'" Lc Z
r
I hereby affirm that Iem exempt from the Contractor s License Lew NjdjE . .( i• +� _ f ^ ,,, r ,r , S,
for the' following reason (Section 703115 Business and Professions..
- ••4• 1� , i' +,� ^ � ' 't o;ry'r`q ^
Code) `� _ ',� ADDRESS
_ I es owner oythe property 'or„my employees witty.we0es
'iis their sole compensation wdI'do the work and the CITY x+ y
sale (S' '7044 , TEL'NO
structure is net intendedor offered for _
0y
Buusmess and Professions Code) _ ')' OWNER '1 1` - 4 i
❑ Qlt�L ctlC' a . ^l'r -
-I as owner of the property am exclusively contracting IA,VL n^ y' , ,/ rni �.1r t-�a, r
with licensed contractorsdo construct the project•(Sec , ADDRESS '" ' '� �• �LI'^L - x ,[i C.+
` nen 7044 Businessland Professions Code)
p+l ,
N ,
CITY, + r5 TEL NO r_
,CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending,ag ency for CONTRACTOR '^ -
t he'performance of the work for which lhm'parmit'Ile issued r -Z-�, -; 1'• }� - t --pG•$: -n—�-_ _'� G
(Sec 3097 Civ C) t _ ,_- h jaetSG`"L'i
ADDRESS 9 o] - a"rlt) (w.`F• T T
Lender's Name ' - ` n (_.- iJj 'i 'i r t'+,
1 I •ia ,�= ,L '.0 , CITV ., TEL ��J�D/ • x+'4, + j .c`
7 -
LendersAtldress STATE. - < LIC^ �f r7� _ « --+R,-... •... Iy �_r. ,. ,+._)�f-7 .�� .,.,.,~ .�n.+�I Z�I� �`
cartlty that I have read this apphcahon,and state that the`ebove LICENSE fK1 (D 7 CUSS
Information is correct I'agree to comply wdh all County orumances
and State laws relating to building construction and hereby euthonze ` �I~ -"—
re" sentalyves of th Court to enter upon the above mentioned ^ n � 'i y . , ` .N _" ` .. t�� '�
' rape y for inspe ompu ores i q r r r _ SEE REVERSE FOR EXPLANATORY LANGUAGE
TURE OF APPLIDArO�Flrr D%TEa,� �• e - SPI , , - '� � t t� �' ' �+��_ � . �� r,.n +
WORKER S COMPENSATION DECLARATION . t'_ �76AJ DPW 0/Be r r rL,�OIAE - GREEN,' +
1' I herebyaffirm hat I have a certificate of`consent to• ' APP_ LIGATION FOR PERMIT-
self ensu e
r or a certificate of Workers CompeTsation,lnsura nce or a certified, r� t t •,GREEN ," ,
+ f ' HEATING=V�NTIO ING -AIR CONDITIONING -
copy thereof(Sec 3800 Lab C) '+ �r _ , o. . .. _ I , '
Policy No Company ' ' - COUNTY OF L( S`ANGELES• N +i*DEPT OF PUBLIC WORKS"� .-BUILDING AND'SAFETY DIV '
,❑A Certified copy is hKo8y furnished r'"„ r ..• I ' i T w ..i) s
y . "
❑t •4Cerbfietl copy is filed kith the counry�tiulWing mspecuon J . `FOR APPLICANT TO FILL IN' ,µ ' BUILDING M1•
department < (PRINT OR TYPE ONLY) , •S ADDRESS S(o�j ti-�Q R.,� Pat__ M14-L, � 2
'� 'r " ' .� .+. _ -` ,,•.,+/ ,LOCALITY. - t' ^'r.t� i w
Date^ ' • Applwent _k •'SN'O TYPE OF APPLIANCE OR EQUIPMENT FEE _T ,
� t NEAREST ^r {' r V.
yu .� CERTIFICATE OF EXEMPTION FROM WORKER$ 7 +• x ,;,+ 7 '1- „ ,h CROSS ST_ ,LIV+ O ys r",' c
,N t COMPENSATION INSURANCE V)t r'I' a ABSORPTION UNIT BTU ' s� -Y ri, . d
(Thumecbon need not be completed f the work Involved by the >i ^ . _ - - ASSESSOR ,- ,.
`permit to for one hundred dollars(1100)or lees) i / ` MAP BOOK r PAGE,, PARCEL
t r . ^ AIR HANDLING UNIT CFM _ �,,,n anocassm eY T
certdynhat m the performance of the work for whmhath is permit' +5,t ,q' _ r'p .or
yIs issued I shall not employ any person in any marine so es to V BOILER%BTU' - �' t , . • �~ r� v T i
'become subject to the
Workers Compenaet vis ,, n :S .vii �; :,�o�, i -
" ^" ' IT A' COMPRESSOR BTU �� •bsvnnv,us _ ° oATE _ wevEcran s"sxwniu�� Y
-'q_/3 ,
Dale C.�� App � VENTILATION SYSTEM� -� - t � � _ ' � •
tN OTICE'TOtAPPLIC ANT site making this CerUhc f ' • + •`5� BOUGH
T ' Exemption you should become subject to the Workers JCompeff&aton '°
< EVAPORATIVE COOLER .
provisions aPthe Labor Cade you must forthwith camply,wrth such . I I, + o- . / FINAL
`i
provisions or this permit shall be deemed revoked ' FURNACE : FAU GRAVITY 'Et . 4+ ,
r LICENSED CONTRACTORS DECLARATION i •� ; + FLOOR ` BTU n " ' �d' VALIDATION
"I hereby affirm that am licensed under provisions of Chapter 9 ^ SUSPENDED _UNIT_ +' �-r " _ r -,r•
(commenclog with Section'7000)of Division 3 of tliOBusmess and HEATER WALL • '
Professions Code and,my license is in full force and effect s
+ License Number9„Z laZ• LIc
GLif?n+e Y Piw`-r2. S 3(�9<f m� „rc. .t - ^te, (^.i 7. t `• IL
Contractor Date a '
❑ am axemp uride'r Sec • sPlen Check fee• v^ , ... _ _� _ f ` 1• r •_,U—, -
1-"ITE M7
'r B&P C for this reason ^ T- ' 'S PERMIT ISSUING FEE$ • ' "` ¢Q
^Date` . f' _J. , r TOTAL FEE �T - ' ^ TUTAV 5 10.6- 65 W
f+ Signature I `L• r•: r� - ' 0" CHECK ti r 106.571 d
• PLAN CHECK APPLICAM . - /O�� 1 Y L.. r9 - , r .q, b 0)
i OWNER BUILDER DECLARATION�'� v . - ,t + 41h�E rq ' LdJ ?
I hereby alltrm that ham exempt from the Contractor a License,Lew , NAAfE
I&the fallowing reason,Sectiom7031 5 tRusmess and Professions r r ,tt G4A ��((y�(''�� r 919--(pt+ '
Coe) ,� ".. ' ^ + ,+ ADDRESS PA'L tM/�'l b. y.' Lin NA ° 0000-MO1 + h/ T17J '
I as owner,of the property oi,my,emplcyees with wages r n •f .,. nit 1,
`
as them set;1
compensation will doathe work en dri h'e Cn"1'�' TEL NO�S(8'�,4'S :ObZS , ' - i } •r'J 1(� ' 1 •r,ry 11V �7
structure Is not intended or offered for sale (Section'7044 ^ a w .A ^' �< t_ i o w '.y✓.t
Busmess84nd Professions'Code) , OWNER " a . L W + y,• + ' ' ' "_ '
yAw
❑
Ilea ovine`of the property am•exclusively'contracting MAIL ..•
with licensed contractors toyconstruct lthe project((Sec ADDRESS 3 - NaR,Til'r Ilia- ; '�, y
�tion17044 Buslness'antl Protasiions Code) } 1 v.-. r Zy- .a . .. . ' 2 y, r , ,
+ CONSTRUCTION LENDING AGENCY .'', , -ITYTTE,n C.t TEL NO$�j' µ.' " _e6z5 + , ''
•I hereby a//irm,that therefis elconstruction (ending a encyv for +- ,' i - - + -!• -T ,H �. t +
he performance of the work tor,which this permnl�e issued COMRACTOR ` } y i ,,
(Sec 3097 Civ C I _ ''"' . ,
ADDRESS '; '6 ,J _ -rr, `.^ t_.:I _ ��. �,
i ,r.h t
f Lenders Name
CITUt-
landersAddress It f
t 5TATEt•2. A' „ LIC ._
'�I certify that I have read this appllcahon and state that the above' LICENSE NO CLASS G.���-'T+-., LL" ` �"� •"y
Information Is correct I agree to comply with all County ordmances
and State laws relating to budding construction and hereby aulhonze ' " ° _ -_ `•+ `•t `•x i '• r '"• ^- — - - +�+-'
representatives,of thts,2ounty to enter upon the above mentioned
praPe pe Purposes �,
SFE REVERSE FOR EXPLANATORY LANGUAGE__ f. '•
S JA EOFA BAeENT GATE • i. ' r •L r• ' y)
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECNANICAL PERMIT
DEPARTMENT OF PUBLIC WORM 9701 LAS TUNAS ME 0508 0608210007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PRONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE5636 PAL MAL AV
FEE DESCRIPTION QUANTITY• JOM _ AMOUNT TEMP CA 917802853
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LIVE OAA
8586-009-018 01 PERMIT ISSUANCE FEB 27 75 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY C
30 AIR INLETS/OUTLHTS 2 00 UNI 8 70
T ANT 41 VENTILATION PAN 2 00 PAN 31 50 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
47 ALTER EXIST DUCT SYS 1 00 SYS 27 00 08/21/06 UK 02/17/07
TOTAL FEES 94 95
OWNER TEL d0 FINAL DATE DE _
TRAM VICTOR
5636 PAL MAL AV
TEMP 917802853 SCRI—IPTI WORK
ALTERATION OF EXIST DUCT SYS G 2'VENTILATION FANS
APPLICANT TEL NO
WANG (626( 821-0672-
735 M DUARTE RD 203 SPECIAL CONDITIONS
ARCADIA CA 91107
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
TRAN VICTOR (626( 327-0155-
5636 PAL MAL AVE LIC NO I FAU WALL FURNACE
TEMPLE CITY, CA 91780 NONE
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER TEL NO DUCT WORK
LIC NO AC COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOFL DETECTION DEVICES
COMMERCIAL HOOD
Y
r �
REPORT ID DPR264 ROUTE TO 8S0508
F3 r