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Home My Public Portal About10617 DAINES DR_Mechanical__ ' LIME GREEN WORKER'S COMPENSATION DECLARATION 2I1•DD4a DPW 9,a9 APPLICATION FOR PERMIT 2D-OD4 C I hereby affirm that 1 have a certificate of consent to sell insure, of a certificate of Worker's Compensation Insurance, or a certified HEATING•VENTILATING=,'AIR CONDITIONING - copy thereof(Sgc.3800 Lab. C.) Policy No. Company COUNTY OF LOS ANGELES - DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ .Certified copy is hereby furnished / VA 7 ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS oG( � l/ /ule s elk department. (PRINT OR TYPE ONLY) Date Applicant LOCALITY � Q FEE ,`NEAREST .. NO. TYPE OF APPLIANCE OR EQUIPMENT _ /C CERTIFICATE OF EXEMPTION FROM WORKERS' C OSS ST.' T • COMPENSATION INSURANCE - N ABSORPTION UNIT,BTU ASSESSOR „(This section need not be completed If0 the work Involved by the MAP BOOK PAGE PARCEL - permit is for one hundred an era($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work /or m Ich am.r s permit _ is issued;,I shall not employ any person in any manner so as to BOILER,BTU become.subject to the Workers'Compensatio aws. - I COMPRESSOR,BTU Date /� A licanl >PPROVAW^ GATE IN CIIXi'S SIGIUTVRE PP VENTILATION SYSTEM NOTICE TO APPLICANT: If, a1teY'meking this Ceipe o ROUGH ZZ11f Exemption,you should become subject to the Workers'Commps anon 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 o oe VALIDATION There( by 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 Cade,and my license is in full force and,effect. ' - G ask Lice Number 5 9 3 41 Lie.Class CIL Contractor Date , - - V ❑, J Plan check fee am exempt under Sac. Q B.BP.C.for this reason - PERMIT ISSUING FEE $ 2& U Date: TOTAL FEE W a Signature' PLAN CHECK APPLICANT OWNER-BUILDER DECLARATION - Z . I hereby affirm that I am exempt from the Contractor's License Law NAME pop. T`.07 ,;I', for the following reason (Section 7031.5, Business'and Professions / - y:- Code): ADDRESS /r 1. IENE, .❑., I,.as owner of the property, or my employees with wages as their sole compensation, will do-the work and the CITY TEL.NO. ICIIAL 77= f`0 iE e/a 4 structure is not intended or de).offered for sale(Section 7044, CHECK � j i t Business and Professions Code). � OWNER 'n—"" 7`r o ✓ upv ❑ I, as owner of the,property, am exclusively contracting MAIL _ G ' H:II]I]G 'i' with licensed contractors to construct the project (Sec- ADDRESS 1061-7 1241Ne n cls. tion 7044,Business and Professions Code). ' CONSTRUCTION LENDING AGENCY CITY ee 1 - TEL.NO. 443_l0� � - 14,7'94 I hereby,affirm that there is a construction lending agency for - the performance of the work for which this permit �s issued CONTRACTOR (Sec.3097, Civ.C.). _ _ yn�' - - ADDRESS Lender's Name - • CITY ��C///. TEL.NO. Lender's Address STATE LJ LIC. I certify that I have read this application and state that the above - LICENSE No. 5a 3 CLASS — information is correct.-I agree to comply with all County ordinances and State laws relating to building con ruction,and hereby authorize representatives of this County to ent r upon the above-mentioned prope>,1or inspection pur as.� SEE REVERSE FOR EXPLANATORY LANGUAGE SIG RE OF APPLIWNTO RGENr DATE - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0306200007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEG FEE PAID BUILDING ADDRESS. ON FILE 10617 DAINES DR FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: TEMP CA 917802815 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: PAL MAL 8586-010-054 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY 41 VENTILATION FAN 2.00 FAN 31.50 TENANT: TOTAL FEES 59.25 ISSUED N: PROCESSED LAN BY: EXPIRES ON: 06/20/03 JK 12/17/03 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: DELA FUENTE HECTOR T;DORETTA M (626) 443-1021- ✓1 ,� 10617 DAINES DR TEMP 917802815 597VIPTION UP WUKK REMODEL 2 BATHROOMS APPLICANT: TEL. 0: SPEEDY STONES PLUMBING (626) 282-5117- 307 N SAN MARINO SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SPEEDY STONE PLUMBING INC. (626) 282-5117- 307 N. SAN MARINO AVE LIC. NO FAU/W LL FURNACE SAB GABRIEL CA 91775 285376BC36 COMBUSTION AIR OPENINGS ARCHITECT OR ENGIN TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DE I S COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508