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HomeMy Public PortalAbout6220 PRIMROSE AVE_Mechanical__ COUNTY OF'LOS ANGLES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1201310025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID 1 BIIILDING ADDRESS: I ITR: 17179 LT: 55 I I 6220 PRIMROSE AV I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:( TEMP CA 917801614 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GARIBALDI 15385-012-020 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl 1 141 VENTILATION FAN 1.00 FAN 15.80 I I (TENANT: I TOTAL FEES 43.60 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 01/31/12 SR 1 (OWNER: TEL. NO: I (FINAL E FINAL BY: CO E: I ISMITH, BERNARD (626) 890-6053- I I �- I 16220 PRIMROSE AVE I - ITEMPLE CITY CA 91780 I ID?SCI O OF WORK I I I (VENT CATION FAN FOR BATHROOM REMODEL (APPLICANT: TEL. NO: I I I ISAME AS OWNER I (SPECIAL CONDITIONS: I I I (CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I LIC. NO I IFAU/WALL FURNACE I I I I (COMBUSTION AIR OPENINGS (ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK _ I I I LIC. NO: I 1AC/COMPRESSOR I I I I ITHERMOSTAT I I I (FIRE DAMPERS I 1 I (SMOKE DETECTION DEVICES I I I ICOMMERCIAL HOOD I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 I I I I I I I I I I WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT • I he�eb'tr'affit:n that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING of a certified copy-thereof(Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING / tion department. (PRINT OR TYPE ONLY) ADDRESS 102-20 Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. y� (This section need not be completed If the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESS the permit is for one hundred dollars(;800)or less.) AIR HANDLING UNIT,CFM Is, �V I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner BOILERBTU PE so as to become subject to the Workers' Compensation Laws. APPROVALS DATE IN 6R'S SIGNATURE Date /'Ore Applicant ' COMPRESSOR,BTU O�0 `O OD ROUGH - NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL e 44 Z {� Exemption, you should become subject to the Workers' -' y / Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. r FURNACE: FAU Y, _ VITY LICENSED CONTRACTORS DECLARATION / FLOOR BTU OD 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 WALL and Professions Code,and my license is in full force and effect. O License Number Lic. Class , t) Contractor Date ❑ I am exempt under Sec. Plan check fee B.BP.C. for this reason4 3 41 A PERMIT ISSUING FEE$ ® Q Date: b # ° 00008 Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I ° ° 30:5 0 I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME ° ° ° 3 Q 5 0 c=� Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS c 4 0 l —86 wages as their sole compensation,will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section 7044, Business and Professions Code.). OWNER �'r�i �0(, IN I, as owner of the property, am exclusively contracting MAIL n �, �/� /� with licensed contractors to construct the project (Sec- ADDRESS 220 �� rw �U tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY 5'M,J0&,G; evrti TEL. NO.%8" I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR ©W J_)�r� (Sec. 3097, Civ. C.). 0 I me. ADDRESS Lender's Name �,�(J CITY TEL. NO. Lender's Address STATE LIC. I certify that I have read this application and state that the LICENSE NO. CLASS above 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 upo�thb -mens' el r erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date