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Home My Public Portal About5703 OAK AVE_Mechanical_8/25/2014_COUNTY OF LOS ANGELES 'DEPARTMENT OF PUBLIC WORKS ` BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 IT: 729 ASSESSOR INFORMATION NUMBER 8587-005-002 TENANT OWNER: FULCO NORMAN J;DOROTHY J 5703 OAK AV TEMP 917802431 APPLICANT: PISANO, ROSS 1350 E LAS TUNAS DR SAN GABRIEL CA 91776 CONTRACTOR: BRYANT HEATING AND A, C 1350 E. LAS TUNAS SAN GABRIEL, CA 91776 ARCHITECT OR ENGINEER TEL. NO: TEL. NO: (626) 286 -1141 - TEL. NO: (626) 286-1141- LIO_ NO 948151 TEL. NO: LIC. NO: (REPORT ID: DPR264 ROUTE TO: ES0508 SPECIAL CONDITIONS: -�/[/��II-#�jj'��/�(($$''�j APPROVAj,S CAT� IN R SIGNATURE ALL FURNACE STION AIR OPENINGS WORK THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD TEMPLE CITY # 0508 MECHANICAL PERMIT 9701 LAS TUNAS ME 0508 1408250011 TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID BUILDING ADDRESS: 5703 OAK AV IFEE DESCRIPTION: QUANTITY: UOM: AMO UNT:1 TEMP CA 917802431 I 1 NEAREST CROSS STREET: LIVE OAK 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 102 COMPRSR < 100 KBTU 1.00 COM 27.00 108 FURNACE/HEATER Q00 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: TOTAL FEES 81.80 08/25/14 SR F/(/I7rNNAL D T�/ - FI Y: CODE: l� OFWORK 1 [REPLACE EXISTING HEAT/COOL UNIT ON ROOF (REPORT ID: DPR264 ROUTE TO: ES0508 SPECIAL CONDITIONS: -�/[/��II-#�jj'��/�(($$''�j APPROVAj,S CAT� IN R SIGNATURE ALL FURNACE STION AIR OPENINGS WORK THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code): Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do (J) all of or (_) portions of the work, and the structure is not intended, or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed ContrhFtor pursuant.to the Contractors' State License Law). (_) I am exemlJt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in whicf1 I must have resided for at least one year priori to completion} of the improvements covered by this permit, I Innot legally sell a structure that I have built as an owner -builder If it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of'the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: httD://www.lealnfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class C Zo License No. ! V(? -5 Date ?-Zd�zz%1 z {l Contractor Signatu/.Z"G WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORIN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. Gn'T�00��3� I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My V kem' coynpensation insurance carrier and policy qumber are: f��'tiC/f �/h2� CSTSTooge'3c I-ZL-/5 ierletiyPolicy NumGer_z Expirs Date r.z � 71 - Name o Agent Phone Number 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 of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth 'tth comply with those provisions Signa of re of Applicant Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to cgfagI lherew 'rough the app7pp, `1111/,,/�v �� t s 4� wArgli ant (Print f�(ame)_ iyant Signatq�e��, 0o H7*� l'�i�� /y Company Name Date LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ No ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirem@nis under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to'each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this county to enter the above -identified property for inspection purposes. Signet/urs,-a/f�Pcop ner or Authorized,ElgepV l //_��Gv-w(i Date -%C'-(�1