HomeMy Public PortalAbout9075 EMPEROR AVE_Mechanical__ WQRKERS'COMPENSATION DECLARATION CEA 8$(2-Bo) \ p p�OCA �.7�O N FO G� P E R L� T
I hereby affirm that I have a' certificate of consent to self j�
insure, or a certificate of Workers'Compensation Insurance,or HEA75NG-VENTIL.ATING-AIR (CO`GJD07110NO MG U
C d f(Sec. Rnn, t al, r)
'W'84-040760 Fremont Indemnity
Policy 1Jo. Company
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUV LDING AMD SAFETY
CITY OF TEMPLE CITY
AJ Certified copy is fired with the county building inspection FOR APPLVCANT TO FILL IN BUILDING �..j�p ����-���r\ ��'•
denartment ADDRESS �4 9075 Emporer,
Date_3/20./,lpplicant (PRINT OR TYPE ONLY)
CERTIFICATE OF XEMPTiON FROM WORKERS'
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY TempleC1.ty
COMPENSATION INSURANCE NEAREST >_
CROSS ST.
(Phis section meed n3'c be con:,Ie_'ed if the work involved ABSORPTION UNIT, BTU I � C)
by the permit,is fez one hur.6red do'Iz-s ($103) or.less.) DISTRICT NO. PROCESS ' BY U
1 certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner AIR HANDLING UNIT,CFM
so as to become subject to the Workers' Compensation Laws. BOILER, BTU
X1/10 APPROVALS DATE INSPECTOR'S S1 TURE LUU
Date Applicant 1 COMPRESSOR,BTU_Ll}2_,_0_0_O .5 0ROUGH
NOTICE TO AP?LICANT: If, after making this Certificate of VENTILATION SYSTEM
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 EVAPORATIVE COOLER VALtDAToO
deemed revoked. FURNACE: F CF._r�
LICENSED CONTRACTORS DECLARATION � 1 FLOOR: -- BTU_lOOM
I hereby affirm that i am licensed under provisions of Chapter I HEATER:. SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Busi- WALL
ness and Professions Code, aaL`my license is in full force and
• License NumbE?61695 Lic.Class C20
Coara&J Htg & A/C Date 3/2/81
® 1 am exempt from the iicensing 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- i PEff�f�dOT ISSUING FEE 7.00
iness and Professions Code).
Lie.or Reg.No. Date I TOTAL FEE 37.00
HOME OWNER-BUILDER DECLARATION I�PLAN CHECK APPLICANT
I hereby affirm 'chat I am exempt from- the Contractor's NAME
License Law for the fn^owing reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
1, as owner of the property, will do the work and the TEL. NO.
structure is not intended .or offered for sale (Section CITY
7.044,Business and Professions Code). `
OWNER 24 4'9.6 A
I, as owner of the property, am exclusively contracting J_otm Se 11
with licensed contractors to construct the project MAIL # ®,O:o ® 41
(Section 7044, 'Business and Professions Code). ADDRESS 2023 Bella Vista
CONSTRUCTION LENDING AGENCY I CITY Arcadia TEL. NO.445-2772 2 37,10 0
I hereby affirm that there is a construction lending agency =
for the performance of the work for which this permit is CONTRACTOR J & J Htg & A/C- °;°1° 33.0 0 r,
issued (Sec. 3097,Civ.C.).
Lender's Name ADDRESS 2379 First St. , .0 3.2 3'=8 1
Lender's Address CITY
Laterne TEL.NO.3.39- 011
I certify that I have read this application and state that the STATE7 LIC" C20
above information is correct.i agree to comply with all County LICENSE N0261695 CLASS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning, and hF— y authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upo i U e ab r e-mentioned property for
:..f�oeetr Pur ,'.se:�t
Signature of Permittee Dat20/81
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1306030020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID BUILDING ADDRESS: 1
ON FILE I 9075 EMPEROR AV I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ! SGAB CA 917752016
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
15382-012-037 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: Hl LOCALITY: TEMPLE CITY, Cl
102 COMPRSR < 100 KBTU 1.00 COM 27.00 - I
(TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: I
I I TOTAL FEES 81.80 106/03/13 SR
I i I I
(OWNER: TEL. NO: j IF DATE FI AL BY: CODE:
ICHENG, PAUL (626) 372-9180- I 100, I
19075 EMPEROR AV I I I
ISGAB 917752016 i ID SCRIPTION OF WORK I
I IREPLACE EXISTING FURNACE & COIL IN GARAGE REPLACE EXISTING I
I IA/C AND DUCTS I
1APPLICANT: TEL. NO: I
IPISANO, ROSS (626) 286-1141- I I -
11350 E LAS TUNAS DR I ISPECIAL CONDITIONS:
ISAN GABRIEL CA 91776
4W T -1'7-95
(CONTRACTOR: TEL. NO: I AP15ROVAAS DATE I SPEC O7-97GNAT19REI1
IBRYANT HEATING AND AIR CONDITIONING (626) 286-1141- 1 I
11350 E LAS TUNAS DRIVE LIC. NO FAU/WALL FURNACE 1 I
(SAN GABRIEL CA 51776 948151 1I
(COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER: TEL. NO: I (DUCT WORK I I I
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I LIC. NO: I IAC/COMPRESSOR 1 I
I � I THERIMOSTAT 1 I I
(FIRE DAMPERS II
ISMOKE DETECTION DEVICES I
I COnlXRRCIAL HOOD I I
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I 1* ADDITIONAL DATA ON FILE
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I !REPORT ID: DPR264 ROUTE TO: BS0508 I i