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HomeMy Public PortalAbout5356 PARMERTON AVE_Mechanical__ WORKERS COhIPENSAfIONDCE ate ECLARATION 76A364C(Z 80) APPLICATION FOR PERMIT I-hereby affirm that I live a certlfioate of consent to self b ' su , or - a•trilcateot Workers'Compensation lnsurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec 3800 Lib C) Policy No Company r I � Certified eopv u heretmy furnished ' COUNTY OF LOS ANGELES BUILDING AND SAFETY derartm copy 6 sled with the county building Inapcctlon FOR APPLICANT TO FI LL IN BUILDING 77-- �Jrpartment Datr Applicant � IPRINT.OR TYPE ONLY) ADDRESSNO TYPE OF APPLIANCE OR EQUIPMENT T FEE LOCALITY CkRTICICAT�OC EXEhfPTIOh CROhf WORKERS' r COMPENSATIQN INSURA14U . NEAREST MIS Section Deed not be completed mf the workytDVOlved ABSORPTION UNIT BTU CROs ST CL by the permit is for one hundred dollars ($J 00 o4 less) DISTRICT NDV ' 10CE89EDa O I certify that m the pl.rformance of file work fpr which this - AIR HANDLING UNIT CFM J �" permit is ms ued, I shall not employ any person in any manner t v 0 w us to become tub)ect to the Workers Comoensation Laws BOILER BTU - 7� n/' �� � ,/�yp(� .APPROVALS DATE 'IN9PE TOR 991G iATUBE 1, Dete%�`/'�.� Applmcanl�/Z!GLfy�gJl% ZI4L��� COMPRESSOR BTU_� �'r' Ja ROUGH` ` I d mNOTICE TO APP!ICANT If,after making lhu CertifiAle of VENTILATION SYSTEM FINAL 1 _ I Z ramptn, you Sh$uld becomm e b)ect to the Workers lC'ompensatum provisions bf thli Labor Code you must forth I EVAPORATIVE COOLER VALID TION Doth comply with suLh provmslons or this permit shall�be v R pt2 deemed retoked ^ . FURNACE FAU_v GRAVITY UrL• ,?a LICENSI U -ONTRAMRS DECLARATION FLOOR BTU_ (TOf 04C-- O - 1 hereby affirm that Cam Ilcenso0 under provisions of Chapter HEATER SUSPENDED UNIT _ 4 (rvmmencjng with Section 7000)of DmvismA 3 of the,Bwl WALL 3159`8 A ne.s and Professons Code, and my license ma m full fdree end ' effect �/ - '#'o ^� 8 LmcLnse Numbe�r/A�z3��--j� 6�"nsmg 1 ,'lass&�U • _ ContractoR44_ �-.�p" _�17-ice— 'I • • Q 5 Q PI pm exempt from thtequlrements as I am a '• • • Q 5 Q licensed architect or` a'registered professional engineer Plan Check fee 25%of above acting in my professonal capacity (Section 7051- Bus # 2 2,']T 8 5 mess and Profession§Code) PERMIT ISSUING FEE $ /O•5,0 Lie or Reg Nh Date TOTAL FEE ROME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT- ' I hetoby affirm Uiat tram exam),( from the Contractors-! NAME /n{ License tn Law for the fu)low ; reason (Section 7031 5, Bus, •-'—r-•=r / nese and Professions Coda) - gDDRESS'9' 7 I as owner of[he property, will do the work( und the^ CITY /�(/DUS TEL NO structure is not intended or offered for sale Sccon 7044 Business and Professions Code) ' ' - ' OWNER©.fin p/>a s I, as ownrr of rile property, am exclusively contracting �% "Ib licensed contrxerors to construct the project MAIL �^ - (Seetion 7044,8"ouiss and Professions Code) ADORES ,j rt m e >'/O, "a r CONSTRUCTION LENDING AGLNCY CITY teOs1a 1T C[ T TEL NO 1 hereby affirm that there u e kforuet ion )ending agency / far the performance til the work far which-thins permn is CONTRACTOR ,a<uedK Ser Cry C) l7�.3 Landers Name ADDRESS - Lender'sAddresf CITU �A/DV f 9/y TEL NO r�•G,,s'�1j-/,i., - 1 scrim Cy that I have read this apphchnoiG and smote that the STATE �1 lO�jY-6 LIC �r above mformafmpn ms correct 1 agree to comply with all County L-CENSE NO /'s! CLASS l.i�� L brdmances and tmatL laws regulatmg;9eatmg Ventilating and Air Conditioning and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Count% to enlar updn�bova mentioned property for , ^.cl ��ZZZJ rT[ee Date�a Signature of Permw � � _ � 1 COUNTY OF LOS ANGELES TEMPLE CITY _ N 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ! ME 0508 0703190020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 265-0488 EXT ' LEGAL ID FEES PAID t BUILDING ADDRESS TR 13613 LT 82 5356 PARMERTON AV (FEE DESCRIPTION QUANTITY 00M AMOUNT TIME CA 917803503 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 8573-007-010 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY C 02 COMPRSR < 100 KBTU 1 00 COM 27 00 ITENANT TOTAL FEES 54 75 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 03/19/07 JK 09/15/07 OWNER TEL NO FINAL,DATE ^/ FIF CODE IORTEGA RALPH JR LILIA M (626) 442-6599- 3 I "Z��iX 1 15356 PARMERTON AV /1 ITEMP 917803503 DESCRIPTION WORK COND1LNSER REPLACEMENT (APPLICANT TEL NO I1 (CONFIDENCE COMFORT INC (626) 301-0590- 900 SO PRIMROSE AVE 1SPECIAL CONDITIONS MONROVIA, CA 91016 CONTRACTOR TEL NO I �� ] , r� IAPPROVALS DATE INSPECTOR SIGNATURE CONFIDENCE COMFORT INC (626) 301-0590-, 1 800 SO PRIMROSE LIC NO 1 FAU/WALL FURNACE I 1 1 MONROVIA CA 91016 772154 C20 I 'r 1 iCOMBUSTION AIR OPENINGS (ARCHITECT OR ENGINEER TEL NO > ♦ 1DUC1 WORK LIC NO AC COMPRESSOR ( �' THERMOSTAT 1 311, ' I FIRE DAMPERS SMOKE_DEPECPION DEVICES 1 ImMMeacrnr. Hoop I I I I I I I I I I I I I I I I I I I I 1 I I REPORT ID DPR264 ROUTE TO BS0508 1 i t