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Home My Public Portal About9177 LAS TUNAS DR_Mechanical__ WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 APPLICATION FOR PERMIT LIME -GREEN I hereby affirm t4-at I have a certificate of consent to self Insure, 76A364C or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lab C) Policy No 11 ompany42#L j�i�1�fHS COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. � Cartlfied copy Is hereby furnished l L6^, Certified co Is filed with the count building Inspection FOR APPLICANT TO FILL IN BUILDING PY Y 9 ADDRESS department (PRINT OR TYPE ONLY) Date �:^ A hcant LOCALITY ' PP NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATC OF EXEMPTI FROM WORKERS' NEAREST COMPENSATION SURANCE CROSS ST ORPTION UNIT,BTU ASSESSOR ' (This section need not be completed if the work Involved by the ` MAP BOOK PAGE PA EL permit is for one hundred dollars($100)or less.) P. AIR HANDLING UNIT,CFM / 400 DISTRICT NO PROCESSED BY I certify that in the performance of the work for which this permit 0 is issued, I shall not employ any person In any manner so as toOILER,BTU �11 r 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 `�Js.�/✓ Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER Q provisions of the Labor Code, you must forthwith comply with such FINAL ^qJ dG provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION 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 and WALL Professions Code,and my license Is In full force and effect /Q xv License Number Lic Class#!:l ( C� �d Contractorate '(ry��2 , O ElI am exempt under Sec p .l�� Plan check fee V B&P C for this reason PERMIT ISSUING FEE $ O H Date TOTAL FEE n() W Signature �- PLAN CHECK APPLICANT W OWNER-BUILDER DECLARATION V6 Z I hereby affirm that I am exempt from the Contractor's License Law NAME J .for the following reason (Section 7031 5, Business and Professions , i—T 3. Code) °� ADDRESS El �_r I, as owner of the property, or my employees with wages ,� X17 1, = as their sole compensation, will do the work and the CITY TEL NO i "TT ;qtr structure is not Intended or offered for sale (Section 7044, i I IL' Business and Professions Code) OWNER TOTAL 173 - 00 I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS CHECK 1;'�,,isl;. tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY CITY E( TEL NO �j C.FiC�hft; I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit is-issued r ' (Sec 3097, Civ C) f1 ",- ADDRESS 200 .1, ,cjfni Lender's Name tr 5 j;7 1 PM 1 ; e CITY 4;i? v �i TEL NO _ Lender's Address I certify that I have read this application and state that the above LICENSE NO LIC 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 upon the above-mentioned property spection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE SI:7 OF APPLICAWT 01NT DATE t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - ) ME 0508 1210260006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT i ILEGAL ID FEES PAID BUILDING ADDRESS ITR 5905 LT 2 SL 001 9177 LAS TUNAS DR I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801937 (ASSESSOR INFORMATION NUMBER I - NEAREST CROSS STREET- 15387-016-002 - '101 PERMIT ISSUANCE FEE 27 80 1 THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY CAI 1 102 COMPRSR 100 KBTU 1 00 COM 27 00 1 1 ITENANT I TOTAL FEES 54 80 (ISSUED ON PROCESSED BY PLAN BY 110/26/12 SR I I I I (OWNER TEL NO (FINAL DATE FI CODE GALAXY MORTGAGE INC,NG WILLIAM W- 5343 VISTA LEJANA IN IIMACRIPTION OF WORK 1 1 (HVAC REPLACEMENT I I (APPLICANT TEL NO I I ILIU, NORMAN - (626) 579-1559- 110932 GRAND AVE ! - (SPECIAL CONDITIONS 1 , ITEMPLE CITY CA 91780 ,� I (CONTRACTOR TEL NO IAPPPOVALS _DATE INSPECTOR SIGNATURE INORMAN LIU (626) 579-1559- _ 1- 1-10932 GRAND AVENUE LIC NO I FAU/WALL FURNACE 1 ITEMPLE CITY, CA 91780 - 559374 1 1_; I I 1 j 1C0 USTION AIR OPENINGS 1 1 (ARCHITECT OR ENGINEER- TEL NO I (DUCT WORK - 1 LIC NO IAC/:OMPRESSOR , I - I 1 _Lli� 1 ITHERMOSTAT I I (FIRE DAMPERS I I I I I SMOKE DETECTION DEVICES 1 1 COM1�ERCIAL HOOD I I I I I I I I I I I I II I I I I I I I 1 I I I I I I I (REPORT ID DPR264 ROUTE TO BS0508 _ I WORKER'S'GOMPENSATIONDECLARATION 20o046DPW 9/89 APPLICATION FOR PERMIT EEN 76A364C I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING - AIR CONDITIONING copy thereof(Sec 3800 Lab C) Policy No Company COUNTY OF LOS ANGELES DEPT OF'PUBLIC'WORKS BUILDING rAND SAFETY DIV. ❑ Certified copy is hereby furnishedBUILDING ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS 91 ? L�S Tuu department (PRINT OR TYPE ONLY) Date Applicant 'TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY t NO "F n, _ l_!'r 1 C/ NEAREST l ! I , y 03 CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST • COMPENSATION INSURANCE ABSORPTION UNIT,BTU This section need not be completed if the work Involved b'the ASSESSOR ( P y MAP BOOK t PAGE 'r PARCEL ' permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO PROCESSED BY I certify that In the performance of the work for which this permit _ is issued, I shall not employ any person In any manner so as to BOILER,BTU becAPPROVALS DATE INSPECTOR'S SIGNATURE ome sub ect to the Workers' Compensation Laws 9 (2-lip) I COMPRESSOR,BTU Date � � Applicant' VENTILATION SYSTEM , NOTICE fO A PLICANT If, after-makind this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER ,provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALI ATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is,In full force and'effeec'', Qt � _ License Number I 1 U Lic ClassC_SS Contract& �LDr_1 i�4 C AX Date 0 I amexempt under Sec ' Plan Check fee B&P C for this reason PERMIT ISSUING FEE$ 7 U Dajs ��,// V/7 /� TOTAL FEE a Signature �!_G�/C / r l/ ' _T PLAN CHECK APPLICANT C0 OWNER-BUILDER DECLARATION _Z I hereby affirm that I am exempt from the Contractor's License Law NAME FLor-fl?e= � for the following reason (Section 7031 5, Business and Professions , _„•, Code) F._t• �� ADDRESS ❑_ I, as owner of the property, Or my employees with wages - -F.i =^ as their sole compensation, will do the work and the CITY �j / �!b Cp TEL NO ” } J r structure Is not intended or offered for sale (Section 7044, rvt tb { ' =-rr Business and Professions Code) OWNER ❑ I, as owner of the property, am exclusively contracting EiF!h'- a-ki- MAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) 'CONSTRUCTION LENDING AGENCY CITY TEL NO I hereby affirm that,there Is a construction lending agency for CONTRACTOR , the performance of,the work for which this permit is issued (SEC 3097,Civ C) ADDRESS '! Lender's Name C- CITY TEL NO Lender's Address " '/ 1 certify that I have read this application and state that the'above LICENSE NO �'7 CLASS 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 upon the above-mentioned , property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT DATE