Loading...
HomeMy Public PortalAbout9228 LAS TUNAS DR_Mechanical__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or to certificate of Workers' Compensation Insurance, HEATING - VENTILATING • AIR CONDITIONING or a certif' copy thereof (Sec 3800, Lab�) 76A364C Policy No Company ' � ND 20-0046 DPW 9/88 ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY n Certified copy Is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING `Y tion department ADDRESS (PRINT OR TYPE ONLY) Date --f Applicant LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION 110M WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST BTU (This section need not be completed if the work involved by ABSORPTION UNIT, DISTRICT NO PROCESS Y 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 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL Z ' Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VA ID TION with comply with such provisions or this permit shall be deem- ed revoked, FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU (� I hereby affirm that I am licensed under provisions of Chapter 9HEATER 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 ,� -r� (7 >- 60 License Number Lic Class00. d Contractor Dr ate t 1 U ❑ I am ex mpt under Se O Plan check fee B&P C for this reason d Date PERMIT ISSUING FEE $ Z 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) v ❑ 1, as owner of the property, or my employees with ADDRESS a wages as their sole compensation, will do the work and AC'C'T. the structure is not intended or offered for sale(Section CITY TEL NO 3307 140.50 7044, Business and Professions Code) OWNER + I, as owner of the property, am exclusively contracting 1 ITEWS with licensed contractors to construct the project (Sec- MAIL ,•, AtTAL 1 �y tion 7044, Business and Professions Code) ADDRESS TOTAL CONSTRUCTION LENDING AGENCY CITY TEL NO CHECK 140.50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR , CHANGE - .00 (Sec 3097, Civ C ) ADDRESS Lender's Name 0000(� r' i CITY TEL NO — 11 11' 1/39 Lender's Address I certifythat I have read this application and state that the STATE Cj6.902 1 AM10:a1 pp L 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 upo thea ove-menTioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE -i -0 gnatu of Applicant or Ar Date ©s . 4 " s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 9909150002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 766 BL: .001 9228 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801907 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ALESSANDRO 8587-002-010 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 30 AIR INLETS/OUTLETS 14.00 UNI 60.90 ISSUED ON: PROCESSED BY: PLA BY: EXPIRES ON: COLDWELL BANKER REALTY 35 AHU < 2000 CFM 1.00 AHU 12.90 11/04/99 UT 05/02/00 75 ADDITIONAL PLANCHECK 4.00 HOU 437.40 OWNER: TEL. NO: TOTAL FEES 565.95 FINAL DATE FINAL BY CODE: CHANG JOHN;SHIRLEY;CHANG LAWRENCE (818) 289-2200 789 RIDGECREST ST ` MTPK 917543759 DESCRIPTIO OF WORK HEATING AND COOLING SYSTEM FOR COMMERCIAL BUILDING APPLICANT: TEL. 0: ACE COOLING & HEATING CORP. (323) 750-7456- 6626 MC KINLEY AVE. _ SPECIAL CONDITIONS: LOS ANGELES, CA = CONTRACTOR: TEL. N0: ! ,��: "'6��� APPROVALS DATE INSPECTOR SIGNATURE ACE COOLING & HEATING CORP. (323) 750-7456 � 6626 MC KINLEY AVE. LIC. NO /� f'i �✓ rr: �� FAU/WALL FURNACE LOS ANGELES, CA 90001 716120 COMBUSTION AIR OPENINGS ARCHITECT OR G 0: y �? 1� ���•�� DUCT WOW DESIGN ONE (562) 809-3878 17615 PIONEER LIC. N0: —--'— I `h 111111'• AC/COMPRESSOR ARTESIA B 503509 I �i THERMOSTATN-1 FIRE DAMPERS SMOKE IO DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508