Loading...
HomeMy Public PortalAbout8905 LAS TUNAS DR_Mechanical__ WORKERS'COMPENSATION DEC RATION CEA 818(2-80) o, p F�p cI Q� 0 O N FOR P E R PA0f I hereby affirm that I have a' certific t of consent to self insure, or a certificate of Workers'Con p s. io I urance,or f�C A7MG9-�fL�4 7l LA7IHG-A1R C(0HDO�O®O�I0MG ac- r /Cope©o /;p„380 „La P y N-. Cc m�pany� ❑�Corflfied copy is hereby furnished. �/ COUNTY OF LOS ANGF"_FS �' MLDONG AMD SAFETY e copy is filed with r`. co ,ty uill inspe depart vent. FOR APPLICANT TO FILL IN BUILDING�O�/� Dat/e �pplica t_ (PRINT OR TYPE ONLY) ADDRESS ' LOCALITY��i„- C',RTI I_ E OF EXEMPTION'FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE _ � COMPENSATION INSURANCE NEAREST (This section need not be completed if the work involved ABSORPTION UNIT, BTU — CROSS ST. a0 by the permit is for one hundred dollars ($100) or less.) DISTRICT NO, PROCESSEr U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM C /y permit is issued, I shall not employ any person in any manner /�!"! t so as to become subject to the Workers' Compensation Laws. BOILER, BTU H APPROVALS DATE INSPECTOR'S SIGNATUhE (� Date Applicant COMPRESSOR,BTU N ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' _ FINAL r 0 Compensation provisions of the Labor Code, you must forth- VAPORATIVE COOLER I I ATION with comply with such provisions or this permit shall be .�y 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 Busi- WALL ness and Professions Code, and my license is in full force and effect. License Num'-�r� Lia Class /}� Contract ZG/f/k'' Date_/(/ _cz� j I am exempt from the licensing requi aments l am a P >� g 9 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). PFRi1flI7 OSSOING FBF $ Lie.or Reg.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I • 1 hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ❑ 1, as owner of the property, will do the work and the CITY TELNO structure is not intended or offered for sale (Section 1 7 1,b A. 704 . . ;'4, Business and Professions Code). ❑ OWNER /ll I, as owner of the property, am exclusively contracting # 0_0 010 0 8 with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESSg�____e�I'� 2 °'° 2t7 CONSTRUCTION LENDING AGENCY CITY�j�yyr� �' TEL.NO. 27.000' o.0 0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR I 0 2 8—8 issued(Sec. 3097,Civ.C.). Lender's Name ADDRESS Lender's Address CITY C /TEL. I certify that I have read this application and state that the STATE LIC. above information is correct.I agree t comply with all County LICENSE NO. _ CLASS G� ordinances StateState laws regulati Heating, Ve tilatmg and Air nditio Itk, and hereby aut., I.e represent trues of this SEE REVERSE FOIL EXY,ANATORY LANGUAGE C my to er ter on the we- ention'd roperty or i spection puri s�.. ^ � / • nab _of._ rmittee Date U / WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or as ccerrrttiff' d coy thereof (Sec. 3800, Lab. C ) 76A364C o-1ty No �� �OCompa ��2c` ���'JA"CE-818(REV. 10/81) T, `p ❑ Certified copy is hereby furnisi �&' iw_jr/ d COUNTY OF LOS ANGELES - {/6 BUILDING AND SAFETY Certified copy Is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING �� I „ ���s tion department. (PRINT OR TYPE ONLY) ADDRESS x::� � Datel a�y� ALOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CERTIFICCOMPENSATION INSURANCE ORKE S' CROSS ST (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED Y ' 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 BOILERBTU so as to become subject to the Workers'Compensation LOWS. , APPROVALS DATE INSPECTOR'S SIGNATURE o rrlJ Date Applicant COMPRESSOR, BTU O d ROUGH _-A X 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- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE FAU G AVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU 6d I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business WALL and Professions Code, and my license Is in full force and effect. / dl oa O License Number f�rlly Llc Class 4C:5;' JrV Contr O H I am exempt under Se Plan check fee Ij H B.RP.0 for this reason PERMIT ISSUING FEE $ 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) E] 1, as owner of the property, or my employees with ADDRESS S% S. A wages as their sole compensation,will do the work and CITY TEL NO 0 C o C the structure Is not Intended or offered for sale(Section 7044, Business and Professions Code) ' OWNER d� lG 4 O ❑ I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS 7- tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY CITY ��G TEL NO JGO��v'y Ll Q—El L! I hereby affirm that there is a construction lending agency for r the performance of the work for which this permit is Issued CONTRACTOR (Sec 3097, Civ C ). f Lender's Name ADDR Lender's Address TEL NZet-1-0s'.71 STATE ! LIC I certify that I have read this application and state that the LICENSE NO `���� CLASS G-dam above Information Is correct I agree to comply with all County ordinances and State jaws relating to building construction, and hereby authorize representatives of this County to enter pan the above-mentioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or ent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0506 MECHANICAL PERMIT ' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0912150016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID I BUILDING ADDRESS: 1 ITR 362 LT O1 1 8905 LAS TUNAS DR I I IFEE DESCRIPTION. QUANTITY: UOM: AMOUNT. 1 TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15387-012-028 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 1 130 AIR INLETS/OUTLETS 1.00 UNI 4.35 1 1 (TENANT: 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON- TOTAL FEES 59.10 112/15/09 SR 12/15/10 1 (OWNER: TEL. NO: IFINAL AAl FIN CODE• ICHASE BANK 18905 LAS TUNAS DR. I v ITEMPLE CITY CA 91780 1 1D SCRIPTION OF WORK I I I ITENANT IMPROVEMENT PROVIDE EW DIFFUSER AND DUCT WORK FOR 1 (CHASE BANK (APPLICANT: TEL. NO: I I ITERRELL LANGSTON (PERMIT PLACE INC. (818) 786-8960- 1 113400 RIVERSIDE DR. ISPECIAL CONDITIONS: SHERMAN OAKS 91423 1 I 1 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I 1DBSI INC (602) 264-7263- 1 1 1 16950 W MORELOS PLACE LIC. NO 1 1FAU/WALL FURNACE 1 1 1 ISUITE 1 931142 B 1 1 11 1 CHANDLER, AZ 85226 I ICOMBUSTION AIR OPENINGS 1 1ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK INUDELL ARCHITECTS (714) 979-8100- 1 1 1950 SOUTH COAST DRIVE LIC. NO: 1 1AC/COMPRESSOR 1 I 1 ISUITE 150 C-30699 1 I I I 1 ICOAST MESA, CA 92626 1 ITHERMOSTAT I 1 1 IFIRE DAMPERS I I I I 1 ISMOKE DETECTION DEVICES 1 I I ICOMMERCIAL HOOD I I 1 I I I 1 I I I I I I I I I I 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 1 I I I I I 1 IREPORT ID: DPR264 ROUTE TO: BS0508 1 I I I I I ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1212030030 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: 1 ITR: 362 LT: 01 I 1 8905 LAS TUNAS DR 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT- 1 TEMP CA 91780 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 15387-012-028 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 1 _135 AHU < 2000 CFM 2.00 AHU 25.80 1 (TENANT: 141 VENTILATION FAN 1.00 FAN 15.80 (ISSUED ON: PROCESSED BY: PLAN BY: 1 CHASE BANK 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 112/03/12 SR I I TOTAL FEES 96.40 1 (OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: I 1CHASE BANK (714) 308-6982- I IDE V 11107 S. HARBOR BLVD. I I IFULLERTON, CA 92832 1 1 SCRIPTI0N OF WORK 1 12 AIR HANDLING UNIT, 1 VENTILATION FAN AND ALTERATION OF 1 I (EXIST DUCT SYSTEM FOR CHASE BANK T/I 1 1APPLICANT: TEL. NO. 1 I 1 (YARN, JUDY (626) 675-9882- 1 1 1 1392 N. LE MAY COURT . I ISPECIAL CONDITIONS: 1 (ORANGE, CA 92867 1 I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 1DBSI INC (602) 264-7263- 1 1 1 16950 W MORELOS PLACE LIC. NO I IFAU/WALL FURNACE I I I ICHANDER AZ 85226 931142 * 1 1 I I ICOMBUSTION AIR OPENINGS 1 1 1 (ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK I I I IMORFORD, PAUL (949) 863-9434- 1 1 11 1 14675 MACARTHUR CT, STE 350 LIC. NO: I IAC/COMPRESSOR I I 1 INEWPORT BEACH, CA 92660 931142 * * I 1 1-1 1 1 I ITHERMOSTAT I I I I 1 11 I I IFIRE DAMPERS I I I I I I I I 1 I ISMOKE DETECTION DEVICES 1 1 1 I I I I I I 1 1 1COMMERCTAL HOOD 1 1 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 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 1 I I I I I* ADDITIONAL DATA ON FILE I I I 1 I I I I I I I I I I I I 1 IREPORT ID: DPR264 ROUTE TO: BS0508 I I 1 1 I I I I I I