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Home My Public Portal About6408 TEMPLE CITY BLVD_Mechanical__ WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT ti hereby affirm that I Mve a certificate of consent to self insure, or a certificate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING or a certified cop thereof (Sec 3800 C ) 76A364C I X7;03 I 'L mCE BIB(REV 10/81) Pal cy Copany Certified copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department (PRINT OR TYPE ONLY) ADDRESS `� O Date Applicant LOCALI.Y NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTI ICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS ST (Tills sMfon nand not be completed If the work Inwhad by ABSORPTION UNIT BTU DISTRICT NO PROCESSED By the permit Is for one hundred dollars($100)or loss) AIR HANDLING UNIT CFM O 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 become subject to the Workers Compensation Laws BOILER BTU APPROVALS DATE InSYECTOR S SIGN TORE Date APPlicant COMPRESSOR BTU ROUGH NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL _ Exemption you should become subject to the Workers Compensation provisions of the Labor Code, you must forth EVAPORATIVE COOLER VALIDATI with comply with such provisions or this permit shall be deemed revoked FURNACE FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED—UNIT— (commencing USPENDED UNIT_ (commencing with Section 7000) of Division 3 of the Business WALL Y and Professions Code and my license a in full force and/effect `/, d do License Num / / 27 41 Lm Classes V , V 09 Contractor Date //// 0 ❑ 1 am exempt under Sec / Plan check foe H B 8P C for this reason PERMIT ISSUING FEE $ = Date TOTAL FEE ow Signature s OWNER BUILDER DECLARATION RAN CHECK APPLICANT f 5 01.3 A I hereby affirm that I am exempt from the Contractor's License , # • • • • • 8 Low for the following reason (Section 7031 5 Business and NAME Professions Code) I • • 2n50 ❑ I as owner of the property or my employees with 'ARES n wages as their sale compensation will do the work and CITY TEL NO 3 • • • 2 0 5 0 255 the structure is not intended or offered for sole(Section 7044 Business and Professions Code) OWNER 0711 -86 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec MAIL tion 7044 Business and Professions Code) ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL NO I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORS M �A. , (Sec 3097 Civ c , q36 &o ADDRESS Lender s Name Lender s Address Cm 4k_ TEL NO 7V3/ _ STATE /� LIC Q I certify that I have read this application and state that the LICENSE NO 7 f22 sP CLASS 461 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 n e a ave me nail prop for nspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote COUNTY OF LOS ANGELES TEMPLE CITY A 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0303100006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID' FEES PAID BUILDING ADDRESS ON FILE 6408 TEMPLE CITY BL FEE DESCRIPTION- QUANTITY UON AMOUNT TEMP CA 917801434 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LONGDEN 5383-014-001 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE 596 GRID J1 LOCALITY TEMPLE CITY 02 COMPRSR < 100 KSTU 1 00 COM 27 00 TENANT 08 FURKACE/HEATER <100 1 00 UNI 27.00 issup ON PROCESSED BY PLAN BY. ExPIRES ON 30 AIR INLETS/OUTLETS 9 00 UNI 39 15 03/10/03 JK D9/06/03 OWNER TOTAL FEES 120 90 FINAL DATE FINAL BY CODE HMS KEN Q� 6408 TEMPLE CITY BL TEMP 917801434 6E5TMION Of WORK INSTALL NEW HVAC SYSTEM APPLICANT GENERAL TRADE CONSTRUCTION (626) 798-8950- 686 S ARROYO PKWYCIS SPECIAL CONDITIONS PASADENA 91105CONTRACTOR- - GENERAL TRADE CONSTRUCTION (626) 798-8950• r - 686 S ARROYO PKWY /15 LIC NO PASADENA CA 91105 539968 B ARCHITECT OR ENGINEER TEL goFAU[WALL FURNACE COMBUSTION AIR OPENiffdr /tib DUCT WORKA LIC NO/ THERMOSTATFIRE DAMPERS SMOKE DETECTION DEVInT COMMERCIAL HOW REPORT ID' DPR264 ROUTE TO BS0508