The URL can be used to link to this page

Home My Public Portal About9650 LA ROSA DR_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION PLICA TION FO^ PERMIT Y her/Nifaffirm that I have a certificate of consent to self /'1 r f1 1 �( PERMIT insure, or a certificate of Workers'Compensation Insurance, )6A964C HEATING - VENTILATING • AIR CONDITIONING or o certified copy thereof (Sec. 3800, ab:C.) �E q18(REV. 10/BI) - Policy NCompan 5� //dlU ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY . 23�Certifi d c y is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDwG / .- tion epa men,. (PRINT OR TYPE ONLY) ADDRESS DateApplicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE �Q CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST '^T �e Blv COMPENSATION INSURANCE CROSS ST. msiRla No. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU I PRESSED the permit is for one hundred dollars($100) or less.) AIR HANDLING UNIT, CFM 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 become subject t0 the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INS ECTOR'S SIGN URE Date Applicant - COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL tl Exemption, you should become subject to the Workers' 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 FATE GRAVITY LICENSED CONTRACTORS DECLARATION - FLOOR BTU — I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED WALL - UNIT_ '(commencing with Section 7000) of Division 3 of the Business � and Professions Code,and my license is in full force and effect. 1 iv o� o License Number Lic. Class s /� V ContractW x`^^/v � 0 ❑ 1 am exempt under Sec. rVir Plan check fee y B.&P.C. for this reason' PERMIT ISSUING FEE $ Z Date: Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): n ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section - -r c- 7044, Business and Professions Code). - - -- IJ I,f OWNER 3M A ❑ I, as owner of the property, am exclusively contracting MAIL i .i�rC with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS50 CONSTRUCTION LENDING AGENCY CITY //��' TEL NO. ,(� / I hereby affirm that there is a construction lending agency for 'sw /e v^' /`i - ,�i1__ti f the performance of the work for which ,his.permit is issued CONTRACTOR (Sec. 3097, Civ. C.). .. ADDRESS 'Al a,44 Lender's Name _ _ CITY TEL. NO. I-' '1 f c/ j/" Lender's Address _ � / LIC. I certifythat I hove read this application and state that the STATE �E pLICENSE NO d CLASS above information is correct. I agree e to comply with all County ordinonces and State laws relating to building construction, and hereby authorize representatives of this County.to enter upon the abo e-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0511090024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 14467 LT: 76 9650 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803860 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 8589-017-024 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 30 AIR INLETS/OUTLETS 10.00 UNI 43.50 11/10/05 JK 05/09/06 41 VENTILATION FAN 2.00 FAN 31.50 OWNER: TEL. NO: TOTAL FEES 156.75 FINAL DATE FINAL BY: CODE: HEASLIP SCOT W;OLACHEA-HEASLIP ROSE (626) 286-3922- /� 9650 LA ROSA DR TEMP 917803860 ' DESCRIPTION OF WORK INSTALL AIR CONDITIONING AND HEATING SYSTEM APPLICANT: TEL. NO: HEASLIP (626) 286-3922- - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE TOM O'LEARY CONSTRUCTION (626) 287-0927- _ 5823 AGNES AVENUE LIC. NO PAU/WALL FURNACE TEMPLE CITY, CA 91780 489354 B-1 COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508