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Home My Public Portal About9467 DAINES DR_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT ., I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING CE_81 or a certified copy thereof (Sec. 3800, Lab. C.) C CE 818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING n ' tion department. ADDRESS 4J,(/ J12 (PRINT OR TYPE ONLY) Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE v G CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by -ABSORPTION UNIT, BTU DISTRICT NO. PRO ESSED BY the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM % ' 6'°p CK I certify that in the performance of the work for which this 7 t,+ ' permit is issued, I shall not employ any person in any manner BOILER, BTU /so as to bec me subject to the Workers'C r pensatio Laws. APPROVALS DATE N CTOR'S SIGNATURE �/ i COMPRESSOR, BTU ©U eµ-- ROUGH Date' Applicant p z NOT IC TO APPLICANT: If, after aking this Certificate of VENTILATION SYSTEM FINAL ✓ Exemption, you should beco a subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU 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 WALL and Professions Code,and my license is in full force and effect. IU5 ? A License Number Lic. Class ► k) r` C c a o o � Contractor Date O 0,5U v ElI am exempt under Sec. Plan check fee = a 30. C7 0 B.&P.C. for this reason � PERMIT ISSUING FEE $ Io 115V 1,G 5_813 � Date: Signature TOTAL FEE Q OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License ► Law for the following reason (Section 7031.5, Business and NAME .� Professions Code): f ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ® the structure is not intended or offered for sale(Section CITY TEL. NO. Ir E ` _ 6.9 17 ,;!r44, Business and Professions Code). l, as owner of the property, am exclusively contracting OWNER with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL. NO. I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS Lender's Name CITY TEL. NO. Lender's Address STATE LIC. I certify that I have read this application and state that the LICENSE NO. CLASS above information is correct. I agree to comply with all County ordinances a State laws relating to building construction, and hereb uthorize rep sent ' es of this County to enter upon t bove- enti edj erty for inspecn purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S' nature of Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0204040003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 = PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING DRES : ON FILE 9467 DAINES DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803113 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 8588-027-006 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: .J4 LOCALITY: TEMPLE CITY 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: TOTAL FEES 54.75 ISSUED ON: PROCESSED Y: PLAN B XPIRES ON: 04/04/02 JK 10/01/02 OWNER: TEL. NO: FINAL DATE FIN lY CODE: SACCHETTO CARLOS;MARIA TRS (626) 285-9629- D / 9467 DAINES DR TEMP 917803113 DESCRIPTION OF WORK RELOCATE AC UNIT APPLICANT: TEL. NO: SAWSUST CONSTRUCTION (310) 480-3350- SPECIAL. CONDITIONS: CONTRACTOR: TEL. N0: /n�� APPROVALS DATE INSPECTOR SIGNATURE SAWDUST CONSTRUCTION - (310) 480-3350- _ 4122 KIMA CT. LIC. NO FAU WALL FURNACE LAKEWOOD, CA 90712 774931-B ' COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: 1111111 AC/COMPRESSOR 1 THERMOSTAT I U FED �T1��/J FIRE DAMPERS (�J/J SMO E DETECTION DEVICES O 0COMMERCIAL HOOD 17 J �laA_ O ❑ _, ** 0 ❑ + � REPORT ID: DPR264 ROUTE TO: BS0508