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Home My Public Portal About9933 HOWLAND DR_Mechanical__ WORKEf3'S COMPENSATION DECLARATION 20-0046 DPW 9/89 �n p� � I hereby affirm that I have'•a'certificate of consent to self insure, 76A364C Qlf'I L�DCL=dTO®M FOR ERN MAE I, II or a certificate of Worker's Compensation Insurance, or a certified ' HEATING -VENTILATING -AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No COUNTY Company 'DEPT E�It7 COUNTY OF LOS ANGELES `DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV:c ❑. Certified copy is hereby furnished. Certified co is filed with the count building inspection FOR APPLICANT TO FILL IN - . BUILDING PY Y 9 P ADDRESS,: department. (PRINT OR TYPE ONLY) Date Applicant 1 NO. TYPE OF APPLIANCE OR EQUIPMENT ;FEE LOCALITY G"'i I � CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. .,' .4\/i5 ` ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the pr i Q MAP BOOK PAGE PARCEL permit is for'one hundred dollars($100)or less.) AIR H N L N UNIT,CFM J (o _ DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit n ' is'issued, i's-hall not employ any person in any manner so as to BOILER,BTU �( x become subject to the Workers'Compensation Laws. COMPRESSOR,BTU APPROVALS DATE• INSPECTOR' SIGNATURE , .Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Ezemption,.yqu should become subject•to the Workers'Compensation EVAPORATIVE COOLER ,provisions of the Labor Code, you must forthwith comply with such FINAL :provisions or this permit shall be deemed revoked.., FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATI 11I. 'I hereby affirm that] am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. r License`Number Lic.Class Contractor Date.L•—� _; .: . ', - - . - ACCT 8 - .. v ❑ I am exempt under Sec. Plan Check fel? ��a O On a:o._ B.&P.C.for this reason PERMIT ISSUING FEE$- Q Date: TOTAL FEE D; 0 1 ITEflS ' a, Signature OWNER-BUILDER DECLARATION - PLAN CHECK APPLICANT• .. ''': TOT50,Z_ I hereby affirm that,I am exempt from the Contractor's License Law NAME CHECK - 80.50 for the following reason (Section 7031•.5,Business and Professions- D L► f f!(0"1 Code): ADDRESS GRANGE , o0 ❑ I, as owner-of the property, or my employees with wages , as their:'sole compensation, will do the work bM the CITY TEL.NO. i structure is not-intended or offered for sale (Section 7044, fltZflft_O(1A1 1/17/70`' Business and Professions Code). OWNER �p VULp/U VV i AAMMo ❑ 1, as owner of the property, am exclusively contracting MAIL ^ 4293 1 °. HI I' 70-50 with licensed.contractors to construct the,project (Sec- ADDRESS qJ tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL.NO. I hereby affirm that there is a construction lending agency for CONTRACTOR i the performance of the work for which this permit Is issued _ (Sec.3097.Civ.C.). ADDRESS ] 1: " Lender's Name y CITY. C4 - .. TEL O.'6 27 Lender's Address STATE Q LIC. vV cc t 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 pro ,r TNpecl2Murp as. SEE REVERSE FOR EXPLANATORY LANGUAGE I S194ATURE OF APOR GENT DAT - .• " - -- - •. f- 0-0046 WORKER'S COMPENSATIONDECLARAT,ION j6A364C QI�I�L�D�W��®Iltl �®� Pl��DPW 9/89 I hereb laffirm tkat I hays a certificate Df consent to self insure, LINE GREEN ' or a cer?ifica'te of Woiker's Compensation Insurance, or a certified _ HEATING -VENTILATING -AIR CONDITIONING copy thereof.(Sec.3800 Lab.C.) Policy NO.73E516V Company �E �l.U.'M COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY,DIV. El Certified copy is hereby furnished. Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUIL department. „, ,e 1 Ii/LJ,� (PRINT OR TYPE ONLY) •Date -V ' Applicanr•t = '✓r—r""-'—r NO. TYPE OF APPLIANCE OR EQUIPMENT' FEE LOCALITY / CERTIFICATE.OF EXEMPTION FROM WORKERS' NEAREST l COMPENSATION INSURANCE ABSORPTION UNIT,BTU CROSS ST. This section need not be completed if the work involved b the ASSESSOR ( ey P . MAP BOOK 7 PAG�•5 PARCEIQI permit is for one hundred dollars($100)or less.) - AIR HANDLING UNIT,CFM - DISTRICT NO. PROCESSED BY . I certify that in the performance of the work for which'this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU f� '• become subject to the Workers' Compensation Laws, O • COMPRESSOR,BTU - APPROVALS• DATE' .INSP TOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO,APPLICANT: If, after making this Certificate of ROUGH, Exemption,you should become subject'to the Workers'Compensation EVAPORATIVE COOLER .'provisions of,the Labor Code, you must forthwith comply with such FINAL'” provisions or this•permit shall be deemed revoked. FURNACE: FAU GRAVITY - LICENSED CONTRACTORS DECLARATION. FLOOR BTU d o lv 101 'I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the.Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number, Lia CIass �f D Contrac6_/ tor Date a am exempt under Sec. Plan Check fee �+J�+� fYJnU O BAP.C.for this reason PERMIT ISSUING FEE$ lj �1, :1 ITEMS 0 Date: TOTAL FEE' tl �Signature C a '• PLAN CHECK APPLICANT - - (A OWNER-BUILDER DECLARATION CHANGE Z I hereby affirm that'I am'exempt from the Contractor's License Law NAME CHANGE X0. for the following reason (Section 7031.5, Business and'Professions -Code): ADDRESS /o - I, as owner of the property, or my employees with wages 0000'0001 vl 1!.7 J as their sole compensation, will do the work and the CITY TEL.NO. _, a i structure is not intended or offered for sale (Section 7044, 1635 .1 Ail10:01 Business and Professions Code).: OWNER i 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). CONSTRUCTION LENDING AGENCY CITY' TEL.NO Q I hereby affirm that there is a construction lending agency for CONTRACTOR./ D the performance of the work for which this permit Is issued (Sec.3097,Civ. C.). ADDRESS 9 Lender's Name CITY �, _ TEL.NO. — o 7 Lender's Address STATE LIC. 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 pro r.inspectio Grp at?s. SEE REVERSE FOR EXPLANATORY LANGUAGE SIG A PLI RNTDA COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0811130001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS': ITR: 6755 LT: 18 9933 HOWLAND DR I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803235 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18589-005-014 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I 141 VENTILATION FAN 1.00 FAN 15.75 (TENANT:. 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I I TOTAL FEES 70.50 111/13/08 SR 05/12/09 I I I I I (OWNER: TEL. NO: (FINAL DATE FINAL BY: CODE: IMARKIS, TED/MARIA 19933 HOWLAND DR 1 I I I (TEMP 917803235 I (DESCRIPTIONOF WORK I (ALTERATION F EXIST DUCT SYSTEM AND VENTILATION FAN I I I I I (APPLICANT: TEL. NO: I ILUIZ R. NUNEZ ASSOC. (626) 284-0055- 1 1324 LOS HIGOS ST. I ISPECIAL CONDITIONS: 1 IALHAMBRA, CA 91801 1 I I I I I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IRON OWENS (626) 285-7725- 1 1 15924 N. RENO AVENUE LIC. NO I IFAU/WALL FURNACE I I I ITEMPLE CITY, CA 91780 2763461 _ 1 I 1 (COMBUSTION AIR OPENINGS 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I (DUCT WORK I I I I 1 11 1 LIC. NO: I IAC/COMPRESSOR I I I 1 ITHERMOSTAT I I I I I I I 1 1 IFIRE DAMPERS 1 1 1 1 1 1 I 1 (SMOKE DETECTION DEVICES I I 1 (COMMERCIAL 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 1 I 1 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 I I I I I I I I I I I I I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 I 1 I I I