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Home My Public Portal About5120 PERSIMMON AVE_Mechanical__ WORKElA'S COMPENSATION DECLARATION 20-004D'S PW 9189 APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a anrti''°ate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy th&:_kf(Sec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. F1 Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN ADDRESS department. (PRINT OR TYPE ONLY) /-DING I/'r s Date Applicant LOCALITY yh C NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST L CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.✓ COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit ®®-� is issued, I shall not employ any person in any manner so as to I BOILER,BTU become subject to the Workers'Compensation Laws. �� COMPRESSOR,BTU DateW"'? q —Applicant �� ' Lyw� APPROVALS DATE INSPECTOR'S SIGNATURE PP 7� VENTILATION SYSTEM NOTIC TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'CompensationEVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU O VALIDATION LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code, /and my license Is in full force and effect. ^ G� License Number "�" Lie.Class r��y _ Contractok� ��`�/JIB Data C F1I am exempt under Sec. Plan check fee C B.&P.C.for this reason PERMIT ISSUING FEE$a F C Date: TOTAL FEE O C Signature V OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 2 1 hereby affirm that I am exempt from the Contractor's License Law NAME,/' , for the following reason (Section 7031.5, Business and Professions Code): ADDRESS (m a 17 122050 1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale(Section 7044, 1 ITEM ❑ Business and Professions Code). OWNER TnT/tit -tl tli"fl 1, as owner of the property, am exclusively contracting MAIL 4hP5]�,1�C+IIDi 1L rl�'11"��iiJ with licensed contractors to construct the project Sec- nL P j ( ADDRESS, tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL O. /97/ .00 I herebyaffirm that there Is a construction lendingagenc for CONTRALTO I he perormance of the work for which this perit Is issued� I (Sec.3097,Civ.C.). , M —W01 8!21/95 Lender's Name ADDRESS, Cj ^7l ✓, � e,/- 171 1 K11 Cr'�7 CITY �', TEL.N�. �. � ..D Lender's Address �,/� 1 certify that I have read this application and state that the above LICENSE NO. (/ -�f�{ CLASS �";•— {� 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 upon the above-mentioned property for inspection purposes. _ _ SEE REVERSE FOR EXPLANATORY LANGUAGE �.• / �: �- ,SIGNATURE OFAPPLICANT OR AGENT "' MIME • ? COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508.P.008080019 • BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 -- • PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING-ADDRESS: ON FILE 5120 PERSIMMON AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803416 ASSESSOR INFORMATION NU B R: NEAREST CROSS STREET: FREER 8574-004-060 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY 30 AIR INLETS/OUTLETS 14.00 UNI 60.90 TENANT: TOTAL FEES 88.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 08/08/00 UT 02/05/01 OWNER: TEL. NO: FINAL DATE FINAL B CODE: . CHING WINNIE K 5120 PERSIMMON AV TEMP 917803416 DESCRIPTION OF WORK NEW DUCT WORK FOR ADDITION AND EXISTING SQ. FT. APPLICANT: TEL. O: PARUNGAO (562) 634-5634- 13241 BARLINE SPECIAL CONDITIONS: DOWNEY, CA ES CCONTRAO DANILOCR PARUNGAO (562)N634-5634- �Q�J ��Ty APPROVALS DATE INSPECTOR SIGNATURE DBA DRP CONSTRUCTION LIC. NO AU/ ALL FURNACE 13241 BARLIN AVE. 575050 B DOWNEY, CA 90242 ` COMBUSTION AIR OPENINGS RCHITECT OR ENGINEER-w- -T . N0: I UCT WORKI L LIC. NO• L 1111111 AC/COMPRESSOR ER OS AT FIRE DAMPERSGIUD C WOFVR � SMOKE DETECTIONEVIC S COMMERCIAL HOOD ❑ 0 ®f - 46 . El _ o� Service Tha$� REPORT ID: DPR264 ROUTE TO: BS0508