HomeMy Public PortalAbout9018 DUFFY ST_Mechanical__ WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9189 APPLICATION
PERMIT L�ME GREEN
76A364C
I herei_ rffirm that I have a certificate of consent to self insure,
Or a c4 � gvie of Worker's Compensation Insurance, or a certified HEATING : VENTILATING -AIR CONDITIONING
copy thereof (Sec.3600 Lab.C.)
Policy NoPC 991357 Company-RFPIIRI Tr. TNIIFiNiTTY COUNTY OF LOS ANGELES.. - DEPT,OF PUBLIC WORKS ` BUILDING AND SAFETY DIV:
❑ Certified copy is hereby furnished.,
' Certified copy is filed with ih oun a tion.' FOR APPLICANT TO FILL.IN BUILDING 912 EAST DUFF Y
department (PRINT OR TYPE ONLY) ADDRESS
Date Q11R,/Q1_Applican o II NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY TEMPLE CITY
NEAREST
CERTIFICATE OF E% ION FROM WO RS' CROSS ST. LONA 6-4
COMPENSATION INSURANCE 1 ABSORPTION UNIT,BTU 7-S15.100
This section need not be completed if.the work involved b the ASSESSOR '
( P Y MAP BOOK- PAGE PARCEL
.permit is for one hundred dollars(5100)Or less.) ., AIR HANDLING UNIT,CFM
oismicr xoPeocssBY
I certify that in the performance of the work for which this permit . s o
is issued, I shall not employ any person in'any manner so as to BOILER,BTU—
become become subje t to the Workers'Compensation Laws. ���
C 1 COM PRESSOR,BTU
Date / /A Imant APPROVALS Dare ixsyscroq's sinxange
PP VENTILATION SYSTEM
NOTICE-TO APPLICANT' If, after making this Certificate of - ROUGH
Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must.furthwith comply with such
provisions or this permit shall be deemed revoked. FURNACE: FAUGRAVITY
LICENSED CONTRACTORS DECLARATIONFLOOR BTU ` VALIDATION
hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT_ ,
(tom mencing'vvhh Section 7000) Of Division 3 of the Business and HEATER: WALL
Professions Code, and my license is in full force and effect.
Rep lace existing furnace End
Ucen be >- -' .Class .r-2f1 rep ace existing air condi ti ner - -
O
Contr to Date a/1_g'>LQ1 '' D
❑ ' Plan check fee - - - - U
1 am exempt a tler ac; IT
B_BP.C.for this reason - - PERMIT ISSUING FEE$, ::1 5 00.- - O
Date: TOTAL;FEE 45 OD W
a
Signature PLAN CHECK APPLICANT ''� Tn
OWNER-BUILDER DECLARATION - •' Z
I hereby affirm that I am exempt from the Contractor's License Law NAME n
for the following reason.(Section 7031.5, Business and Professions
Code): - ADDRESS - `I
❑ I, as owner of the property, or my employeeswith wages .. - =,:•)17, �' ,I!.IJ
as their sole compensation, will do the work and the CITY '` TEL.NO. '
structure isnot intended or offered for sale (Section 7044,
Business and Professions Code). OWNER MRS. MARY A. COPPOLINO ' '- - T�fTLri- I
F-1I, as owner of the property, am.exclusively contracting ntracting MAIL 912$. EAST DUFFYi
with licensed contractors to construct the project (Sec- ADDRESS _..
'tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY - CITY TEMPLE CITY, CA TELND .235-0355 '
hereby affirm that there is a construction lending agency for CONTRACTOR -BRYANT'HEATING AND AI'R COND. .
'the performance of the work for which this permit is issued
ISe . 3097, Civ,C.).:
ADDRESS 1350 EAST LAS TUNAS, CA 91776 ttli i All y ,-
-
Lender's Name - . .
CITY SAN GABRIEL, 91776 TEL.NO' 286-1141
Lender's Address ' STATE LIC. - -
I certify that I have read this application and slate that the above LICENSE NO. 221 751 CLASS C-20 -
information is correct. I agree to comply with all County ordinances '
and State laws relating to building construction,and hereby authorize `.
Wslafiryf thi ounty to enter upon the above-mentioned (ti purposes. ,(! SEE REVERSE FOR EXPLANATORY LANGUAGE -
S URE OF APPL AMO A M DATE '
y COUNTY OF IAS ANGELES TEMPLE CITY 4 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1105190018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 16134 LT: 13 9128 DUFFY ST
I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802448
1ASSESSOR INFORMATION NUMBER: I 'NEAREST CROSS STREET:
15389-021-008 101 PERMIT ISSUANCE PEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI
102 COMPRSR < 100 KATU 1.00 COM 27.00
1 TENANT: 108 FURNACE/HEATER 400 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 81.80 105/19/11 SR I
OWNER: TEL. NO: FT AL DATE FI AL BY: CODE:
Il cxov, weI (626) 215-20e0- I I ///TJ,/ � /yy� I
19128 DUFFY ST
ITEMP 917802440 D7>�'S�CRIPTION OF WORK I
(MECHANICAL CHANGE OUT WITH DUCTING REPLACEMENT AC AND HEATINI
IG REPLACEMENT
(APPLICANT: TEL. NO: i I I
IDELA CRUZ, SERGIO (868) 924-1316- 1 1 1
111951 WELLER PLACE ' I ISPEC_IAL CONDITIONS: I
II
MORENO VALLEY 92557
(CONTRACTOR: TEL. NO: IAPPROV S DATE INSPECTOR SIGNATURE
(CALIBER HEATING & AIR CONDITIONING (888) 924-1316-
111951 WELLER PLACE LIC. NO 1 1FAU/WALL FURNACE
MORENO VALLEY CA 92557 892098 O e
I I ICOMBUSTION AIR OPENINGS I
I 1 I
ARCHITECT OR ENGINEER: TEL. NO: I 1DUCT WORK Iyr I I
LSC. NO: I IAC/COMPRESSORI I-
I ITHERMOSTAT
I
(FIRE DAMPERS I I
I
ISMOKE DETECTION DEVICES
COhP1ERCIAL HOOD
II I I I I
III I I I I I
I I I I I I
I I I I I I
I I I I I I
II II � II II II
I I I I I I
I I I I I I
I I I I I I
I I I I I
II I II I I I
I II II 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 (REPORT ID: DPR264 ROUTE T0: 850508 I I I I
I I
76A364 - CEBiB - 3-69
APPLICATION FOR PERMIT /
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 9128 East Duffy
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY Temple Cit
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDINGNEAREST
CROSS ST.
FOR APPLICANT APPLICANT TO FILL IN OWNER Stephen Feh r
(PRINT OR TYPE ONLY) MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS 9128 East Duff
ABSORPTION SYSTEM, STUJB-IUUU CITY Temple City TEL. NO. 286-5631
CONTRACTOR Bryant Htg. & Air Cond. Inc.
AIR HANDLING UNIT, CFM
ADDRESS1350 E. Las Tunas Drive
BOILER, HORSEPOWER
CITY San Gabriel TEL. NO. 286-1141
COMPRESSOR, HORSEPOWER
LICENSE NO. 221751 CLASS Ci20
VENTILATION SYSTEM DISTRICT NO. GROUP /ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU X GRAVITY
1 FLOOR BTU 80.000— 5 004 INSPECTION RECORD
HEATER: SUSPENDED—UNIT— r
WALL n
O
V
O
u
v
w
a
N
Z_
NEW_ADDITION_ PERMIT S 3 00
ALTER--REPAIR— TOTAL FEE S 1 13100 '
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL OROINANC AND LAWS REGULATING HEATING,VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LA D'
AIR CONMI .
I HEREBY CERTING IN VIOLATION OF ROUGH ry A
CHAPTER 9, OIVSS AND PROFE IONAL FINAL J
CODE OF THE ST
SIGNATURE JACK R. ALLEN, SURE RV ECHANICAL ENG'R.
OF PERM ITi
PERMIT VALIDATION CK. M.O. ,CASH
PLAN ECK VALID I N
X 1879iz AUc1041 D 13.00- v
SEE BACK OF APPLICATION FOR COMPLETE FEES II6DULE; V /