HomeMy Public PortalAbout5327 PARMERTON AVE_Mechanical__ WORKERS COMPENSATION DECLARATION
I hereby affirm ihot'rhave a certificate of consent to self APPLICATION FOR PERMIT
T Insure 'or,o cerhftate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING
or a ceTtifie'd copy thereof (Sec 3800, Lab C) 7EA364C
��t d _ "'_ t - + 20)D46 DPW 9%88
Policy No Company COUNTY OF LOS ANGELES - -BUILDING AND SAFETY o
gsve Certified copy is hereby any
,
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`Certified copy ,s filed with this county building mspec- FOR APPLICANT TO FILL IN BUILDING d
"+ }ton department''• ' +" +� I ADDRESS V
,• 14 4 --;- ,u, tf .-c- _(PRINT OR TYPE ONLY} .. _
j,Data Applicant LOCALITY
,4Lt /� NO TYPE OF APPLIANCE OR EQUIPMENT, ,F FEE2 • {
CERTIFICATE OF EXEMPTION FROM WORKERS ' NEAREST,
} •.' - COMPENSATION INSURANCE T" CROSS ST : +
' ABSORPTION UNIT BTU" `T• '�
.YT (Thu section nsod not be,coinplatad rf the work involved by - olsTRia No . . ,ivo[ s er ,
n ths,par'mn a For one%unErad'dollars ($100)orYlnss )
x1, r ). i - - AIR HANDUNG,UNIT CFM
I certify Ihal in thepperformance of the'work for which this 5r Or/
' permit,is issueda I sholl'Rot employ any person'm any manner �- t 1 '
' so as'to become sublBCf t6.the'Workers Compensation Laws (BOILER BTU -- " 4 - APPROVALS ' DATE INSPE ORS SIGNATURE ^�r
�r�3 9+O r L' f 'COMPRESSOR BTU �� ��� ROUGH r e
—App co(
•t •� 1
" /NOTICE TO APPLICANT If 'a er making this Certificate of VENTILATION SYSTEM FINAL
Exemption,,you should'become "sublect9fo the Worker"s
* Compensation provisions•of the Labor Code, you�must forth- V LIDATION '
EVAPORATIVE COOLER
, ,,;with comply with such provisions or this permit shall be deem " + *-- - ''"i -`
•B - ed revoked i - ' i FURNACE FAU TY O'
LICENSED CONTRACTORS DECLARATION FLOOR - BTU
v^ I hereby affirm that I ann'licensed under provisions of Chapter 9' ER SUSPENDED UNIT—
HEAT
(commencing with Section 7000)of Dlvision,3 of the Business T - WALL
,t ,and,Professions,Code,andpny license Is,n full force and effect [ . , t • r
License NumLIc Class
L.- ONO. - n 7
�Contra � G"Dat ��` „
IJ
,` r ' 'GC
I amiexempt under.
_ , y Plan check fee
B 8P C for this reason , ,
PERMIT ISSUING FEE $ in,
r+ %_ I'o s's Date ^ .. • TOTAL FEE 0,
OWNER BUILDER DECLARATION • - PLAN CHECK APPLICANT
_ I hereby affirm that 1,6m exempt from the Contractor's License y�
'Law for tFe-following`reoson'(Section 7031 5 Business and +- NAME .i r -5........ -
4 Professors Code) - •c. F. ' _ . - ., AULT
I, as owner of the'property r°or my employees with ADDRESS - 07
t wages as their sole compensation,will do the work and t '
'the structure is not intended or offered for sale (Section •., CITY _ ,r.�. _ TEL NO - - 1 ITOIS v s'
7044 Business and Professions Code)
,N t n _
•Ej I, as owner of the property, am exclusively contracting +-t T - 1 TOTAL y r3Y3 00
with licensed contractors to construct the project (Sec MAIL ' �L1� V
on 7044!Business'ond Professions Code) - ADDRESS 3;
h _ - �C.NE53.00
_ • •CONSTRUCTION LENDING AGENCY,•R' CITY G' " ° TEL NO
I hereby affirm that there is a construction lending agency for
h , the performance of the work for which.this permit Is issued CONTRACTO / -
'(Sec 3097 civ C ) " 4- -f •G- , ' t I • ,r`��(}(�t �y
ADDRESS - ' VtJWr VVV1 ,t-i'.7�•��I741
Lenders Name " '� w Y_ k
civ'- EL' oa J� Jho ' --- y- 1976,- -- AM `7:16
Lander s Address -
r I certify that 1 have read thulapplixatkon and state that the" STATE CENSE NO ' CLASS •G .z
LIC
above mformahon Is'correct I agree to"comply with all County
ordinances,and State laws relating to.building construction, L
and hereby authorize representatives of this County to enter ^ i' (` Yr
upon the above'menboned property for,Inspection purposes =r a- - " + f+_ _ y ;'.-„ - _ti ,�, __ -
r, +-� SEE REVERSE FOR EXPLANATORY LANGUAGE23—
Si gravure of Applicant or Agent 1, Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0209040013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 13613 LT 58 5327 PARMERTON AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803504
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET MCCLINTOCK
8573-006-012 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY
41 VENTILATION FAN 1 00 FAN 15 75
TENANT TOTAL FEES 43 50 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
09/04/02 JK 03/03/03
OWNER TEL NO
OPAL (626) 357-6024-
631E FINAL BY - CODE
� �i��
631 LAUREL LANE
MONROVIA 6E$Ckl7 e
MECHANICAL FOR ADDITION
APPLICANT TEL NO
WEAVER CONSTRUCTIONSPECIAL CONDITIONS
CONTRA -
PNTOR TEL NO GELES CO APPROVALS DUE— tNSF9cT5v_9r6wKrowr_
JOHN PCWEAVER (626) 401-0777- V� Ay
P 0 BOX 15 LIC NO FAU/WALL FURNACE
5940 N OAK AVE # 15 HIC
TEMPLE CITY CA 91780 / OPENIWffr
ARCHITECT OR ENGINEER DUCT WORKi
LIC N0,//
L171111
G IULJ LIJC �`J L'/ OO �K3 DAMPERS
` E DETECTION DEVI=
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vb El
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Service That
ADDITIONAL DATA ON FILE
REPORT ID DPR264 ROUTE TO BS0508