HomeMy Public PortalAbout10424 DAINES DR_Mechanical__ DECLARAT
er • WORKER'S I' COMPENSATION
ate of consent to 76AW6DPW9/89 APPLICATION'FOR PERMIT LIME GREEN
76A364C
I hersby affirm that I have a certificate of consent to self Insure,
or a Sehdicate of Worke/r'sC ensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy the
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P�y No Company` COUNTY OF'LO,S ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy Is hereby furnished
❑ Certified copy Is filed with t e c unty bAngctiont FOR APPLICANT TO FILL IN BUDRE S- department (PRINT OR TYPE ONLY)
Date — ` Applicant LOCALITY
e NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTIO FROM WORKERS' NEAREST
COMPENSATION IN RANCE CROSS ST
ABSORPTION UNIT,BTU ASSESSOR
(Thisisection,need not be completed if the work Involved by the MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less)., AIR HANDLING UNIT,CFM
DISTRICT NO - PROCESSED BY
I certify that In the performance of the'work for which this permit
13„Issued, Iishall not employ any person In any manner so as to BOILER,BTU '
become subject to the Workers' Compensation Laws '0
COMPRESSOR,BTU
' APPROVALS DATE INSP CTOR S SIGNATURE
-Date- Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT If, after making this Certificate of a ROUGH
Exemption,you shoul'dp,become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you_must forthwith comply with such FINAL
,provisions.or this permit shall be deemed revoked FURNACE FAU GRAVITY VALIDATION u
LICENSED CONTRACTORS DECLARATION FLOOR BTU
hereby,affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT
(commencing'with Section 7000) of Division 3 of,the Business and WALL
Professions Code,and my license Is in full force and effect _ 1_
License�u Y ber. L'C Class -
^ A-,{Tea -c a
Contracto Date d _-{ y_,II I 0
" Plan check fee - Y hi
❑ I am xempt under Sec i~t i
B&P C for this reason PERMIT ISSUING FEE$ /3 OO j O
Date E�{trfL 225 00 V
TOTAL FEE,' O8
--HECK �f{=j d
Signature
PLAN CHECK APPLICANT C a{�I Z
"OWNER-BUILDER DECLARATION
LiTNI IsJ�- Z
I hereby affirm that I am exempt from the Contractor's License Law NAME ,-
for the following reason (Section 7031 5, Business and°Professions !
Code) ADDRESS13 I�{—f l {4� }/ D0 9 i
❑, I, as owner of the property, or my employees with wages t,r ci2
as their sole compensation, will do,the work and the CITY TEL NO x!�-1ti' 1 rS 12-j'-
structure Is not Intended or offered for sale (Section 7044, +'
Business and Professions Code) OWNER
❑' 1, as owner of the property, am exclusively contracting MAIL n
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code) r--
r` s
CONSTRUCTION LENDING,AGENCY t CITY TEL NO =
I hereby affirm that there Is a construction lending agency for CONTRACTOR ,
the performance of the work for which this'permit Is Issued -
(Sec 3097, Civ C)
ADDRESV r)
Lender's Name
` CITY TEL NO Q,- 8
Lender'sAddress STATE LIC aJ7 v
6 I certify that I have'read this application and state that the above LICENSE NO CLASS `
Information is correct' 1 agree to comply with all County ordinances
and State laws relati6g to building construction,and hereby authorize `
represe atives of this my to enter upon the above-mentioned
pr ert or-
is
r inspect
n oses SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGN LIF zW APPLICANT OR AGE E
I �
1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0210180009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL TD: S PAID BUILDING ADDRESS:
ON FILE 10424 DAINES DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802811
ASSESSORNEAREST CROSS STREET: HALIFAX
8586-028-014 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
08 FURNACE/HEATER <100 1.00 UNI 27.00EXPIRES
30 AIR INLETS/OUTLETS 10.00 UNI 43.50 10/18/02 JK 04/16/03
TOTAL FEES 125.25
OWNER: TEL. NO: FI AL A FI L BY: CODE:
HYOSOOK;KIM (626) 401-1751- ;�i% 2�z _
10424 DAINES DR
TEMP 917802811I
C/O FU NACE & A/C
APPLICANT: TEL. N
GLOVER (909) 279-0604-
5030 VICEROY AVENUE SPECIAL CONDITIONS:
NORCO 92860 -
CONTR OR: TEL. NO: ���j, �"� kjAPPROVALS D INSPECTORSIGNATURE
GENERAL HEATING ANDA C (626) 358-0022- ��
1310 S. MYRTLE AVE. LIC. NO �� ��� URNACE
MONROVIA, CA. 91016 469166 C20
COMBUSTION AIR OPENING
ARCHITECT0 E R: TEL. /l 0
LIC. N0. ( �� j -- -a AC/ OMPRES OR
1
THERMOSTAT
FIRE DAMPER
J 11111 \1 \ f \ I \ I \\ \
SMOKE DETECT
COMMERCIAL H00
17
REPORT ID: DPR264 ROUTE TO: BS0508