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ION
WORKER'S I have
a certificate
of consent to 76A346DPW9189 APPLICATION FOR PERMIT LIME GREEN
76A364C
I hereby affirm that I have a certificate of consent to salt insure,
or a�,yryificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy t 7reof(Sec.3800 Lab.C.)
Nd �. "_*company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
y l Certified copy is hereby furnished. BUILDING /
Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS
department. (PRINT OR TYPE ONLY)
Date ApplicantLOCALITY a v`
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
EFICATE OF EXEMPTION FROM WORKERS' NEAREST
R I
CROS 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($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
Is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,you.must forthwith comply with such FINAL 92
l
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
HEATER:
(commencing with Section 7000)of Division 3 of the Business and WALL ���
Professions Code,and my license is in full force and effect. r
License Number 7 d f 7d Z Lic.Class LC—_)o-3
Contractor Data 6fW _9 ,
❑ I am exempt under ec. Plan check fee
a
BAP.C.for this reason PERMIT ISSUING FEE$ Ufa FC-
I Date TOTAL FEE 0 U.
Signat1! .L a
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I 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 I••i t•�•!o a
I, as owner of the property, or my employees with wages' :.Tj i .-.�
as their sole compensation, will do the work and the CITY TEL.NO. �•r•=0 25.(f.,
structure is not Intended or offered for sale(Section 7044, ^ i I r ti
Business and Professions Code). OWNER
❑ 1, as owner of the property, am exclusively contracting MAIL TOTAL 25 01D
with licensed contractors to construct the project (Sec- ADDRESS Roo 0 HE
tion 7044,Business and Professions Code). CITY TEL.NO.&[
CONSTRUCTION LENDING AGENCY 4 CHP.NGEE Au
Ihereby affirm that there is a construction lending agency for CONTRACTO r ,
the performance of the work for which this permit 1s Issued
(Sec.3097,Civ.C.). �►'
ADDRESS J16 �i' 011300-11-11,301 6 f0/91
Lender's Name T 74.1 3iE Cj o(f.`,I
CITY TEL.NO��,J 7
Lender's Address STATE ^� LIC.
I certify that I have read this application and state that the above- LICENSE NO. /I� CLASS '3
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 in�ec�n purpok�; � SEE REVERSE FOR EXPLANATORY LANGUAGE '
SIO A%7gE APPLICANT RAGE lu1TE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0903230005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
JTR: 5904 LT: 0 BL: .001 5911 RENO AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801529
ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET:
5384-018-026 1101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
108 FURNACE/HEATER <100 1.00 UNI 27.00
TENANT: TOTAL FEES 54.75 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
03/23/09 SR 09/19/09
OWNER: TEL. NO: IFI AL DATE FIN Y. CODE:
IZHANG, XUAN (626) 757-6685-
15911 RENO AV
TEMP 917801529 JDESCRI11TIONNOF WORK
REINSTALL WALL FURNACE
APPLICANT: TEL. NO:
JJ. P. CONSTRUCTION CO. (626) 572-9181-
12714 STINGLE AVE. ISPECIAL CONDITIONS:
IROSEMEAD, CA 91770
CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
1J. P. CONSTRUCTION CO. (626) 572-9181-
12714 STINGLE AVENUE LIC. NO IFAU/WALL FURNACE
IROSEMEAD CA 91007 642751 B
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK
I - I
LIC. NO: I JAC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508