HomeMy Public PortalAbout4881 FRATUS DR_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA 818C(2 BO) ° p p L� pC� p®� FOR f�C G�3�Vli p�f'
I hereby affirm that I have a certificate of consent to self
insu+_:, or a c,•rtificate of Workers'Compensation Insurance,or HEATINGVENTIL,ATIRIw-AlR CONDITIONONG
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a certified copy thereof(Sec 3800, Lab C)
Policy No Company COUNTY OF LOS AN ELES'� BUILDING AND SAFETY
Certified copy is hereby furnished � �
ElCertified copy is filed with the county building inspection c
department FOR APPLICANT TO FILL IN BUILDING
Date— Applicant (PRINT OR TYPE ONLY) ADDRESS �-
CERTIFICATE OF EXEMPTION FROM WORKERS' NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
COMPENSATION INSURANCE NEAREST
(This section need not be completed If the work Involved ABSORPTION UNIT, BTU CROSS ST164V ?_AI&sa_9 �p Q� 0
by the permit is for one hundred dollars ($100) or less) DISTRICT 6—
NO ((_11 PROCE� -� U
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM
00 cc
permit is issued, I shall not employ any person in any manner G
so as to become subject to the Workers' Compensation Laws BOILER, BTU F—
APPROVALS DATE INSPECTORS SICNATU _ a
W
Date Applicant COMPRESSOR, BTU
ROUGH Cn
NOTICE TO APPLICANT ,If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth-
with comply with EVAPORATIVE COOLER' VALIDATION
such provisions or this permit shall be
deemed revoked
FURNACE FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Bust` WALL
ness and Professions Code, and my license is in full force and,
effect
License Number Lic Class
Contractor Date /
PI am exempt from the hcensmg'requirements as I am a
licensed architect or a registered professional engineer Plan Check fee 25%of above
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code) PERMIT ISSUING FEE$ �I
Lic or Reg-No Date -TOTAL FEE I
HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's NAME ;-9: '0'0 410 7 A
License :,aw for the following reason (Section 7031 5, Bust- �9 r
ness d Professions Code) ADDRESS g� , ��- , # e)o'o 0 0 $
I, as owner of the property, will do the work and the ��� oto
Structure is not Intended or offered for sale (Section CITY , LC L.� TEL NO ` 2 2,7,0 0
7044, Business and Professions Code) P en. f- - _ 7�(D67 '0 =
a ;e 27.00
OWNER t- v
I, as owner of the property, am exclusively contracting __C(/fL _ o��
with licensed contractors to construct the project MAIL 0,7,2,0'-8 1-
(Section 7044, Business and Professions Code) ADDRESS _
CONSTRUCTION LENDING AGENCY
CITY TEL NO ' t
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 ADDRESS
Lender's Address CITY NO
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
ispecti<i rl pues
of
oignature "e mit ee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1108090007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
(LEGAL ID FEES PAID 1 BUILDING ADDRESS 1
ITR 22321 IT 12 I 4881 FRATUS DR I
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803718
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET RIO HONDO I
18590-030-037 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY, Cl
IO2 COMPRSR < 100 KBTU 1 00 COM 27 00 I 1
ITENANT 108 FURNACE/HEATER <100 1 00 UNI 27 00 (ISSUED ON PROCESSED BY PLAN BY
I 130 AIR INLETS/OUTLETS 10 00 UNI 43 50 108/09/11 VG
I I TOTAL FEES 125 30 1 I
1OWNER TEL NO I IF DATE F CODE I
ITODA MASAFUMI,EIKO (626) 285-0311- I I
14881 FRATUS DR 1 I I
(TEMP 917803718 1 (DESCRIPTION OF WORK 1
I IA/C CHANGE OUT, CHANGE OUT AND RELOCATE FAU FROM CLOSET TO
I I (ATTIC, REPLACE DUCTING
(APPLICANT TEL NO 1
ICONTRERAS, CARRA (626) 286-3157-
I 1SPECIAL CONDITIONS I
I
(CONTRACTOR TEL NO JAPJROVALS I D INSPECTOR SIGNATURE I
ICONNOR AIR CONDITIONING (626) 286-3157- I
I
14931 ENCINITA AVE LIC NO I (FAU/WALL FURNACE
II
(TEMPLE CITY, CA 91780 403735 CIO II 10N
ICOMBU-TION AIR OPENINGS I
(ARCHITECT OR ENGINEER TEL NO 1DUCT WORK I 1
I -
1 LIC NO IAC/COMPRESSOR
ITHERMOSTAT I I I
(FIRE DAMPERS I I
I (SMOKE DETECTION DEVICES I I I
I 1 (COMMERCIAL HOOD
I I I
I I I I
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(REPORT ID DPR264 ROUTE TO BS0508