HomeMy Public PortalAbout9506 FLAHERTY ST_Mechanical__ ION
WOthat I h ve a certificate
of consent to 76A346DPW9/69 APPLICAT�iON FOR PERMIT LIME GREEN
76A364C
I herebyriaffirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof ec.3800 ab.1161q3C.) 1J
Policy No. r Company S, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
Certified copy is filed with the counly building i(spectiop FOR APPLICANT TO FILL IN BUILDING
de rtment. (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
Date Applicant �Jl NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM R CERS' NEAREST
• COMPENSATION INSURANCE ABSORPTION UNIT,BTU CROSS ST.
(This section need not be completed if the work involved by the ASSESSOR
MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.)
AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws. I �
COMPRESSOR,BTU
000
Date Applicant VENTILATION SYSTEM
APPROVALS DATE INSPECTOR'S SIGNATURE
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. I FURNACE: FAU V
.LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER:
WALL-
Professions Code,and my license is in full force and effect.
License Number 6 Lia Clas q
§CCT°s C.
Contract Date -�-�) -r
125.25 0
❑ Plan check fee
I am exempt under Sec. ,
B.BP.C.for this reason PERMIT ISSUING FEE$ 0
Date: TOTAL FEE LU
i ITEMS a
Signature �
PLAN CHECK APPLICANT A{
OWNER-BUILDER DECLARATION TIlTI-11 ��� �� �
s .. o .a _
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions , CHECK 125°25
Code):
❑ ADDRESSCHANGE
H r
I, as owner of the property, or my employees with wages QU� °
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale (Section 7044, ((�jyy'��(f'ttff'yy 4001
Business and Professions Code). OWNER / / ) �j+t�4 V 1� �yJb q�+
I, as owner of the property, am exclusively contracting I (� +/OOtt__
MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
in
CONSTRUCTION LENDING AGENCY CIT TEL.NO.
I hereby affirm that there is a construction lending agency for CONTRACTOR ,
the performance of the work for which this permit Is issued
Ir
(Sec.3097, Civ.C.).
ADDRESS
Lender's Name
CITY TEL.NO
Lender's Address STATE J
LIC.
1 certify that I have read this application and state that the above LICENSE NO. ' CLAS
information is correct. I agree to comply with all County ordinances
and State laws relat' to building construction,and hereby authorize
representatives o this County to enter upon the above-mentioned
pro t for insp ction ur o es.
�� SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPL NT O AG NT I DATEf
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0107090001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID BUILDING ADDRESS:
TR: 17179 LT: 12 9506 FLAHERTY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801643
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: PRIMROSE
5385-008-012 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
31 AIR INLETS/OUTLETS 2.00 SQ 37.05
TENANT: TOTAL FEES 64.80 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
07/09/01 UT 01/05/02
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
DELLAQUILA CAROL J (626) 287-5501-
9506 FLAHERTY ST
TEMP 917801643DESCRIPTION OF WORK
410 ADDITION (FAMILYRM, 3/4 BATHRM, & LAUNDRY) KITCHEN REMOD
APPLICANT: TEL. NO:
O'LEARY -
5823 AGNES SPECIAL CONDITIONS:
TEMPLE CITY
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
TOM O'LEARY CONSTRUCTION (626) 287-0927-
5823 AGNES AVENUE LIC. NO - FAU/WALL FURNACE
TEMPLE CITY, CA 91780 489354 B-1
COMBUSTION AIR OPENINGS
4
ARCHITECT OR ENGINEER: TEL. NO:
DUCT WORK
LIC. N0: �._ AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
E9M�RGIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508