Loading...
HomeMy Public PortalAbout9019 CALLITA ST_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C APPLICATION '� q �'Opl I�Op PERMIT CE-818 (2 80) A Ir Ir L A I V r R Ir E Ifs IVY 1 �. 1 hereby affirm that 1 have d Certificate of consent to self , insure;'or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING u certified copy thereof(Sec. 3800, 1 ab.C..) Policy No ozC,l_G/_YCom pony_✓—�/7E�7�'.'yI7/ - ❑ Certified copy is hereby' furnished., COUN Y OF '_�' ANC /GE BUILDING AND SAFETY Et?"Certified copy is filed with the county building inspection BUI',.. JG -+ n dvnart-e^ FOR APPLICANT TO FILL ,P' qD Ess O/f� L ' Date~L` 0Applicant_r4/�f Zkc-- (PRINT OR TYPE.ONLY) �'�'•,'� GELE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ,�y°�'�,(/�J��yly�i����.r /�(� COMPENSATION INSURANCE - NEARESN p�w_ /p •F / r %K.JT (This section need n0[ be completed if the Work involved ABSORPTION UNIT, BTU CROSS ST O_ by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROF .;ED" r OU I certify that in the performance of the work for which this Al R HANDLING UNIT,CFM ©� L cc permit is issued. 1 shall not employ any person in any manner Z�Jr-V so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INo—CTOWSS'm 'ARE W Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM r2VV Z Exemption, you should become subject to the Workers' FINAL 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:✓U_ 1V ITY LICENSED CONTRACTORS DECLARATION FLOOR: BTUD -/� I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT - - (/"-CF�•'w', r -_ - 9 (commencing with Section 7000) of Division 3 of the Busi- WALL , ness and Professions Code, and my license is in full force and ' effect* pG7 License Numher47/_a—// Lie.Class V r B� Con[racturl--G( ! i Date_�zf ❑ I am exempt from the licensing requirements as I 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 Lie.or Reg.No. Date TOTAL FEE /, HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT J I hereby affirm that I am exempt from the Contractor's NAME / JG�t�.�/ License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS 2X V2 45!/7,4 ' ❑ 1, as owner of the property, will do the work and the CITY ��� . i/•� TEL. NO�71J7yy1. structure is not intended or offered for sale Section 7044. Business and Professions Code). ❑ 1, as owner of theOWNER - property, am exclusively contracting with licensed contractors to construct, the project MAIL (Section 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL.NO. ;2'18.74 A I hereby affirm that there is a construction lending agency / l for the performance of the work for which this permit is CONTRACTOR f�' �y ` . # -'-1-'° (l ) � issued (Sec. 3097.Civ.C.). ` Lender's Name ADDRESS #�e e4•e (I ) o� l3iL/I B '.N Lender's Address CITU /�.'/'�' `' 'TEL.NO.'y�j/���y j 2 e o 1 7,00 I certif-v that 1 have read this application and state that the STATE y O��1"5/f'i LIC. z above information is correct. 1 agree to comply with all County LICENSE NO. .2/ CLASs °j°'° 1 ;7,O O o ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby Au" mime ry sentatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE 0 8 2'5j—8 O Countv to en•-r anon the ...over.? '.uned property for insper•Rn r0" Sip•,r.re of ermittee Date O 7 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT _ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0207110017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GA D BUILDING TR: 12522 LT: 3 9019 CALLITA ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917752005 ASSESSORINFORMATION NEAREST CROSS STREET: ROSEMEAD 5382-011-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY 30 AIR INLETS/OUTLETS 1.00 UNI 4.35 TOTAL FEES 32.10 ISSUED ON: PROCESSED B PLAN Y: EXPIRES 0 : 07/16/02 JK 01/12/03 OWNER: TEL. NO: FINAL DATE, FINAL BY: CODE: GAO' XIO 901' CALL ITANST (626) 336-8592- /i2 2- SGAS 917752005 DESCR[PfION OF WORK - EXTEND HVAC SYSTEM TO SERVE ADDITON APPLICANT: . SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. O: APPROVALS DATE -INSPECTORS GNATURE SAME AS OWNER - LIC. NO FAU/WALL FURItACE COMBUSTION AIR OPENINGS ARCHITECT 0 EL. . DUCT WORK LIC. NO: AC/COMPRESSOR 1 THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES ( Oo( COMMERCIAL HOOD J'REPORT ID: DPR264 ROUTE TO: OS0508