HomeMy Public PortalAbout6346 TEMPLE CITY BLVD_Mechanical__ Wl Jbat I hveacertificate
COMPENSATION Df consAnoN 2000416 DPW 2/89 APPLICATION FOR PERMIT LIME GREEN
I hereby aNlrm Chet I have a cartlllcate of consent to Bell Insure
ar a gertificate of Worker a Compensation Insurance or a certified ,I HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec 3500 Lab C)
Policy No PC946069 Company RRPrTRT.TC TNDF- NI'6UNTY OF LOS ANGELES- DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
❑ Certiff d copy Ia hereby furnished
IN Cenmed copy le hied wren the coun building l FOR APPLICANT TO FILL IN ADDRESS
6346 N. TEMPLE CITY BLVD.
I (PRIM OR TYPE ONLY)
� LOCALITYDate�7! / �
, NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
CROSS ST
COMPENSATION INSURANCE ABSORPTION UNIT BTU ASSESSOR
(This section need not be camplated If the wort Involved by the MAP BOOK PAGE PARCEL
,permit Is for one hundred dollars(11100)or Mse) AIR HANDLING UNIT.CFM
oismcr w momem er
1 cenly, that in the performance of the work for which this permit
Is Issued I shell not employ any person In any manner so as to BOILER BTU p'
become subject to the Workers Compensation Laws
Dat
't' 1 COMPRESSOR BTU e Applicant W nxvanwua core rKrecroe a BroNxTlllE
VENTILATION SYSTEM
NOTICE TO APPLICANT If altar making this Certificate of ROUGH -
Exemption you should become subject to the Workers Compensation EVAPORATWE COOLER
provisions of the Labor Code you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked FURNACE FAU
LICENSED CONTRACTORS DECLARATION 1 FLOOR ens - 23. 75 VALIDATION
I hereby affirm that I em licensed under provisions of Chapter 5 SUSPENDED UNIT_
(commencing with Section 70D0) of Division 3 of the Business and HEATER WALL
Professions Code and my Ilcenae is in full force and effect
License Number 468609 Lic Dyes C20
Con Date 7/30/92 V
❑ Plan check fee
I sin exempt under Sec
B aP C for this reason PERMIT ISSUING FEES 2 4 7 5 0
Date TOTAL FEE V
Slgneture N/A d
PLAN CHECK APPLICANT in
OWNER BUILDER DECLARATION Z
I hereby affirm that I em exempt from the Contractors License Law NAME , g
for the following reason (Section 7031 5 Business and Professions
Code) ADDRESS w�
❑ I as owner of the property or my employees with wages ACCT.1ra
as their sole compensation will do the work and the CITY TEL NO 3307 r2.2"i
structure Is not Intended or offered for sale (Section 7044
Business and Professions Cade) OWNER JOHN KABLER 1 ITEM
❑ I as owner of the property em exclusively contracting MAIL
with licensed contractors to construct the project (Sec ADDRESS 6346 N. TEMPLE CITY BLVD. TOTAL 72.25
Iron 7044 Business and Professions Code) pry TEMPLE CITY TEL NB18-285-07 9 CHECK 72'25
CONSTRUCTION LENDING AGENCY ryu-r r�l
I hereby affirm that there Is a construction lending a •ncy for 4Twe
the performance of the work for which this permit PB Issued 0014TRACTOR IARVINEWEST HTG. 6 A/C IN
(Sec 3007 Civ C)
Lander a Name
N/A ADDRESS638 SOUTHERN AVE. 0000-0001 8/17/92
O CIT ORANGE TEL NO714-921-08 5050 1 AMIO:7,
Lender a Address
STEI certify that I have reed this application and state that the above LICENSE NO 468609 �C20
Information Is correct I agree to ccmpfy with all County ordinances _ -
and State laws refahng to Wilding construction,and hereby autharin
reRressintatives of this County to enter upon the above mentioned
pro arty for pact n purposes • BEE REVERSE FOR EXPLANATORY LANGUAGE
92
7/30/ -
N TUIIEO APPl1C