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Home My Public Portal About9865 FLAHERTY ST_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA 81 8 (2-80) \ PPL� C A T O®II�I FOR�S I� ERII�%U 0 U • I hereby affirm that F have a certificate of consent to self insure, or.a certificate of Workers'Compensatiorr*Insurance,or H EATING_! kNTIL ATING-AIR CONDITION ONG a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company -. l ❑, Certified copy is hereby furnished; ' COUNTY OF LOS ANGELES / BUILDING AND'SAFM Certified•copy is filed with the county building inspectionBUILDING i FOR APPLICANT TO FILL IN • 9 ��'� �/�'� Date 7/Oz� Applicant (PRINT OR TYPE ONLY)- ADDRESS LOCALITY�•' ��/ �i .� CERTIFICATE OF EXEMPTION FROM WORKERS'- NO. TYPE OF APPLIANCE OR EQUIPMENT FEE //�_lr--v_ n(� T COMPENSATION INSURANCE NEARESTCROSS ST, (/I `� ��rr (�l1,�� / O (This 'section need not be completed if the work involved ABSORPTION UNIT., BTU' I6—ok I I_L by the permit is for'one hundred dollars ($100) or less.) DISTRICT NO. 71111 CESSED BY' 0 I certify that in the performance of the work for which his AIR HANDLING UNIT,CFM permit is issued, I shall not employ any erson in 2 iy m mer v /!`• O so as to h-come subject to the Y�r (err Com em tion .aws. BOILER, BTU � ti APPROVALS DATE INSPECTOR'S SIGNATURE W Dateq_f _Applicant / _ _ _ COMPRESSOR, BTU !� � tL ROUGH SNOT CET APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, 'you should become-subject to the Workers' FINAL �'-3'' — ,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— LICENSED RAV.ITY LICENSED CONTRACTORS DECLARATION FLOOR:_-BTU I hereby affirm that I am licensed under prgvisions of Chapter HEATER: SiIcoENDED UNIT �- 9 (commencing with Section 7000)of Division 3 of th'e Busi- WALL nem and Professions Code, and my license is in full force and feet, / • _3_ —� 'Contractor Date 1 License Number_-__ Lic.Cla�ss/ G - ` // � �ot ❑' I am exempt from�the licensing requuements'as I am a 5.6,5-,31A licensed architect or a registered professional engineer Plan check fee 250 of above. acting in.my professional capacity (Section 70 1•, Bus- - #,o o e:oio 8 iness and Professions Code). PERMIT ISSUING FEE $ O t 1 0 o f �_ _ � TOTAL FEE 0 Lic.or Reg.No. Date__ ,.,_ - � •��'6 HOME OWNER-BUILDER DECLA ATION 2 O,5 O= P aN CHECK APPLICANT o o,o v . I hereby affirm that I, am exempt from- the Contractor's N'„M? 1 0.9,2 8-i8 3 License Law for the following reason (Section 7031.5, Busi- L O��1�� ness and Prbfessions Code): A 3DRE?S j�s 1` �y A->�C�; El I, as owner of the property, will'do.the work and the' 'structure- is not intended or offered for sale (Section CITY /,7 J� �y-1/+ /' , \N0�9�'�� .,7944,-Business and Professions Code). OWNER' , I, as owner of tfie property, am exclusively contracting with licensed contractors to construct the project' MAIL' (Sectiop 7044, Business and Professions Code). ADDRESS ! Jj I (j _ It�1�..IT Y T'rlrll � �EL.NO. CONSTRUCTION LENDING AGENCY CITY L r�G 1 1 �/1r) I hereby affirm that there is a constfuction lending agency CONTRACTOR for the performance of the work -for which this,permit is 0 issued(Sec. 3097,Civ.C.). -— Lender's Name ADDRESS',�� Lender's Address CITY�'�T i ru►2”, (a� 3)�L�°�� I certify-that I have read this application and state that the STATE ! LIG. above information is correct. I agree•to comply with all County LICENSE NO. ( CLASS ordinances and State laws regulating Heating. Ventilating and Air Conditio ing, and hereby authorize representatives of this SEE-REVERSE FOR•EXPLANATORY LANGUAGE (',unty to enter uprn the above-mentioned pro tray for rispe�t r�"urpo•es � � ,, .. - .. - ' . " Signature of Permittee Date — firm that I have COMPENSATION ate of consent to 76A346DPW9/89 APPLICATION FOR PERMIT LIME GREEN, 76A364C � I hereby affirm that I have a certificate of consent to self insure, or ancertificate of worker's Compensation Insurance, or a certified HEATING -VENTILATING -AIR CONDITIONING copy thereof(Sec.3800 Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �- Certified copy is-filed with the county buildi inspection PRINT OR TYPE ONLY � ADDRESS 0art ent. ( ) Date L Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION M WORKERS' NEAREST CROSS ST. C COMPENSATION INS RANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the 'n MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM L DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this'permit is issued, I shall not employ any person in any manner so as to BOILER,BTU ,J� f9�j Als become subject to the Workers' Compensation Laws. fir' COMPRESSOR,BTU G...7 APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER / FINAL provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,,and my license is in full force and effect. License Number • �" Lic.Class �2d — ^ ► O ContractoY `~�Date C— U ❑ 1 am ex pt under sec. Plan check fee o B.&P.C.for this reason PERMIT ISSUING.FEE$ Z4 75 0 Date: TOTAL FEE 7/ 25 LU Signature CLI.(n OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CO I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER _ ❑ 1, as owner of the property, am exclusively contracting ':•` °� ` MAIL , with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for �` ,he performance of the work for which this permit Is issued CONTRACTOR �i rid�/v b - (Sec.3097,Civ.C.). _f i ADDRESS S-7 Lender's Name CITY C /` TEL.NO. Lender's Address STATE `-Y r ( LIC. �J I certify that I have read this application and state that the above LICENSE NO. CLASS 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 the above-mentioned prop ty for i spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Q SIGNAT TF APP11CANT OR AGE F DATE ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1203070004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 265-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 18002 LT. 18 I 9865 FLAHERTY ST 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801711 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15385-025-021 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl I 102 COMPRSR < 100 KBTU 1.00 COM 27.00 I I ITENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 11SSUED ON: PROCESSED BY: PLAN BY: 1 130 AIR INLETS/OUTLETS 7.00 UNI 30.80 103/07/12 SR I I TOTAL FEES 112.60 I_ 1 1OWNER: TEL. NO: I IFINAL DATE FI BY: CODE: 1 1PAZ, WILLIAM (626) 309-6067- 1 I \ �1 19865 FLAHERTY ST 1 1 _ v ITEMP 917801711 1 IL17SCRIPTION OF WORK 1 I ICHANGE OUT A/C AND HEATING SYSTEM AND 7 AIR INLETS 1 I I I I 1APPLICANT: TEL. NO: IDUEK, LIOR (818) 845-0777- SPECIAL CONDITIONS: 1 1CONTRACTOR: TEL. NO: 1 IA P.gVALS DATE INSPECTOR SIGNATURE 1 (AIR TECH HEATING AND A, C, INC. (818) 845-0777- _ I 2514 N GLENOAKS BLVD LTC. NO - - i FAU/WALL uFURNACE BURBANK CA 91504 897430 C20 I ICOMBUSTION AIR OPENINGS 1ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK I I I 1 LIC. NO: 1 IAC/COMPRESSOR 1 I I I I I I I I ITHERMOSTAT I I I I I I I I I 1 IFIRE DAMPERS I I I I I_ I I I ISMOKE DETECTION DEVICES I I I I CON'siERCIAL HOOD 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 I I I I I 1 (REPORT ID: DPR264 ROUTE TO: BS0508 I I I I