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Home My Public Portal About9103 LAS TUNAS DR_Mechanical__ woRKER'S COMPENSATION DECLARATION 20-0046 DPW 9169 l .eby firm thW.4&have a certificate of consent to self insure, 76A36aC , ►PPLICATION FOR PERMIT LIME GREEN oii��iiia certilicaie of''jWorker's.Compensation Insurance, or a certified t HEATING -VENTILATING-AIR CONDITIONING copy tY-'aof &'c.\3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY-DIV. Certified C`Opy is hereby furnished.`- ❑ Certified copy is filed witli.the county building inspection FOR APPLICANT TO FILL IN BUILD JI i department. - (PRINT OR TYPE ONLY) Date Applicant LOCALITY r NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE,OF EXEMPTION FROM WORKERS' NEAREST • CROSS ST._ COMPENSATION INSURANCE ABSORPTION UNIT,BTU This section need not be,completed if the work involved Y the MAP BOOK PAGE PARCEL b ASSESSOR ( P , permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PocesseD ev 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 become subject to the Workers'Compensation Laws. COMPRESSOR,BTU - - APPROVALS DATE INSPECTOR'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 VALI_ D�j I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT HEATER: T (commencing with Section 7000) of Division 3 of the Business and WALL ACCT. Professions Code,and my license is in full force and effect. , / '/� 3303 16=a !I License Number Lic.,Class C7 ACCT a a e� o Contractor Date ' ❑ Plan check fee �'�.-, 91.50 U I am exempt under.Sec. �' Q B.&P.C.for this reason PERMIT ISSUING FEE `� ITEMS Q Date: O TOTAL 257 1 w TOTAL FEE �� E a CHECK 2I_j a Signature PLAN CHECK APPLICANT h' C0 OWNER-BUILDER DECLARATION CHANGE r,0:4 Z .1 hereby affirm that l am exempt from the Contractor's License Law NAME , for.the following reason (Section 7031.5, Business and Professions t Code):, I, as owner.of the property, or my employees with wages ADDRESS 0000-0001 JI S7IUr� ❑ i [[HH Cn as their sole compensation, will do the work and the CITY TEL.NO. 2-A„�y?+f�6 1 PM _le structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER 6� I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS o, um6 r tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY� v i C.1i CA EL.NO.ti ) m �oI I hereby affirm that there is a construction lending agency for CONTRACTOR pop performance of the work for which this permit Is issued (Sec. 3097„ Civ.C.). ADDRESS Lender's Name Gv v CITY TEL.NO. Lender's Address STATE LIC. I certify that I have re this pplication and state that the above LICENSE NO. CLASS information is correct. agree to comply with all County ordinances and State laws relati to buil ng copstruction,and hereby authorize representatives of th s Count to enter upon the above-mentioned property.for inspection pur Is. SEE REVERSE FOR EXPLANATORY LANGUAGE XSIGNATURE OF APPLICANT OR AGEfTJ uAll E WORKERS'COMPENSATION DEGLARATIOf�I APPLICATION FOR ' PERMIT I hereby,affirm that I ha,)e a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, H.E'ATING -,-VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) Policy No.—Co mpany Certified copy is herey furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING L' Tion department. ADDRESS , j d 4 S /vAl (PRINT OR TYPE ONLY) Date Applicant . LOCALITY -TE ` Vt-7- NO.. TYPE OF APPLIANCE OR EQUIPMENT: FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST' COMPENSATION INSURANCE ' CROSS ST. JV ABSORPTION UNIT, BTU (This section need not be completed if the wort(Involved by DISTRICT NO, PROCESSED BY the permit is for one hundred dollars($100)or less.) I certify that in the performance,of the work for which this AIR HANDLING UNIT,CFM permit is issued;I shallnot employ any person in any manner so as to become subject to the Workers''Compensation Laws. BOILER, BTU APPROVALS DATE INSPE R'S SIGNATU E COMPRESSOR, BTU ROUGH Date G vJ APPIiccint NOTICE PLICANT: If, after making This Certificate VENTILATION SYSTEM FINAL Z Exemption, ou should become subject' to the Work Compensation.provisions of the Labor Code;you must forili- EVAPORATIVE COOLER VAI IDATI N with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED IT ®�) '(commencing;with Section 7000) of Division 3 of'the,Business WALL— and and Professions Code,and my license is in full force and effect. O License Number Lic. Class ► I� Contractor Date o ❑ I•am exempt under Sec. 3 3 rJ 8 APlan check fee IL B.&P.C. for this reason # •,o a 0-0 $ H� PERMIT ISSUING FEE $ Dare: d I * 20.50 Signature TOTAL FEE • OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT o e.o 2 0'5 0 6 I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME ;I 0,3.1 —8 5,-,— Professions .\ProfessionsCode): ® I, as owner of the property, or my employees with ADDRESS / wages as their sole compensation,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 contracting ,1 AJ with licensed contractors to construct the project (Sec- MAIL44 ` tion 7044, Business and'Professions Code). ADDRESS- (� rolb/ CONSTRUCTION LENDING AGENCYr CITY �,�-�. �� /� �., TEL. NO. "71 I hereby affirm that there is a construction lending agency for ► the performance of the work for which this permit is issued CONTRACTOR' (Sec. 3097, Civ. C.). ADDRESS Lender's Name CITY "TEP NO. Lender's Address STATELIC. I certify that I have read this application and state that.the LICENSE NO.. CLASS above 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 u on the-above-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 0912070005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID I BUILDING ADDRESS: I ITR: 5905 LT: 28 I 9103 LAS TUNAS DR I I - IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917801904 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 15387-016-024 101 PERMIT-ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 1 102 COMPRSR < 100 KBTU 1.00 COM 27.00 I I (TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 1 130 AIR INLETS/OUTLETS 8.00 UNI 34.80 112/07/09 SR 12/07/10 1 1 141 VENTILATION FAN 1.00 FAN 15.75 1 1 (OWNER: TEL. NO: I TOTAL FEES 132.30 IFINAL DATE FIN CODE: 1 ILEE, MICHAEL (626) 202-7249- 1 1375 POCO WAY 1 IMONTEREY PARK 91754 1 ID SCRIPTION OF WORK I I I ITENANT IMPROVEMENT -INSTALL AIR CONDITIONING AND HEATING I I I ISYSTEM I 1APPLICANT: TEL. NO: I I I IMARIA ARIAS (626) 442-4637- I 1 111818 RIO HONDHO PWY I ISPECIAL CONDITIONS: 1 1EL MONTE CA 91732 (CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 ID C GENERAL CONTRACTOR - (562) 693-1324- 1 1 1 18662 OCEAN VIEW LIC. NO 1 1FAU/WALL FURNACE 1 I 1 1WHITTIER, CA 90605 570165 C33 *I I I 1 1 1 1 ICOMBUSTION AIR OPENINGS 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK I - I I �l I 1 LIC. NO: 1 1AC/COMPRESSOR I 1 1 ITHERMOSTAT 1 1 IFIRE DAMPERS I I I I I I 1 1 ISMOKE DETECTION DEVICES I 1 I I I I I I 1 (COMMERCIAL HOOD 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 1 iI I I I 1* ADDITIONAL DATA ON FILE 1 IREPORT ID: DPR264 ROUTE TO: BS0508 1 1 I I I I I I I I