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Home My Public Portal About9637 BROADWAY_Mechanical__ WORKER'S hveacertificate COMPENSATION DECLARATION 76A364 DPW 9/89 APPLICATION FOR PERMIT LIME GREEN 0,0046 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy therd'af(Sec. 3800 Lab. C.) •�-- 'Policy No•I0 I,/v 0 Company C '-�lP f" COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. �❑ Certified copy is hereby furnished. CJ Certified copy is filed with the count building inspection FOR APPLICANT TO FILL IN BUILDING cI Y 9 P ADDRESS { Y ✓ LY tlepatlment�l ''C (PRINT OR TYPE ONLY) Date Q S /1e I Applicant �` -E7�r�� NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY 'r CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. rtJ Lf( L L�t e✓/ COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR ✓ �f,, (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL d/V permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to BOILER,BTU / become subject to the Workers' Compensation Laws. ✓h Q� COMPRESSOR,BTU APPROVPLS DATE INSPECTOR'S SIONATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER Provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE FAUGRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDA ION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT_ ` (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. /O -License NumbervJ Lia Glassf, } Contractor U 171' L�/-, /it Date , ^y , V ❑ I am exempt under Sec. Plan check fee 's rIt O BAP.C.for this reason PERMIT ISSUING FEE$ b .o ='!i_ _ •r'.'t! U Date: TOTAL FEE Signature 'E( '� a W `1 _ _ Sis nature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT TOTAL 34 Z c: I hereby affirmthat am exempt from the Contractor's License Law NAME , t 'ti�!` 74 for the following reason (Section 7031.5, Business and Professions AN ( ilk Code): ADDRESS j.(�ANGE at.._ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. _ _ structure is not intended or offered for sale (Section 7044, _F!00-11{Ml.'J j Business and PrOfeSaIODS Code). WNER 51 —y / `1 I. +^_-, i wff 1�icy ❑ I, as owner of the property, am exclusively contracting MAIL ✓T Tr •y-v 1 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ��- CONSTRUCTION LENDING AGENCY CITY / TEL.NO. CONTRACTOR I hereby affirm that there is a construction lending agency for Y the performance of the work for which this permit IS issued (Sec.3097, Civ. C.). �A ADDRESS -2-3, 6 7i fl.l rT L�Fe.�D �✓c� Lender's Name CITY / `e TEL. Lender's Address - STATE 7 Vf LIC. - I certify that I have read this application and state that the above LICENSE NO. tl 3 CLASS 17 information is correct. I agree to comply with all County ordinances _ and State laws relating to building construction,and hereby authorize representatives this Cy t r up above-mentioned I id r pcti p po SEE REVERSE FOR EXPLANATORY LANGUAGE rop �-' pe • SIGNATURE OF APPLICANT OR AGENT DATE WORKERS'COMPENSATION DECLARATION 76A364C I hereby affirm that 1 have a certificate of consent to self CE-818 (2-80). APPLICATION FOR (PERMIT insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800,Lab.C.) Puis`y No. Company.)T4_f/ i!1�� Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspection BUILDING de artment a FOR APPLICANT TO FILL IN ,� ate .-� e-, Applican '��"✓"'�� (PRINT OR TYPE ONLY) ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY i�rl- �t z COMPENSATION INSURANCE NEAREST > CROSS ST. t� a (This section need not be completed if the work involved ABSORPTION UNIT, BTU v" ( O by the permit is for one hundred dollars (SI00) or less.) p ® DISTRICT NO. PROCESSED 8Y L) I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM--6.4c It permit is issued. I shall not employ any person in any manner �//p (�/fiL' C-�C/ 0 I so as to become subject to the Workers' Compensation Laws. BOILER, BTU ry APPROVALS DATE INSPECTORS SIGNATURE W 1 Date Applicant l COMPRESSOR,BTU±t QC 0— ROUGH y NOTICE TO APPLICANT: If, after making this Certificate of � - Z VENTILATION SYSTEM FINAL Qy� Exemption, you should become subject . the Workers- =t_Y Compensation n provisions of the Labor Code, you must forth- l with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU—GRAVITY_ LICENSED CONTRACTORS DECLARATION FLOOR: BTU - I hereby affirm that I am licensed under.provisions of Chapter KEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi- WALL T`I -- -;c ness and Professions Code, and my license is in full force and { zffect. /'X-6-8 /(� r _.1'_� �0=' �9 .�. iff=rir - License Numbel��!�J8� Lie.Classes f-�� Date —`irk Contractor_� rw t= - H CK 1 am exempt from the licensing requirements as I am a I ..I�_ licensed architect or a registered professional engineer Plan Check fee 25%of above. 41-�Rf,13t ,IJIJ acting in my professional capacity (Section 7051, Bus. iness and Professions Code). PERMIT ISSUING FEE $ Lie.or Reg.No. Date TOTAL FEES s_I,i�tt l-,_Ifljf) {{ 4 t^z'fln HOMEOWNER-BUILDER DECLARATION PLAN CHECK APPLICANTYllj I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code); ADDRESS 1, as owner of the property, will do the work and the CITY TEL. NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). - OWNER // I, as owner of the property, am exclusively contracting �1�=�� r with licensed contractors to construct the project MAIL /7 - (Section 7044, Business and Professions Code). _ ADDRESS ` TEL NOI/Z.� CONSTRUCTION LENDING AGENCY CITY I hcrebv affirm that there is a construction lending agency r� '• �/ for the performance of the work for which this permit is CONTRACTOR issued (See.3097,Civ.C.). Lender's Name ADDRESS Lender's Address C IT V TEL.NO I certify that I have read this application and state that the STATEluP�:,r lr� LIC. n above information is correct.I agree to comply with all County LICENSE NO!f / ✓ CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon he above-mentioned property for inspect' u noses. C 7 ✓ Signature of"Permittee Dare COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0606010014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 9637 BROADWAY - FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803211' ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-009-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C 32 APPL VENT (OTHER) 1.00 UNI 12.90 TENANT: TOTAL FEES 40.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 06/01/06 JK 11/28/06 OWNER: TEL. N0: FI!]pL PATE PINAL BY: CODE: NDA BAA;MONICA M (6261 285-0180- 9 9637 BROADWAY Y TEMP 937803211 DESCRIPTION OF WORK KITCHEN REMODELING HOOD VENT APPLICANT: TEL. NO: MORAD (018) 519-7706- 12340 MAGNOLIA BL. SPECIAL CONDITIONS: VALLEY VILLAGE 91607 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HIGH STAR CONSTRUCTION (BOB) 272-6868- 18375 VENTURA BLVD. #206 LIC. NO FAU/WALL FURNACE TARZANA, CA 91356 - 877520 B COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY $ 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0707100006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 9637 BROADWAY IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TIME CA 917803211 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 18588-009-020 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl 102 COMPRSR 1 100 KBTU 1.00 COM 27.00 1 1 TENANT: 108 FURNACE/HEATER 1100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 130 AIR INLETS/OUTLETS; 8.00 UNI 34.80 107/10/07 SR 01/06/08 I I TOTAL FEES 116.55 IOWNER: TEL. NO: (FINAL D BY: CODE: 19637 BROADWAY A;MONICA M XPI R� 9637 BROADWAY (TEMP 917803211 IDESCRIPTION OF WORK IA/C UNIT, FURNACE & (8) AIR DUCTS APPLICANT: TEL. NO: ARGO CONT. SERV. (626) 581-4577- 11915 EDMORE AVE (SPECIAL CONDITIONS: IROW HIS, CA 91748 CONTRACTOR: TEL. NO: ' APPROVALS DATE INSPECTOR SIGNATURE ARG0 CONTRACTOR (626) 581-4577- - 11915 EDMORE AVE LIC. NO FAU/WALL FURNACE ROWLAND HEIGHTS CA 632879 C20 + COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: IDUCT'WORK _ I I I LIC. NO: IAC/COMPRESSOR THERMOSTAT (FIRE DAMPERS 1A t� 11` [SMOKE DETECTION DEVICES I COMMERCIAL HOOD I i I I 11 I I I I I I I 1 I I I I I I I I I I I I I I I I * ADDITIONAL DATA ON FILE I I I I I REPORT ID: DPR264 ROUTE TO: BS050B I I I I I I