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Home My Public Portal About5645 PERSIMMON AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C I hereby affirm that I have a• certificate of consent to self CE-818 (2-80) APPLICATION FOR PERMIT insure,or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800,Lab.C.) f" Policy Company > tznc� COUNTY OF LOS ANGELES I BUILDING AND SAFETY Certified copy is hereby furnished.shed. Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING de artment. DateL2 Applicant ��71j_BA[a�u A I (PRINT OR TYPE ONLY) (ADDRESS Soh O!� CERTIFICATE OF EXEMPTION FROM WORKERS' [TABSORPTION E OF APPLIANCE OR EQUIPMENT FEE 'LOCALITY 7-r� COMPENSATION INSURANCE NEAREST } CROSS ST. ' tl (This section need not be completed if the work involved UNIT, BTU j-I O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED BY U I certify that in the performance of the work for which this IHANDLING UNIT,CFM I cc permit is issued, I shall not employ any person In any manner 0 so as to become subject to the Workers' Compensation Laws. BOILER, BTU ` APPROVALS DATE INSPEC OR'S SIGNA'WE fU Dater" O-- Applicant A.1.6,oits_/�/-c I COMPRESSOR,BTU ROUGH N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, ybu should become subject to the Workers' (FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER with comply with such provisions or this permit shall be i VALIDA deemed revoked. FURNACE: FAU AVITY LICENSED CONTRACTORS DECLARATION ; j FLOOR:-BT ® OD I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 70.00)of Division 3 of the Busi- WALL eness ffect and Professions ttC��ode, and my license is in full force and 1 8 lie f3 /N ret Q License Number,99TZAI Lic.Class Contractor Orge ALV# !U Date F1 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). Lic.or Reg.No. Date TOTAL FEE 4 ' HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS I, as owner of the property, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044,Business and Professions Code).. `= OOWNER I, as owner of the property, am exclusively contracting �- with licensed contractors to construct the project MAI Lr (Section 7044,Business and Professions Code). ADDRESS 0o _-_' 7 n 00 CONSTRUCTION LENDING AGENCY CITYCry TEL.NO. I hereby affirm that there is a construction lending agency , for the performance of the work for which this permit is CONTRACTOR /Z_ _ ;UTAL 00 issued(Sec.3097,Civ.C.). Lender's Name ADDRESS -2�'} 2 rrl 1 t!0J o!_l� Lender's Address CITY tioug + TEL.NO. �? f�� ' I certify that I have read this application and state that the STATE LIC. above information is correct.I agree to comply with all County LICENSE NOZfWC.1J&1 CLASS ordinances and State laws regulating Heating, Ventilating and " Air Conditioning,and hereby authorize representatives of this SEE REVERSE TOR EXPLANATORY LANGUAGE Ku County to enter upon the above-mentioned property for i j.1 i:" i1,7 ANL=L•. iuspectionpu o s. SignatuTel6f Permittee Date I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS I ME 0508 0602160018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ERT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13935 IT: 20 5645 PERSIMMON AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802809 ASSESSOR INFORMATION NUMBER: NHAREST CROSS STREET: 8573-001-018 01 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C 30 AIR INLETS/OUTLETS 12.00 UNI 52.20 TRUANT: TOTAL FEES 79.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 02/16/06 JK 08/15/06 OWNER: TEL. NO: FAL DATCODE: BROUGHTON AMOS W CO TR (626) 447-8112- 5645 PERSIMMON AV TEMP 917802809 DESCRIPTION OF WORK REPLACEMENT ATTIC DUCTING FOR CENTRAL HEATING USE OWERS OLDER FAU OUTLET FANS & BOOTS ARE WRAPPED WITH ASBESTOS APPLICANT: TEL. NO: NO H$RS TEST AAA GRANGER'S A/C CO. (626) 579-3680- 16336 ARROW HWY SPECIAL CONDITIONS: IRWINDALE CA 91706 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE 4600165501015 A, C CO. (562) 694-1710- 16336 ARROW HWY LIC. NO FAU/WALL FURNACE IRWINDALE CA 273569 C20 COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/CO MPRESSOR THERMOSTAT FIRE'DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD I I i REPORT ID: DPR264 ROUTE TO: BSO508 1