HomeMy Public PortalAbout5333 PARMERTON AVE_Mechanical__ WORKERS' COMPENSATION DECLARATION
I hereby Sffirm that I have a certificate of consent to ,elf APPLICATION FOR PERMIT -
I Ware-'Yr a certificate of Workers Compensation Insurance HEATING VENTILATING - AIR CONDITIONING
or a certified copy thereof (Sec 3800, Lab C ) • 76A364C - ' t
` -r C. _ - 20 0046 DPW 9;88-,,o '
Policy No Compony -
❑ - - - • - v
Certified copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
r „Certified copy is filed9with the count`y'building inspec FOR APPLICANT TO FILL IN BUILDING z 2
FT'
,•tion department (PRINT OR TYPE ONLY) ADDRESS -5✓ 30
r Dote Applicant LOCALITY
NO TYPE OF APPLIANCE'OR EQUIPMENT, , FEE
IFI
.n `CERTCATE OF EXEMPTION,FROM WORKERSNEAREST
'COMPENSATION INSURANCEl _ CROSS ST
1, (This sedlon need not be completed If the work Involved by ABSORPTION UNIT BTU DISTRICT NO PROQ BY
- the permit Is for one hundred dollars ($100) or Iws ) f�/`
I certify that in the performance of the work forrwfnch this iAIR HANDLING UNIT CFM
1 V✓7
permit is Is Issued, 1 shall not employ any person in any manner
` so as to becomkers bEC
e subject to the Worompensoon Laws BOILER BTU-' APPROVALS DATE INSPECTOR S SIGNATURE
1
• to_ �J-"-Appllca o r n COMPRESSOR BTU d DO ROUGH - f r -�
NOTICE TO APPLICANT If after' making this Certificate of VENTILATION SYSTEM FINAL
_ Exemption you should become subject to the Workers -
Compensotion+provisions of.lhe Labor Code, you must forth-I, EVAPORATIVE COOLER , a ` ' V LIDATION q '
' • with comply with such provisions or this permit shall be deem- , ,
" 1•ed revoked'#" t > ' FURNACE FAU (J
iy f
A's ...0 t LICENSED CONTRACTORS`DECLARATION - / FLOOR
' -I hereby affirm that I am licensed under provisions,of Chapter 9 : HEATER_ SUSPENDED UNIT—
Tu- (commencing with Section 7000)of Division 3 of the Business WALL '
and Professions Code and my license is in full force and effect _ r a
LicenW,se Numb Ic Cl 'sS� ,I- ' O
•fir n - / /rr
• Contract' VotoC �L _
y ❑ O
I am'.,em undo;Sec •' ~
4 Plan check fee v
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" - B`8P C for this reason ' - .CIL
2
Data , PERMIT ISSUING FEE $
e TOTAL FEE 3'
Signature '
r " OWNER BUILDER DECLARATION PLAN CHECK APPLICANT L '
I hereby affirm that I am exempt from the Contractor s License ,
Low for the following reason (Section 7031 5, Business and - NAME
Professions Code) r t , 1 r a Av!` -
^'- A. Ak ADDRESS-` t r _. ACCt
T 1, as owner of the property or my employees with _ r 'T
❑
• wages as their sole compensation will do the work and CITY- •- - - - TEL NO - - . 3307 • 33.(0
Y+ the structure is not intended or off ered,for sole (Section �'
7044 Business and Professions Code) OWNER _ _ 1 ITEM '
❑ ,I, osrowner of the property am exclusively contracting - • , - �-:
with licensed contractors to construct the project (Sec MAIL - _ - .TOTAL _•, P _ 00
. tion 7044, Business and Professions Code), r ADDRE _ . .. _ �. .. CHECK - 53.G
CONSTRUCTION LENDING AGENCY ' T i
CITU TEL' NO
hereby affirm that there is a construction lending agency for pop-
ADDRESS
ithe performance of the work for which this permit is issued CONTRACTOR G
P (Sec 3097, Cit C ) -
ADDRESS v,�^ f Ie
-
.13000-0001 . 4 7/23/°0
Lender s Name
• CIN L NO �'�� '_
Lender s Address 1977 --�i AM i7e 1.
I certify that I have read this a hcation and state that the STATE' / LIC` - - -` -- -- '
fY PP LICENSE t� [ CLASS G ZO - Y
above information is correct I agree to comply with all County _ _ --
ordinances and State jaws relating to building construction r••- •> - P_ "
and,hereby authorize representatives of this County to enter
upn a above-menboned'property f�or'7inspec/tiJon7purposel` SEE REVERSE FOR EXPLANATORY LANGUAGE - C •~• J w -
SlgnaNre of ppl¢ant or Agent Date ' it
COUNTY OF LOS ANGELES TEMPLE CITY 1 0508 MBCRANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0612040003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626( 285-0488 EXT
LEGAL ID - - FEES PAID BUILDING ADDRESS
TR 13613 LT 59 5333 PARMERTON AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803504
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET DASHES
8573-005-020 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3 LOCALITY 'TEBPLE CITY, C
30 AIR INLETS/OUTLETS 2 00 UNI 8 70
TENANT 47 ALTER EXIST DUCT SYS 1 00 SYS 27 00 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TOTAL FEES 63 45 12/04/06 SR 06/02/07
OWNER TEL NO FINAL DATE AL By CODE
MCCLEMAH MARE I818) 566-8966-
S333 PARMERT
TLTiPLB CITY CA CA 917 91780 DESCRIPTION OF WORN
ALTERATION OF EXIST DUCT 9YSTSM
APPLICANT TEL NO
SENA (818( 754-6155-
6260 LAUREL CYN SPECIAL CONDITIONS
N HOLLYWOOD CA 91606
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
ALFREDO MACCIONI CONSTRUCTION (818) 566-8966-
1121 N GRIFFITH PARR DR LIC NO ' �- FAU WALL FURNACE I-
BURBANE, CA 91506 676843 B
1 COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER TEL NO DUCT MORN
LIC NO AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL ROOD
REPORT ID DPR264 ROUTE TO BSOSOB