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HomeMy Public PortalAbout4503 ELLIS LN_Mechanical__ I hereby, affirm that I have a' certificate,of consent ! 76A364C WORKERS'COMPENSATION DECLARATION , CE:$,$.(2-80,_ = �G�pf�d�� ©;1�a0�1 [�Oo G�3 p�G�3�19�( t,to self insure, or a certificate of Workers'Compensation Insurance,oi'` h4IEA�I�Cv-V ENTILATIR1t9-AIff3 CONDITIONING a certified copy ihereof,(Sec..3800,Lab:C:) - Policy 140 �2=Company �ertified copis herebfurnished: ' y -COUNTY ✓ -TY�)Ad- OF LOS ANGELS �UILDI�IG'ANO SAFE V Certified copy is-filed with the county building inspectionBUi LDING rtment. - FOR APPLICANT TO FILL IN ' (PRINT OR TYPE ONLY) > llate.dea3 APplicant _ �`—� ADDRESS LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE' e ��' r COMPENSATION INSURANCE - t�v O}. NEAREST (This 'section. need not be_completed if the work'ihvblved ABSORPTION UNIT,-,BTUCROSS$ _ _ _ O by the,permit is for one hundred dollars ($100)_ or, less.) rRlcT C(� ' DIS N0. _ PROCr S 'ABY - I certify that in the performance of the work.fdr which,thAIRHANDLING UNIT,CFM is permit is issued, I shall noVemploy any person in any manner .so'as to become subject to the Workers' Compensation'.1,aws. BOILER, BTU U r - APPROVALSDATE :1NSPECTOR'Ss1GNA-,9E Date Applicant _ COMPRESSOR, BTU— Date m ROUGH NOTICE TO APPLICANT: If, after,making this,Cert ficate of VIE NTiLATION;SYSTEIVI` _ �Z�t C11 Z" "Exemption,' you should become "subject;to. the Workers'; FINAL _ Compensation provisions of the,Labor Code,:you must forth - with comply with such provisions, or this permit shall,be_ E VAPORATIVE COOLER" - deemed revoked. FURNACE:; ' FAU GRAVITY ;�PIIIATIIN, LICENSED CONTRACTORS-DECLARATION FLOOR: BTU–/ I hereby,affirm that I am licensed under provisions of Chapter HEATER: ' SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3'of the Busi- WALL ness and Professions Code, and my license is in full force and,_effect.' J License Number ad✓i6 Lic.Class ContractorP/Z!?' Date _ I Air, exempt from the licensing requirements.as I-am a - a. . licensed architect or a registered professional' engineer: . Platt Check fee 25%of above. acting,in my professional capacity (Section '7,051; "Bus-- - iness and Professions Codej. s PERMIT ISSUING FEE ' Lic.or Reg:No. ate 1OTAL TEE HOMEOWNER DECLARATION PLAN CHECK APPLICANT /� G'4'5�5 A' - I hereby 'affirm' that 1.,am."exempt from-the Contractor's NAME a." A ` #.,0 00,0:0 8 License*Law for the following reason (Section 7031.5,'Busi-' *. ness and.Professions Code): ADDRESS 2�©�°J_7,0 0 1, as owner of the prop erty,?'will do the work and'the' „ _ CITY, TEL. NO. . o 0 0 7 0 au structure is snot intended 'or offered,for' sale (Section- - ,' = • '� I 2044,'Bu`siness and,Professions Code)., �r�Gh�% 8", OWNER'S 0'7 77 :_O I, as owner'of the property, am,exclusively contracting. — with" licensed contractors to construct :the project: MAIL V (Section 7044,Business and Professions Godej. ADDRESS�� . _ CONSTRUCTIQ,N LENDING AGENCY CITY o TEL.NO 7r. / 1,hereby affirm that there is a construction lending agency for the .performance of the work for which this permit is CONTRACTOR' issued (Sec. 3097,Civ.Ci), Lender's Name ADDRES — Lender's Address CITY TEL'.,NOy�r`yj?i .� 1f�4 l certify that I have read this application,and state that,the STATE , / LIC: + . above information is correct.1 agree to comply with all County LICENSE NO. _ �3 1� CLASS �Z! ordinances and State laws regulating'Heating, Ventilating,and ,Air Conditioning, and hereby authorize representatives of this SITE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for in(, ion purpose ohature of Permittee Date 364C WORKERS'COMPENSATIO.N DECLARATION CEP 818(2-80) A M If- UC AT�011 1 FOR R 1T"E R M 0f I hereby affirm that I have if certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR G®R1®BVI®(rZIBN�i a certified copy thereof(Sec. 3800,Lab.C.) Policy No./.S �Company!�c7— �� O�rtified copy is hereby furnished. COUNTY OF LOS A'VGELES BUILDING ARID S�,FEYV�yI/ � Certified copy is filed with the county b rilding inspection BUILDING " de art in FOR APPLICANT TO FILL IN _ ADDRESS ( �1L/S Dafe_ = --V Applicant - (PRINT OR TYPE ONLY) LOCALITY c. CERTIFICATE OF.EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE _ COMPENSATION INSURANCE NEAREST } (This section need not Abe completed if the work involved ABSORPTION UNIT, BTU CROSS ST —_ a0 by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. © PR -:'S Y L) I certify that in the performance of the work for which this AIR-HANDLING UNIT,CFM permit is issued, I shall not employ any person in any manner O so as to become-subject-,to the Workers'Compensation Laws. BOILER, BTU U APPROVALS DATE INSPECTOR'SSIG .,TURE W Date Applicant COMPRESSOR,BTUN' ROUGH ?�/ / _ NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM /6 r"r/r �`S Z Exemption, you should become subject to .the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY ! 7,;7 LICENSED CONTRACTORS DECLARATION / FLOOR:- -1 LOOR-1 hereby•affirm that I am licensed under provisions of Chapter 1 HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. License Number.7-it3�ZO_ Lic.•Cr''asss e 2 Contractor --Pi'1,-E? Date F1I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. �} acting in my-professional capacity (Section 7051, Bus- PERMIT ISSUING FEE $ iness and,Professions Code)., Lic.or Reg.'No. Date TOTAL FEE HOMEOWNER-BUILDER DECLARATION PLAN CHECK APPLICANT l7(��ZO I hereby affirm .that Iam exempt from- the Contractor's NAME ;2'0 4 5 3 A License Law for the following reason (Section 7031.5, Busi- rim and Professions Code): ADDRESS # o 0 0''0,0'$ ❑ 1, as owner;of the property, will do the work and the CITY TEL. NO. 2 0 Structure, is not intended 'os offered for sale (Section , lo., - 7044, Business and Professions Code). , OWNER ? j° o 0:13.I, aowner of the property, am exclusively contracting U.M , ? with licensed contractors to construct the project MAIL ' 9ao L� o,7 2 2-;­8(Section 7044; Business and Professions Code). ADDRESS �- Q CONSTRUCTION LENDING AGENCY CITr("{�/5Y-_^6�. TEL.NO.�6;,_2�/ I hereby affirm that there is a construction lending agency for:the performance of the work for which this permit is CONTRACTOR issued(Sec. 3097,Civ.C.). Lender's Name ADDRESS3_3ee ,57- Lender's Address CITY TEE.NO,�.� TEL ; 9DDz3 �`y;U Z, .. I certify. that,I have read this application and state that the, STATE _ LIC. above information is correct.I agree to comply with all County LICENSE NO. _J iQ.J �/ CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for insr•-,tion purpo es. gnature of ermittee Date ' WORKERS'COMPENSATION DECLARATION 76A364C � n � o 0 0 I hereby affirm that I have a' certificate of consent to self CE-818 (2-813) G=� h O�G ,\��.O �� uvU U insure, or a certificate of Workers'Compensation Insurance,of HEATI(, G-V ENTIL.A�'G(�'G-AIR COG DOTI®f�'ONG a certified copy thereof(Sec. 3800,Lab.C.) Policy No..�_��1?_C ompany—/_ 7 COUNTY OF LOS ANGELES rrtified copy is hereby furnished. � BUILDING AND SAFETY. p �r��f Certified copy is filed with the county building spection FOR APPLICANT TO FILL IN BUILDING �. department. ADDRESS5� l as Date� �/X Applicant, (PRINT OR,.TYPE ONLY} a LOCALITY CERTIFICATE OF EXnPTION FROM WORKERS' NO. TYPE'OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST / CROSS ST. (This section need not be completed if the work involved ABSORPTION UNIT, BTU . —_ _ �/ J O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESS F' P t U I certify that in.the performance of the work for which this• AIR HANDLING UNIT-,CFM permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU U APPROVALS DATE INSPECTOR'S SIGNA RE J M Date Applicant COMPRESSOR,BTU ROUGH _ d / N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM / -� 'L Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER with comply with such provisions or this..permit shall be VALIDATION deemed revoked. FURNACE: FAU GRAVITY LICENSED,CONTRACTORS DECLARATION / FLOOR: - BTU_/�_pdd 77/ I hereby affirm that I am licensed under provisions of Chapter / HEATER! SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code; and my license is.in full force and effect. License Number- ���_ Lic.Class `2 J Contractor I am,exempt from the licensing requirements as I am 5 , licensed architect or a registered professional'engineer Plan Check fee 25%ofabove. acting in my professional'capacity (Section 7051,.Bus- F°ERMIT ISSUING FEE iness and Professions Code). Lic.or Reg.No. Date TOT'A'L FETE' HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT, /Z Ad I hereby affirm ,that•I ami exempt -from'the Contractor's' NAME. z;O 42 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS( CITY #'o' oto 0 I, as owner•,of the property, will do the work and the I o io ; structure is not Intended or offered for sale Section TEL NO 7044, Busmess'and Professions Code). 2 �,�.1 7,0 0 1, as owner of the property, am exclusively contracting OWNER , ,(/� /' //���`� PoYo 1 7,A0110. Q with licensed contractors to construct the ,project MAIL pOsO� - /doW_(y�Z��' "' ADDRESS T �/ (Section 7044,Business and Professions Code). 017;22(--8.1 CONSTRUCTION LENDING AGENCY CITY TEL. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR issue Sec. 3097 Civ.C. . d ) Lenders Name ADDRESS? d4 4;& ' Lender's Address CITY TEL.N0.26� �� pO �3 I certify that I have read this application and state that the STATE ff LIC.A above information is correct. 1 agfee to comply with all County LICENSE NO. p CLSS e 02© ordinances and State laws regulating Heatingi Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for iPZn.t ion pu! ose' r_ Permittee Date / WORKERS'COMPFRSATION DECLARATION CEA S 8C(2-80) A!r Il UC/r�T U V FOR Il– R WT I hereby affirm.that I have a certificate of consent to.self insure, or:a certificate of Workers'Compensation Insurance,or G�1(El�TI1�1Cv-�![i= 'ITlLl�TII�1G-lalf ®N®ITl®Ir�I(r�l�i a certified coCpy thereof(Sec.3800,.La�b,.C.)J,� ,Policy No'/�� Company—z e �, J• er'tified copy is hereby furnished. COUNTY OF LOS ANGELFf .�C2 -BUILDING ARID SAFETVCi„ i/ Lam. L� Certified copy is filed with the county building inspection BUILDING FOR department. FOR APPLICANT TO FILL IN ADDRESS Date�3 Applicant (PRIN'T OR TYPE ONLY) CERTIFICATE O.F Ek'MPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY LC COMPENSATION INSURANCE NEAREST ” (This section,need not. be completed if the work involved ABSORPTION UNIT, BTU CROSS -,. '�'?/ _ _ d by the permit is-foi one hundred dollars ($100) or less.) DISTRICT NO. PRO'.cS'-D P' 4 V I certify that in.the performance of the work'for which this AIR HANDLING UNIT,CFM �iD� cc permit is issued, I shall not employ any person in any manner . so as to become subject to the Workers' Compensation Laws. BOILER; BTU I-- . APPROVALS DATE wSPECTOR'S SIGNATURE (� Date ApplicantW COMPRESSOR, BTU ROUGH Cn `NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM rZ�1 ` Z Exemption,.-you should become .subject to the Workers' FINAL Compeosation-provisions'of the Labor Code,.you must forth- EVAPORATIVE COOLER with comply with` such provisions or this permit shall be VALIDATION deemed revoked. FURNACE: FAU GRAVITY '/.(f/ //7 LICENSED CONTRACTORS DECLARATION / FL00R: BTU_l' i-Gv4 Y/ I hereby affirm that'I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT- 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect.' License NumbLic.,Class 2f) Contractor :Date ElI am exempt from the licensing requirements as I am a - licensed architect or a registered professional engineer Plan Check fee 25%Of above. acting in my, professional capacity (Section 7051, Bus= iness and Professions Code). PERMIT ISSUING FEE Lic.orReg.No. Date _ -[TOTAL FEE —,D:�15;�;A HOME OWNER-BUILDER DECLARATION PLAN,CHECK APPLICANT # oIo o o,o 8 l.,hereby.-affirm-that .I "am.exempt from- the Contractor's NAME,: 2 °l0 i7, Q License Law for the following reason (Section 7031.5, Busi- 0Qv ness and Professions Code): ADDRESS M F, as-owner of the property, will do, the'work and the CITY TEL. NO, r7.2 2—8 structure,is' not intended or offered for sale (Section I r 7044, Business and Professions Code). ' MOWNER — I, as'owner of the property, am exclusively contracting with licensed contractors to constructthe project MAIL (Section 7044, Business and Professioxs Code). ADDRESS 9�(/ �_ _ CIT TEL.NO. CONSTRUCTION LENDING AGENCY �AL'�� ► ��/_f'�a/ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR�J issued(Sec.3097,Civ.C.). Lender's Name ADDRES5�Z3 'eF: a 6 Yk Q r Lender's Address CITY,.�, 7+��� �3 TEL.NOa�f!�3y5� I certify that I have read this application and state that the STATE / LIC: above information is correct. I agree to comply with all County LICENSE NO. Jj i�3(9 CLASS t ordinances and State laws regulating Heating, Ventilating and Air.Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspP^tion purpose;. • - -i>',ature of,'.;rmittee Date WORKERS'COMPENSATION DECLARATION CEA 8 8(2.80) /11\ P I(- L� C A T�O��l FOR P E R II�%U T I hereby affirm that I have,a certificate of consent-to selfI "fl insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec. 3800 Lab Polic• o._- -_ voinpany I� �dO�O. COUNTY OF LOS ANGEL S / BUILDING R,i�D SAFETY Cert.fied copy is hereby furnished. t` Certified copy is filed with the county building inspection department. BUILDING ❑ FOR APPLLCAI�T TO FILL IN ADDRESS DateApplicant.-�� (PRINT OR TYPE ONLY) ` LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE CROSS ST >- (This section need not be completed:if the work involved ABSORPTION UNIT, BTU CLp by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. P 10CF SE dY Q I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DAt INSPECTOR'S SIGNATURE V W Date Applicant COMPRESSOR,BTUN ROUGH NOTICE TO .APPLICANT: If, after'inaking this Certificate of. VENTILATION SYSTEM f O� a��� Z Exemption, you should; become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth. EVAPORATIVE COOLER VALIDATION with comply with such provisions or -this permit .shall be _ deemed revoked. , FURNACE: FAll GRAVITY,7 'LICENSED CONTRACTORS DECLARATION FLOOR: BTU � _�rc? /� I / I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)ofDivision 3 of the Busi- ness and Professions Code, and my license is in full force and effect: rnrn/ License Numb'erz 0-I6 Lic.ClassA-Z-0-7'2'a Contractor __ Date I am exempt from the licensing requirements as.1 am a licensed -architect or a registered professional 'engineer -Plan Check fee 25%of above. acting in my professional capacity (Section 7051, Bus- inegs and Professions Code). PERMIT ISSUING-FEE$ Lic.or Reg.No. Date TOTAL FEf .2'0'4 5.4 A 'HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT #;a;ola o. o g I hereby affirm that .I am exempt from-the Contractor's NAME o;o. License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ❑ 1, as owner of the property, will do the work and the O 7' structure is not intended or offered for sale ,(Section CITY TEL. NO. 7044, Business and Professions Code). ° 2 2_$.� ' ❑ OWNER I, as owner of the property, am exclusively contracting /f with licensed contractors to construct the. project MAIL (Section 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCYCITY TEL.NO�h 7� I hereby affirm that there is a construction lending agency & b for the performance of the work for which this permit is CONTRACTOR e issued (Sec. 3097,Civ.C.). , Lender's Name ADDRESS���i� �6 A Lender's Address T-EL.L./NO�►6 1 CITY I certify that I have read.this application and state that the STATE /r/ LIC. above information is correct. I agree to comply with all County LICENSE NO. 3-3,2203-1- CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter .upon the above-mentioned properly- for inson purposer.. - i ,uarure o. r.,m'ittee Date WORKERS'COMPENSATION DECLARATION CEA 8 8(2-80}," q pp pCQT p FORp p ►pT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insuranc of HEATING-VENTILATING-AIR CONDITIONING Po1�cy NZS. "�� C om/�any ' COUNTY OF LOS ANGELES BUILDING AND AFETY Certified copy is hereby furnished. Certified copy is filed with the county build' g inspection FOR APPLICANT TO FILL IN BUILDING d art a t. ADDRESS V DatApplicant—= � f (PRINT OR TYPE ONLY) eE�� - a—� . LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE _ COMPENSATION INSURANCE NEAREST (This section need not be completed if-the work involved ABSORPTION UNIT,BTU CROSS ST. 't� !/ — O by the permit is for one*hundred dollars,($100) or less.) DISTRICT NO. PR( D BV V I certify that in the performance of AIR HANDLING UNIT,CFM the work for which this �`/� � 0 permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws. BOILER, BTU F- • . - .� ' APPROVALS DATE INSPECTOR'S SIGNATURE d Date .Applicant COMPRESSOR,BTU._ �Q�� / lJ0 ROUGH N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z--Y---U( z Exemption, you shouldbecome subject to the Workers' FINAL Compensation provisioris'of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be- deemed revoked. FURNACE: FA AVITY LICENSED CONTRACTORS DECLARATION FLOOR:- BT I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with.Section 7000)of Division-3 of the Busi- WALL ness and Professions Code, and•m.y license is in full force and effect. License Number Lic.Class Contractor Date 0 I am exempt from 'the licensing requirements as I am a licensed architect or a-registered professional engineer Plan Check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and"Professions Code). �( Lic.or Reg.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT - I 'hereby affirm that I arry exempt from- the Contractor's NAME 1 License Law for the following reason (Section 7031..5, Busi- ness and Professions Code): ADDRESS I, as owner of the property, will'do the work and the - structure is not intended or offered for sale (Section Cl TEL. NO. k5_7 7044, Business and Professions Code). 0,0 8.3 A ❑ OWNER' e�2t:i a ' I as owner of,the property, am exclusively contracting i, with licensed contractors to construct the project MAIL # o o;o;o LI:� (Section 7044, Business and Professions Code). ADDRESS .12 2 '0,.'617,.Q Q op , CITY T NO. CONSTRUCTION LENDING AGENCY ` :o:a o' I hereby affirm that there is a construction lending agency i 6 ],0.Q U for .the performance of the work for which this permit, is CONTRACTO'i'� ,t , issued(Sec. 3097,Civ.C.). _� `6.0 8!_81 Lender's Name ADDRESS. , Lender's'Address CITY TEL.NO. j/2 I certify that I have read this application and state that the STATE _ 4-IC. `•- above information is correct. I agree to comply with all County LICENSE NO. e'i� CLASS ordinances and State laws regulating Yieating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection purpose 6- Signature of Permittee Date _ WORKERS'COMPENSATION DECLARATION 76A364C I hereby affirm that I have a' certificate of consent to'self CE-818 (2-80) l>—,If— L��� ll V' FOR -tf� -�IIV U 0 u insure, or a certificate of Workers'Compensation Insurance,dr HEATING-VETILATING-Al R CONDITIONING a ceri d co thereof(,qec. 3800,LaL C.) ❑ Certified copy"is hereby furnished. COUNTY OF LOS ANGELES BUI LDJNG D SAFT, Certified copy is filed with the county build* g inspection. BUILDING part ent ///�� FOR APPLICANT TO FILL 1N �j if J _ /-C1i 9'1 pp - (PRINT OR TYPE ONLY) ADDRESS Dat&"G A licant ' LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved ABSORPTION UNIT,BTU CROSS ST. �. .li.?-rte✓ a. by the permit is for one hundred dollars ($100)-or less.) O " DISTRICT NO. PROCESS Y L) I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �f G permit is issued, I shall not employ ani, person in any manner " 0 so as to become subject to the Workers' Compensation Laws. BOILER BTU APPROVALS DATE INSPECTOR'S SIGNATURE U LU Date Applicant COMPRESSOR,BTU: —*2G Q� ROUGH - CL NOTICE TO.APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you' should become subject to the Workers' FINAL — Compensation provisions of the Labor Code, you,must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions of•this-permit shall be deemed revoked. FURNACE: FA VITY �q LICENSED CONTRACTORS':DECLAP ATION FLOOR: B U 3,-) p'V I Frereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness.and Professions.Code,and my license is in full force and effect. License Number Lic..Class Contractor Date ❑ lam exempt from the licensing requirements as I am a licensed architect or, a registered professional engineer Plan cheek fee 25% of above. acting in 'my professional capacity:•(Section 7051, Bus- iness and Professions,Code). PERMIT ISSUING FEE $ Lic.or Reg.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION .PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAM_ Al— License Law for the•following reason "(Section 70311.5,.Busi- ness and Professions'Code): ADDRESS , 7 I, as owner of the property, will do the work and the Cl x,.0,0 812 A structure is not intended,or offered for sale (Section Lam- TEL. NO: �=f�i 7044, Business and Professions Code). f # P o*,o'o,41 OWNERy i ❑ I, as owner'of the property,-am exclusively contracting 0 o,p with licensed contractors •to construct the project MAIL � _ ,a _ 1�/2 D 2 G�7 0 0 (Section 7044;Business and Professions Code).. ADD RESS / _fir /"X�t 50 CONSTRUCTION LENDING AGENCY CITY - ° -L. NO. !0!0`o'fj;]'0 0 I hereby affirm that there -is a construction lending agency __—• �f6'0'8•.8 1 . for the- performance of the work for which this permit is CONTRACTOR^ issued (Sec. 3097,Civ.C.). — Lender's Name ADDRESS �� ✓ - " ' Lender's Address CITY EL.NO��C7 / � I certify that I have read this application and state that the STAT above information is correct.I agree to comply with all County LICENSE NO. ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for �J_cr t oyeose I • Sig>Yature of Permittee Date 76A364C , o �p �p (off �/� WORKERS'COMPENSATION DECLARATION CE 818 (2,80)'• Alf- P L� C L T� O tl YI FOR II— E R IVU QT I hereby affirm that I'have,-a7 certificate-of consent,to self insure or.a certificate of Workers'Compen sat on•Insurance ai ..HEATING-VENTILATING.-AIR COINDITIONING a�crte feed'c y th AJ§ 3800,Lab pp olity / 'Cr/mpan`y ❑ Certified copy is hereby.furnished, COUNTY OF LOS ANGELES' BUILDING ARI[ S>9+'FETY I • Certified copy is`filed with the county building inspection BUILDING FOR,APPLICANTTO FILL 14 f Date "ApPlicant: i.-. � ` ,� ��`� � (P:RiNT OR TYPE ONLYI ESS , 1 ADD.R __ LOCALITY C CERTIFICATE OF EXEMPTION FROM WORKERS' ` EQUIPMENT FEE'w COMPENSATION INSFJRANGE NO TYRE OF APPLI"AN,CE OR r -EAREST }, CL (This section need:.not,be completed if the work involved ABSORPTION UNIT; BTU CROSS ST. C) by the permit is for•one.-hundred'-dollars ($100) or,less.) DISTRICT f40._ PR SEE)BY I certify that in the performance of the�work,for.which this AIR HANDLING UNIT,CFM permit is issued,'I shall not employ.-any person m-any manner-T--' so°aS to become subject to, he Workers' Compensatiori`Laws. i BOILER, BTU O j j Date Appflcani' �. �. a 0- ,� 'J COMPRESSOR; BTU _�CL�� �t�= ;ROUGH APPROVALS DATE' INSPECTOR:SSIGNATORE- NOTICE TO APPLICANT.' If, after`,making this Certificate of -'- `i VENTILATJAN SYSTEM' Z Exemption, ou should 'become rsub)e`cf to; the Workers'. Jl FINAL Compensation provisions of the,Labor Code, you must forth-,' with comply With`such provisions 'or this •permit-shall.be,.. EVAPORATIVE COOLER. - deemed revoked: �.H FURNAGEc.. -FAO AVITY VALIDATION LICENSED CONTRACTORS DEChARATION FLOOR! BTFJ z, I hereby affirm that:i am'.Iicensed`urider'provisions of Chapter HEATER,; SUSPENDED, UN I'1 .° 9"(commencing with Section 7000.).of Division 3 of-the-Busi- _` WALL ness and-Professiors`Code;•and'my Iicehse is to full,force and •� effect. License Number Lic.Class „ 1 , Contractor' Date • ❑. I am exempt from the licensing requireinents as`I am a licensed architect or"a�cegistered,professional engineer.`. Plan•e6eek,fee.25%of above,. ` acting-in.my professional capacify`(Section 7651 Bus- "', iness and Professions Code)...` .* .,-PERMIT ISSUING,FEE Lic:or Re' .,No. Date TOTAL":FEE HOME OWNER-BUILDER DECLARATION P N'CHECK`RPPGICANT'= ' LA ''I hereby,affirm,that I am. exempt ',from-the •Contractor's=:: NAMn L _ � �_ ,." .License Law for the .following reason (Section 7037:5, Busi- ��1=1 # o 04 ness and Professions Code):" ADDRESS. �C CY r I, as owner of the.property, will•do'the.work and the ,2'E�, CITY<, TEL N'O. u structure is not intended or`offered for_sale (Section ! , -- 87006 ' ? .7.044,`Busmess,and.,Professrons Code).., ' OWNER •. I,'as owner`of•ihe property,'am exclusively contracting. i3 �• with`licensed contractors to,construct the, project.' MAIL (Section 7044;Business-and,Professions Code). ADDRESS /4,/0, ^6� ' CONSTRUCTION LENDING AGENCY` CITY `� �. "EL,NO.' I hereby affirm that there is a construction lending agency , for the performance of the work for'which this permit is CONTRACTOR G issued(Sec. 3097.,Civ.C.). Lender's Name ADDRESS " �. Lender's'Address CfT V TEL.N I certify that I have read this application and state that the STATE LIC. above information is correct.I agree to comply with all County LICENSE NO, _� CLASS ordinances and State laws regulating Heating, Ventilating and Air'Conditioning, and hereby authorize.representatives of this SEE REVERSE FOR.EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection purpose Signature of Permittee. Date - i WORKERS'COMPENSATION DECLARATION 71E 818 _0 n n p C T 10 p FOR P E R n/) T I hereby affirm that I have a certificate of consent to self CE-818 (2-80) G I!— If— l� b II�I If— If1S IIVU 0 insure, or a certificate of Workers'Compensation lnr-Trance;c: - HEATING-NENTILATING-AllR CONDITIONING a cer ' q , re f(Se 3¢00, Lab.C.1 ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING 9ND SXFETY Certified copy is filed with the county building inspection BUILDING de a�r� t �` FOR APPLICAIVT.TO.FILL IN ADDRESS Date 1nen 6p. Applicant (PRINT OR TYPE ONLY) NO. TYPE OF APPLIANCE OR EQUIPMENT QUIPENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' f COMPENSATION INSURANCE NEAREST 1 }a (This section need not be completed if the work involved ABSORPTION UNIT, BTU O CROSS ST. ���1i�� by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED BY (� I certify that in the performance of.the work for which this AIR HANDLING UNIT,CFM ��.� 0 permit is issued, I shall not employ any person in any manner g- so as to become subject to the Workers' Compensation Laws. BOILER, BTU. - - �_ APPROVALS DATE INSPECTOR'S SIGNATURE - U W Date Applicant'` COMPRESSOR, BTU CL ROUGH /^� NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM !2'�� z Exemption, you. should become subject 'to.the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit'shall be deemed revoked.. FURNACE: Fl z'TI '' AVITY �y LICENSED CONTRACTORS DECLARATION FLOOR: e 00 „ I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code,-and my license is in full force and effect. License Number Lia Class Contractor Date ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered'professional engineer Plan check fee 25%of above. acting in my professional capacity (Section-7051, Bus- iness and Professions Code). PERMIT,ISSUING FEE.$ Lie.or Reg.No. Date TOTAL'FEE elo HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the, Cont'ractor's NAME � � &0'�'a`5 A License Law for the following reason (Section 7031.5, Busi- A 00 41nessand Professions Code): ADORE S , I, as,owner of the property, will do the work and the- EEL.CI NO�kS"'��` 2.o`o 6700 structure is not intended or offered for sale (Section 7044, Business and Professions Code).. I0 0'o 6 7 Q Q= �f v ❑ I, as owner of the property, am exclusively OWNER .contracting � � with licensed contractors to construct the project MAIL �t Q'6 0 W—8 1 (Section 7044, Business and Professions Code). ADDRESS Cf Cf ' ", l%' 10 CONSTRUCTION LENDING AGENCY CITY - CEL.NO. I hereby affirm that there is a construction lending agency w��C for the performance of the work for which this permit is CONTRACTOR`— issued(Sec. 3097,Civ.C.). r L C✓Yv Lender's Name ADDRES ' Lender's Address CIT TEL. IvO� I certify that I have read this application and state that the STATELIC. /� 7 ✓ above information is correct. I agree to comply with all County LICENSE NO. 4:!P"_ CLASS Li— t7t ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection purposes. G%_ /< . A:ae 1-1 1 Signal a of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - ME 0508 0512270012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 37582 UN: 3- 4503 ELLIS IN 1 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804250 ��y ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:LdUv�aZ- 8592-001-049 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C 02 COMPRSR c 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: TOTAL FEES 81.75 12/27/05 JK 06/25/06 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: SOLIS, ALEX (626) 401-2955- ' 4503 ELLIS IN LL L:;, / - TEMP 917804250 DESCRIPTION OF WORK REPLACE ROOF TOP PACKAGE UNIT AIR CONDITIONING AND HEATING SYSTEM APPLICANT: TEL. NO: COMFORT CLIMATE CONTROL (626) 815-1632- 1017 W. FOOTHILL BL SPECIAL CONDITIONS: AZUSA, CA 91702 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE COMFORT CLIMATE CONTROL (626) 815-1632- 1017 W FOOTHILL BLVD. LIC. NO FAU/WALL FURNACE AZUSA, CA 91702 641060020 COMBUSTION 'AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508