HomeMy Public PortalAbout6027 IVAR AVE_Mechanical__ Wtj ;CtRS'COMPT.NSATION DECLARATION 76A364C. (off p (gip o no j p �/� y�
r 1 CE -818 (2-80) /rJPirLL KATION FOr- If� L�RUVU1, II
1',I1p, effrm that I have a certificate of consent to self
insure ora certificate of Workers'Compensation Insurance,o-r HEATING-VENTILATING-AIR' CONDITIOR901r G
a certified copy thereof(Seg. 3800,Lab.C.)
Policy No. Company
Certified copy is hereby furnishers. COUNTY OF,LOS ANGELES BUILDING ARID SAFETY
Certified copy is filed with the county building inspection BUILDING
FOR APPLICANT TO FILL IRI `
department; ADDRESS (
Date Applicdnt (PRINT OR TYPE ONLY) J
CERT LOCALIT
CERTIFICATE OF EXEMPTION FROM WORKERS' NO, TYPE OF APPLILINCE OR EQUIPMENT FEE
'COMPENSATION INSURANCE NEAREST: }
CROSS
('phis Section need not be completed if the worlc involved / ABSORPTION UNIT„BTU�� � „j�a✓� ' r"�'� a
by the permit is for One huadred dollars ($100) or less.)' DISTRICT NO. P CESSE BY 0-'
I certify that in the performance of the work for which this' AIR HANDLING UNIT,.CFM ` /L J
permit is issued, I shall.not employ any p son in any roan ,r 1/ 0
so as to become subject-to the W�:sa ,' "or.pensation .a .s. BO'FLER,:STU'
APPROVALS TE INSPE.TO R',>I NATURE .0
� W.
Dat ApplTcanf' — COMPRESSOR,BTU
,.f . ROUGH
NOTICE TO APPLICANT: ff, after making this Certificate f VENTILATION SYSTEM,
FINAL,
. . f Z"
Exemption, you should become subject to the Workers' -
"'
Compensation ptovisions_of the Labor Code, yodmust'forth- EVAPORATIVE COOLER
with comply'.withI such provisions or thi's permit-"shall be VALI A ON
deemed revoked. QI�
FURNACE: FAU A Y
LICENSED CONTRACTORS DECLARATION FLOOR 8TU } -1J- �V
I hareby affirm that,I aril licensed undei:provisions of Chapter HEATER: S.USPENDED UNIT. alO �`�.
9;_(commencing.with Section 7000)of Ihivision 3 of the Busi- WALL
riess and Professions Code, and my license is in full•force and W
effect..
License Number Lic.Class
Contractor Date
9.101,8;A
0 lam exempt from the licensing-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- PERMIT ISSUING FEE $ " 0 0 3(1.5,0
iness and,Professions Code). !!��,
Lic.oi• Reg.:No,- Daae TOTAL FEE' J� �� 0 0 0 3 Q 50 U
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 8 `'8
I li&eby.affirm that I am 'exempt .from- the,Cohtractor's NAME
License Law for the following.reason•(Se7:tion 7031.5, Busi-
nessand.Professions Code): ADDRESS
� .
1, as 'owner of the property,`will do,the work and the
structure is not intended or offered-for sale (Section CITY TEL. NO.
7044;Business and Professions Code).
OWNER
I, as owner of the property, am exclusively contractingE �c�
with licensed .contractors to construct the project„ MAIL.
(Section 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENIJTNG AGENCY
CITY TEL.NO� ?..!• � �I
I r the perforri that .theyh is a construction lending g agency /ter J sv
far the erformance of the work for which this permit is CONTRACTOR g f
issued(Sec. 3097,-Civ.C.). • fFL{�
a.
AMY
Lender s Name ADD RE$S /J2�� �4
Lend er's Address C.ITGIf /1i�✓�i', �� TEL.NO.
I certify that T"have read this application and state"that the STATE LIC.
above information is correct-I agree to comply with all County L•ICENSf NO CLAS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning, and hereby authorize representatives of this- SEE.REVERSE FOR EXPLANATORY LANGUAGE
'Co
?0 9nter upon the r',ve•mentioned property for
1175^^'.J'"'�❑ ^�.dS-�' r }+�% � �- � r ' - - ,
Signature of Permittee Date ,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508`0006120010
> BUILDING AND SAFETY / LAND DEVELOPMENT- TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5904 LT: 119 6027 IVAR AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801522
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN
5386-011-067 01 PERMIT ISSUANCE FEE 27..75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: TOTAL FEES 54.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
06/12/00 UT 12/09/00
OWNER: TEL. NO: FINAL DATE FINAL B E:
YASSINE SAM H;FATMEH N
6027 IVAR AV
TEMP 917801522 DESCRIPTION OF WORK
UPGRADE EXISTING A/C UNIT
APPLICANT: TEL. NO:
KATSOF, ARON (626) 564-9323-
975 E. GREEN ST. _ SPECIAL CONDITIONS:
PASADENA
CONTRACTOR: TEL. NO: �� f�\ APPROVALS DATE INSPECTOR SIGNATURE
TAI HEATING AND A, C (626) 575-0843- fy��
9625 ALPACA ST LIC. NO FAU/WALL FURNACE
S. EL MONTE, CA 91733 506659 C20/
vj \ COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. N0: p� — 1 /rte \ DUCT WORK
AIKD ARCHITECTS (626) 564-9323/ I _ ___
975 E. GREEN ST. #205 LIC. N0. _ _^ I ` AC/COMPRESSOR
PASADENA, CA 91006 C20713'f�! t_ --_� I i _J ��l,ll THERMOSTAT
FIRE DAMPERS
0 Il `� =� i SMOKE DETECTION DEVICES
Li
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508