HomeMy Public PortalAbout9231 LA ROSA DR_Mechanical__ WORKER"COMPENSATION DECLARATION CEA-818.(2-80)
ti 8.2 80) A P P ISS C A T O O N FOR, P E R wU T f�
I hereby affirm that I have a- certificate-of consent to self
insure, or a certificate of Workers'Compensation•Insurance,or ._ HE�ATING-VENTIUAYIRIG-AIR CONDITIONING
a certified copy thereof(Sec. 3800,Lab.C.)
PolicyCompany COUNTY OF LOS ANGELES' BUILDING SAFETY ry
Certirti fied copy is hereby furnished. - - • - •
-certified copy is filed with the county building inspection FOR APPLICANT TO FILL-IN BUILDING
,department.
ADDRESS o5A
Date Applicant (PRINT OR TYPE ONLY) '• —/Z�� ' `�
FEE LOCALITY /rCj
NO. TYPE OF APPLIANCE OR EQUIPME(�lT' 7�
CERTIFICATE OF EXEMPTIQN.FROM WORKERS'
COMPENSATION INSURANCE NEAREST }
.(This section need not be completed.•if.the work involved ABSORPTION UNIT, BTU CROSS ST. O
by the permit is for one hundred dollars ($100).or less.) DISTRICT NO. I PROCESSE9 By U•
I certify that in the performance of the wprk for which this -. AIR HANDLING UNIT,CFM
permit is issued,.I shall not employ any person in n
apy mariner �,/,� � O
so as to become subject to the Workers' Compensation Laws. BOILER; BTU
APPROVALS DATE INSPECTOR'S SIGNATURE U '
BTU_ -OCP �' ROUGH ; W
Date, Applicant COMPRESSOR,
^ W
NOTICE TO APPLICANT: If, after making this Certificate of _ VENTILATIQN SYSTEM fZ
Exemption, you should become subject:•tb the Workers' FINAL
Compensation provisions of the Labor Code, you must forth-
EVAPORATIVE COOLER VALIDATION
Mt-h.comply with "such provisions or this permit` shall be
,deemed revoked. FURNACE: FAU - GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR: BTU,— S Opo /t5'
I hereby affirm that I am licensed under provisions of Chapter' HEATER:. SUSPENDED ONJT
9 (commencing with Section-7000)of.Division 3'of the Busi- WALL
ness and Professions Code, and my;license is in full force and " -
effect.
License Number Lic.Class
Contractor Date
I am exempt from the licensing requirements as`I am a
licensed architect' or 'a registered'professional"engineer`y ' Plan check fee 25%'of'above.
acting in my professional capacity,(Section 705.1, Bus-
iness anddAProfessions Code). PERMIT ISSUING FEE $ ;
Lic,or Reg.,No, Date TOTAL FEE _
HOME OWNER-BUILDER DECLARATION PLAN CHE'CK APPLICANT " �O�ErLr, v'
I hereby affirm that 'I am exempt.from- the' Contractor's NAME -.� %#{opoIo+o o 8
License Law for the following reason'(Section 7031.5, Bausi, >
ness ind Professions Code): ADDRESS 5.0
y2 ; Gf� t�aSi9 2. 3&
I,'-as owner of the property, will do the work and the
structure 'is not intended or offered for CITY q
285!Q
sale (Section 744 C, TEL. NO.
_b,001
_� UT „ !$ 0 0,3"&,5 Q
7044, Business and Professions Code).
OWNER _ 7i�O 2��$.2
ISI I, as oJF
wner of ttie property, am exclusively contracting" E .,�— + 1 -
'with licensed .contractors to construct. the, project MAtr ,
(Section 7044, Business and Professions Code)." ; ADDRESS
a CONSTRUCTION LENDING AGENCY CITY TEL.NO: -
I -hereby affirm 'that there is a'construction•lending agency u
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 TEL.NO
I certify that I have read this application and state ihat'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 authorise representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County tr en onLve above-mentioned property for
inspectit, pup
r se'
sig—Are of Permittee Date, _
o - - COUTZTY OF LDS ANGELES - TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0506240024
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 16475 LT: 104 9231 LA ROSA DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803732
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: FRATUS
8590-010-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID• JS LOCALITY: TEMPLE CITY
03 COMPRSR 101 500 KBTU 1.00 COM 52.20
TENANT: 09 FURNACE 101 500 KBTU 1.00 UNI 52.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
30 AIR INLETS/OUTLETS 3.00 UNI 13 05 06/24/05 JK 12/21/05
47 ALTER EXIST DUCT SYS 1.00 SYS 27 00
OWNER: TEL. NO: TOTAL FEES 172.20 FINAL DATE FINAL BY: CODE•
MAGALLANES, ALBERT/LORI (626) 285-9345-
9231 LA ROSA DR
TEMP 917803732 DESCRIPTION OF WORK
INSTALL AIR CONDITIONING AND HEATING SYSTEM
APPLICANT: TEL. NO:
SAME AS OWNER -
' - SPECIAL CONDITIONS: -
CONTRACTOR: - TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - _-
LIC. NO FAU WALL FURNACE
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
BREIG ARCHITECT (626) 257-8537-
431 CHERRY DR. LIC. NO: , AC/COMPRESSOR
PASADENA CA 91105 NONE
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508