HomeMy Public PortalAbout9932 DUFFY ST_Mechanical__ WORKERS' COMPENSATION DECLARATION /�p�n p n (��p n2Rnn�n/�
I hereby affirm That I have a certificate of consent to self !i-�1U"PL��Cl�-�1�� N FOR I�LSII�lIV T
insure, or a certificate of Workers'.Compensation Insurance, I
HEATING !VENTILATING'- AIR CONI DO I-PdG
or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C
1 20-0046 DPW 9/88
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
tion department. - ADDRESS YV
(PRINT OR TYPE'ONLY)
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE,
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE ' CROSS ST.
(This sABSORPTION UNIT, BTU
'section need not be completed if the work inVOIV@d by, DISTRICT NO. PRoqtSED BY ,
the permit is For one hundred dollars ($100) or less.) ;
I certify that in the performance of the work for'which this AIR HANDLING UNIT, CFM
permit is issued, l shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. BOILER, BTURIVALS ATE SPECTOR'S SIGNATURE
Date Applicant 'COMPRESSOR, BTU ROUGH
NOTICE:TO APP.LICANT.' If, after making this Certificate of VENTILATION SYSTEM. ,. FINAL u
Exemption, you' should become subject to the Workers' �r; ,M
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER (1 ALIDATION
with comply with such provisions or4his permit shall be deem'-. v'
ed revoked ?'—` ; FURNACE: FAU _GRAVITY'_
o
LICENSED CONTRACTORS FLOOR BTU DECLARATION '
I hereby affiri -that Fam licensed under provisions of Chapter 9 SUSPENDED UNIT
HEATER:. WALL.
with Section 7000)of:Division 3'8f the Business ,
and Professions Code,and my license is-in full force and effect.
TV
} .
License Number Lic. Class D a
Contractor Date OC
❑ I am exempt under Sec.
Plan check fee
B.BP:C. for this reason: a.
PERMIT ISSUING-FEE $ IIA z
Signature TOTAL.FEE
OWNER-BUILDER DE BAR TION PLAN CHECK APPLICANT' .
I hereby affirm that Lam exempt,from the,Contractor's License D
Law'for the following reason (Section 7031.5, Business and NAME
Professions Code): l
I, as owner of the property, or my em to ees with ADDRESS r
wages as their`sole compensation, will do the.work and It#�•C•I eF
the structure is not intended or offered for sale(Section CITY - TEL. NO.. _ ;_
7044, Business and Professions Code). 330y- s{ ._,°01_I
OWNER _ {�
I, as owner of the pro1
property, am exclusively contracting ITEM
with licensed contractors to construct the project (Sec- 'MAIL
Tion 7044, Business and Professions Code): ADDRESS TOTAL TAL 25m00
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
I hereby affirm that there is a construction lending agency for CHE"K 0° Ill
the performance of the work for which this.permit is issued CONTRACTOR
(Sec: 3097, Civ. C.). CHANGE
D .100
ADDRESS
Lender's Name i I
CITY TEL. NO. �I�EII-11J vi 1 !;`f(
Lender's Address
15
I certifythat I have read this application and state That the ' STATE LIC. X41 1 - 'AM 8-'16
°i=
PP LICENSE NO. CLASS �=° t
above information is correct. I agree to comply with all County
ordinances and State laws relating to.building construction, "
and hereby authorize.representatives of this County to enter'
upon t above-m nti ned prop rty for inspection pur oses. '
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
Sigriature of pplicant or Agen Date
es
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0206190006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 17200 LT: 8 9932 DUFFY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802607
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN
8588-014-008 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
30 AIR INLETS/OUTLETS 11.00 UNI 47.85 06/19/02 JK 12/16/02
TOTAL FEES 129.60
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
YUE DONALD;KATHLEEN TRS YUE TRUST (626) 475-4805-
9932 DUFFY ST
TEMPLE CITY 91780 DESCRIPTION OF WOR
INSTALL NEW HVAC SYSTEM
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO:
\. APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO % ��� � �`��� FAUIWALL FURNACE
r,
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. 0: 6r �� --- _, ,\ , ` DUCT WORK
i
LIC. NO:�: �� � ! AC/COMPRESSOR
� - ---i •I_ _', ,,ilii.,
THERMOSTAT
FIRE DAMPERS
` SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508