HomeMy Public PortalAbout9421 1/2 BROADWAY_Mechanical__ WORKERS*COMP' ..;;' y-.N DECLARATION CEA64 (2.BG) - APPLICATION FOR • PERRAITSIB -
1 hereby affirm that I have acertificate of consent to self
insure, or a certificate at Workers'Compensation Insurance,of HEATING-VENTILATING-AIRCONDITIONING
•
a certified copy thereof(Sec. 3800,Lab.C.) -
Policy Nc23107900779pany. -Ca. Ca su 1 aty I ndem• - " -
�DBI,o-G
Certified copy is hereby furnished. ' "
COUNTY OF LOS ANGELES BUILDING AND SAFETY
O Certified.copy is filed with the county building inspection - "FOR APPLICANT TOFILL IN - BUILDING - t
department: ADORESS 9421
Date-111—"1.9=82 _C
1.9=82 Applicant_E._L._PAYNEOMPANY (PRINT OR TYPE ONLY) z Broadway
em
• CE RTI F:IQATE OF EXEhiPT[ON FROM WORKERS' NO.• TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY T 1_e_P Cit.y
COMPENSATION INSURANCE NEAREST
CROSS ST. ."Cloverly >
(This section need 'not' be completed if the work involved ABSORPTION UNIT, BTU _ It.
by the permit is .for one,hundred dollars ($100) or less.) - DISTRICT NO, /�) PROCESSED BY O
I certify that in the performance of, the:work for which this AIR HANDLING UNIT,CFM' - O
permit is issued, Lshall not employ any person,in any manner L
'so as to bedtime subject to the Workers' Compensation Laws.. BOILER, BTU 11O
• - APPROVALS DATE INSPECTOR'S.SIGNATURE V
Date ApDl lean[ COMPRESSOR, BTU ROUGH d
NOTICE TO`APPLICANT: If,after making this Certificate of - t N
Exemption,..you should become subject to the Workers' VENTILATION SYSTEM FINAL - `Z 147th1a- Z
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or.this permit shall be EVAPORATIVE COOLER ,.VALIDATION
' deemed revoked. - FURNACE: FAUX— GRAVITY_
LICENSED CONTRACTORS DECLARATION, 1 FLOOR: BTU_75.,000— _
I hereby affirm that 1 am licensed under.provisions of Chapter HEATER: SUSPENDED UNIT
9'(conimencing with Section 7000)of Division 3 of the Busi- WALL -
ness and Professions Code. andmy license is in full force and
effect. -
License Number_1.20228_ Lia Class C-20 -
Contmctor_E.-L.._P.AY.NE_ -Dat._l1_1.9_l32
❑-I am exempt from the licensing requirements as 1 am a '
licensed architect or a registered professional engineer , Plan check fee 25%of above.
acting in my professional capacity (Section 7051. Bus- -
iness and Professions Code).' PERMIT ISSUING FEE $ 50 -
or Reg.No. Date TOTALFEE
L-
Lic. 5t -
HOME OWNER-BUILDER DECLARATION, PLAN CHECK APPLICANT -
I hm�ereby affirm that I aexempt from8 1 T2'A
- the Contractor's - NAME � - � '
c f
License haw for the following reason (Section 7031.5, Busi- ��:e • e eye 8 .
ness and Professions Code): - ADDRESS - - ;`'s t
], as owner of the'proper[y,'will 2
do'the work and the � - �2i-'-,2 3,!5'0
.structure is .not intended or offered-for sale (Section CITY - - TEL. NO. e r .i
-- 7044, Business and Professions Code). - ••(• • 2 3.'50'5
❑ - - OWNER _ .Fal Cetgfl0
1, as owner of the property, am exclusively contracting Mr._and_MC..S . R:. •i•208;=•'82
with licensed contractors to construct the-- project MAIL.
(Section 7044, Business and Professions Code). ADDRESS 9421.Z_B"rOadway
CONSTRUCTION'LENDING AGENCY CITY Temple Cilty TEL.No. 286-9577 "
1 hereby affirm that there is a construction lending agency, L pAYNE COIRP
for the performance of the work for which this permit is CONTRACTOR
issued (Sea.,3097.Civ.C.). - - E'—' ANY
-Lender's Name ADDRESS -9242' Beveri y BIVd. - • -
Lender's Address - CITYTEL.NO.
Beverly Hills 793-113:1
I certify that 1-have read this application and state thut the STATELIC.
-above information iscorrecC.l agree to comply with all.County LICENSE NO. 1.20228 CLASS C-20
ordinances and State laws regulating Healing. Ventilating and -
.Air Conditioning,and hereby.authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
'On'"'
to enter up'- 'he above-mentioned property for
iuspe,aon our se, -
1.1_1.9m82
nature of er tutee Date
:< COUNTY OF LOS ANGELES TEMPLECITY4 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0802130001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
I LEGAL ID: FEES PAID
ON FILE BUILDING ADDRESS:
9421 1/2/2 BROADWAY
(FEE DESCRIPTION: QUANTITY: UDM: AMOUNT: ( TEMP CA 917802446
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: ALESSANDRO
8588-003-019 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
102 COMPRSR, < 100 KBTC 1.00 COM 27.00
TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
130 AIR INLETS/OUTLETS 1.00 UNI 4.35 02/13/08 SR - 08/11/08
141 VENTILATION FAN 1.00 FAN 15.75 I
OWNER: TEL. NO: I TOTAL FEES 101.85 (FINAL D TE FINAL BY: CODE:
POOSANGTONGCHAI NOPPORN;CHEN KATHY - n
19421 1/2 BROADWAY I�-�(J�
TEMP 917802446
. DESCRIPTION OF WORK V
' JINSTALL AIR CONDITIONING AND HEATING SYSTEM
APPLICANT: TEL. NO: -
IYU YAO TANG (626) 456-3816-
5926 TEMPLE CITY EL.
ITEMPLE CITY CA 91780 (SPECIAL CONDITIONS: -I
CONTRACTOR: TEL. NO:
ISO CAL CONSTRUCTION (APPROVALS DATE INSPECTOR SIGNATURE
(626) 712-9823-
P.O. BOX 96 -LIC. NO
ISAN GABRIEL, CA 91778832488 B FAU/WALL FURNACE /
COM3USTION AIR OPENINGS'
ARCHITECT OR ENGINEER: TEL. NO:
_ I IDUCT WORK
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LIC. NO: IAC/COMPRESSOR
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(THERMOSTAT
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IFIRE DAMPERS
SMOKE DETECTION DEVICES
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(COMMERCIAL HOOD I I I
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(REPORT ID: DPR264 ROUTE TO: BS0508
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