HomeMy Public PortalAbout9446 DAINES DR_Mechanical__ i ERb'COMPENSATION DEC,.ARATION 76A364C - �pp pp,,"��••�� ��' ii �i�'pp '- �p '(�/� -
I hereby affirm that I have a`certificate' of consent to self CE 81$ (2-80) APII- 14..U�r>G"dT11 U�1, ��� 1I-"EgWT
insure;or a certificate of workers''Compensation lnsurance,.or
Ff1EAY1G=bl 'NTILAYIRIG A163 GOW®IYI®R11NG
a certified copy thereof(Sec.'3800,Lab.C.) -
Policy NOPC 17J l ,.o pany_�e:�JcLG IN�L'/l P��f
ANGE LESS
. ❑. Certified copy is hereby.furnished.-- C D$AFETV '
OUIVTV OF L'OS BUILDING Aftl
k
Certified.copy;;is filed with the county building un-vection
R APPLICANT TQ FILL B4UtLDING.
deparrgent �O :. FOR IN ADDRESS- �[� e S
Date_1 VSs (PRhNT OR TYPE ONLY);. F
Applicant
CERTI,FICATEF E"XEMPTIOhi FROM WORKERS NO. TYPE OF LI
4PPANCE OR EQUIPMENT • FEE fQ
' LOCALITY
COMPENSATION`INSURANGE L
NEAREST.
• (This section need not be completed• if the wOrlC involved ABSORPTION UNIT, BT,U CROSS ST. d ,
by the ,permit;is for 'one hundred`dollars ($10,0) of:less.) DISTRICT ND; PI3ocEse"o' ® :'
„•
I certify that in the performance of the work for wlueh this AIR HANDLING UNIT,CFM
::.permit is`issued, I shall-not'employ any person in any rnanner Q~
so as to-become subject to the Workers Compensation Laws. BOILER, BTU F-
ii
Date Applicant l COMPRESSOR,BTU— & QSCZ � (� E / Ate.
APPROUALS�� 'DAT INSPEC, SIGNATURE.. '�
Cn
NOTICE TO,APPLICANT:If,'afte:f making"this Certificate of VENTILATION SYSTEM
p - , you. Should become 'subject -to Workers'
•a
ROUGH. _
Exem tion " FINAL
Compensation•provisions,of.the Labor Code; you`must forth-
With comply•with.-such .provisions or this,permit shall-,be EVAPORATIVE COOLER' i
VALIDATION
deemed revoked.
FURNACE;'" FAU C VITY `
-` LI.CENSEDCONTRACTORS DECLARATION � FLOOR, BTtJ��'CC}rJ
Thereby affirm that 1 am licensed-under pro visions of Chapter -
p P ..1-1EATER:•�•SUSPENDED :`� UNIT•• ,
9 (commencing with Section 7000)of Division 9°of the-Busi- ` WALL
ness and Professions Code,and my aicense is in full.force and. ,
Y �7 q ;• Q
Liecnse'Number_/ �`� 73S' Lib:'Class C 3.O . � 1
,f
4
Contracfor. C Date
El I am exempt fro m'the licensing requirements.as I am a
licensed architect or a'registered'professionaUengmeer.; Plan ¢heckJee 25% Of4abOV,e o.o
acting in my professional capacity (Section 7051,. ?�0.5,0
Bus-
iness ants,Professions Code). ' :- ' PERMIT'ISSUING FEEd
•Lic or Reg.No: Date TOTAL.FEE" ° 'J Q 5.&0
HOME OWNER-BUILDER IJECL'AR'rCTION
PLAN CHECK,APPLICANT
0 0`4 85
I .hereby' affirm that f am exempt front-Abe Contractor's NAME ( b 2
License, Law for the-following reason-(Section 7031:5; Busi- `2 IYIJt S, t`c I��2 •2 `�2,
•ness and Professions Code), ADDRESS-
1, as owner of the property, will do the work'and the
structure is Trot intended or offered--for sale '(Section' CITY "�e,M (�^ TEL. NO
.7044,,Business and Professions Code).. "• p
F. 36
F-1 _asT_as owner-of the property;,am'-exclusively contracting
with licensed contractors to'construct 'the project At `
(Section 7044,•Business'and Professions Code).;,. ADDRESS"
CONSTRUCTION LENDING AGENCY CITY .TEL.NO.
I hereby affirm that there 'is a construction lending agency-
for the perforrnance of the work for'which this CONTRACTOR `n -t
` permit.is �O oN N,r)ii.- ,>��` ►`'@I ei 9
issued(Sec.ma• ADDRESS 1l 3097,Civ.C.). 'G � s
Lender's'.Na
ll I� - _/V Cir.J; t4
tender's Address-' CITY y NO
e��Q �l TEL.
I certify that I have read this application and state that the STATE: L1C.
above information is correct.I agree to comply with all County LICENSE NOQ3?3 S' CLASS
ordinances and*State laws regulating Heating, Ventilating and
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORYLANGUAGE
County, to enter upon the above-mentioned property' for
inspection purposes
J=9J,
Signature of Permittee Date ,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1107280016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID BUILDING ADDRESS: I
ON FILE 9446 DAINES DR 1
IFEE DESCRIPTION: .QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803112 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: CLOVERLY 1
18588-028-009 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY I
1 103 COMPRSR 101 500 KBTU- 1.00 COM .52..20
(TENANT: 109 FURNACE,101 500.KBTU 1.00 UNI • 52.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1
130 AIR INLETS/OUTLETS 8.00 UNI 34.80 107/28/11 SR 1
136 AHU 2001-10000 CFM 1.00 AHU 38.80 1 1
(OWNER: TEL. NO: .141 VENTILATION FAN 2.00 FAN 31.60 1F DA FIN CODE: . 1
ILICHTENBERGER JOSEPH;LYDIA R (626) 286-2571- 1 TOTAL FEES 237.40
19446 DAINES DR I I 1
ITEMP 917803112 1 IDESCR PTI6N OF WORK - 1
(INSTALL NEW AIR CONDITIONING AND HEATING SYSTEM . I
I I I I
(APPLICANT: TEL. NO: I I
1PETTIT, RICHARD (760) 559-0205- I 1
1 ISPECIAL CONDITIONS: 1
I I I I
ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
(OAK HILLS CONTRACTORS INC. (760) 559-0205- I 1 1
19722 FARMINGTON ST. LIC. NO I IFAU/WALL FURNACE I 1 1
10AK HILLS, CA 92344 928789 B 1 1 1 I I
I I ICOMBUSTION AIR OPENINGS I I
I I I I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK I I I
LIC. NO: IAC/COMPRESSOR
I I I /
I 1 1THERMOSTAT 1 I I
I I 1-1-
I
I I IFIRE DAMPERS
I I I I I I
I ISMOKE DETECTION DEVICES I I
1 I ICOMMERCIAL HOOD I I 1
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
1 IREPORT ID: DPR264 ROUTE TO: BS0508 1 I I