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HomeMy Public PortalAbout9679 LAS TUNAS DR_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA 64 (2-80) A P L� C A T P® f� FOR P E R�iI T I hereby affirm that I have a' certificate of consent to self 1 insure, or a certificate of Workers'Compensation Insurance,o'r p-pEqTINQ_yEN'�ILATIN'd_AIR CONDITIONING a certified c thereof(Sec.3800,Lab.C.) y ��7 &f� l�y/'� POliC Company- ❑ Certified copy is hereby furnished. ` COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with-the county buil ing inspection FOR APPLICANT TO FILL IN BUILDING de arttmen . Date Applicant— + (PRINT OR TYPE ONLY) ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY vla COMPENSATION INSURANCE NEAREST } (This section need not be completed if.the work involved ABSORPTION UNIT,BTU CROSS ST. _/g'J. 14O by •the permit is for -one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED BY (� I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ` permit is issued, I shall not employ any person in-any manner. _ Q so as to become subject to the Workers' Compensation Laws. BOILER,BTU APPROVALS DATE INSPECTOR'S SIGNATURE,, Date Applicant , CL ' COMPRESSOR,BTU N ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM i � Z Exemption, .you should become subject to the Workers' I FINAL Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU RAVITY n LICENSED CONTRACTORS DECLARATION MCI FLOOR: BTU OF 1 I hereby affirm that,I'am licensed under provisions of Chapter HEATER: SUSPENDED UNIT r 9 (commencing with Section 7000)of Division 3 of the Busi- WALL riess and ProfessionsCode, and my license is in full force and effect. 2 y a 1 •� , LQ .� i _ License Number � LiicC.11assss- •�g��o �d Contractor / LGI Date ❑ I-am.exempt from the licensing requirements .as I am a ,1i + licensed''architect or a registered professional engineer. Plan Check'fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness'and Professions Code). PERMIT ISSUING FEE$ Lic,or Reg.No. Date i TOTAL FEE h HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT J "9667 A. Ihereby affirm-that .I am exempt, from-the Contractor's I NAME F' License Law for the following reason (Section 7031.5, Busi- t o 0 0,0 0 8 ness and Professions Code): ADDRESS ❑ I, as owner of the property, will do the work and thea 0 30.5.0 structure is not intended or offered for. sale (Section I CITY TEL. NO. a` ! 7044, Business and Professions Code). i + o: 3 0 6 0 ox ElfOWNER I, as owner of the-property, am exclusively contracting ` 3'� 3=8 4 with licensed contractors to construct the project MAIL (Section 7044, Business and.Professions Code). ADDRESS AIAS CITY CONSTRUCTION LENDING AGENCY �i1-•_� TEL.NO. -670 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR I issued SSec.3097,Civ.C.). I. Lender s Name ADDRESS I.$- , O Lender's Addressr CITV,7—em k-C TE L.NO��i��I�V CK I I certify that.1 have read this application and state that theSTATE nn LIC. above information is correct.I agree to comply with all County LICENSE NO. F CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this ! SEE REVERSE FOR EXPLANATORY LANGUAGE. County to enter upon the above-mentioned property for inspection purpos c. Signature of Permittee Date ) WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT (ereby affirm that I have r certificate of consent to self or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING ortified co thereof (Sec. 3800, Lab. C.) CE-818 ��-j � Ln-A, CE-818(REV. 10/81) Policy No. v F Company T/7✓G �! ❑• Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING l� T Tion department. / (PRINT OR TYPE ONLY) ADDRESS IiJ Li( Date —Applicant APPlicant r `' LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. LL Z (This section need not be completed If the work involved by ABSORPTION UNIT, BTU 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 0Q�� permit is issued, I shall not employ any person in any manner BOILERBTU I cow so as to become subject to the Workers ,Compensation Laws. APPROVALS DATE INSPECTOR'S SIGNATURE ICOMPRESSOR, BTU Q ROUGH ��/ ? R Date Applicant— e 421 .11 ,, NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL 177 .2 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: T l © r17 LICENSED CONTRACTORS DECLARATION FLOOR 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. License Number ,U!/ 9 O LCic. Class V Contractor am 6) ❑ I am exempt under Sec. Plan check fee B.&P.C. for this reason' r /I PERMIT ISSUING FEE$ O Date: TOTAL FEE ZO ` Signature , OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT o I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME VM,00 ® t• ;�J Professions Code): ❑ ADDRESS I, as owner of the property, or my employees with —s r • — '- �' wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITrn C G TEL. NO. 7044, Business and Professions Code). r OWNER ❑ I, as owner of the property,am exclusively contracting MAILIQ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY CIT, � TEL. NO. 07aG I hereby affirm that there is a construction lending agency for ' the performance of the work for which this permit is issued CONTRACTO /V (Sec. 3097, Civ. C.). ADDRESS , Lender's Name ClTfj� TEL. NO. Lender's Address /� �1 r� I certify that I have read this application and state that the STATELICENSE NO., 7 V 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 ^upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ,I COUNTY OF LOS ANGELES I. TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1105030008 BUILDING AND SAFETY / LAND DEVELOPMENT i TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: I ILEGAL ID: II FEES PAID I BUILDING ADDRESS: I ITR: 6561 IT: 127 I I I 9679 LAS TUNAS DR I 1IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802103 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18587-020-010 1101 PERMIT ISSUANCE FEE 27.80 I I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl I .130 AIR INLETS/OUTLETS 2.00 UNI 8.70 1 1 1 ITENANT: 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 ISSUED ON: PROCESSED BY: PLAN BY: I ISHAN GHAI KITCHEN i TOTAL FEES 63.50 105/103/11 SR (OWNER: TEL. NO: 1 IFINAL DATE FINAL BY: CODE: 1 ISHAN GHAI KITCHEN - 19679 LAS TUNAS DRIVE ITEMPLE CITY CA 93.780 1 IDESCRIPTION OF WORK 1 ALTTER TION OF EXIST DUCT SYSTEM AND RELOCATED TWO AIR (APPLICANT: TEL. NO: 1 I I IFEN, YAN (626) 475-6583- 1 I 5434 RYLAND AVE I ISPECIAL CONDITIONS: TEMPLE CITY CA 91780 I _ ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IL & T A/C HEATING CO. INC. (626) 475-6583- 1 i I' 12609 SEAMAN AVENUE LIC. NO 1 IFAU/WALL FURNACE I I I EL MONTE, CA 91733 509737 1 i (COMBUSTION AIR OPENINGS I I I ARCHITECT OR ENGINEER: TEL. NO: - i IDUCT WORK a-f I I LIC. NO: i JAC/,COMPRESSOR ii 1 (THERMOSTAT I I IFIRE DAMPERS I I ISMOKE DETECTION DEVICES I I I COMMERCIAL HOOD I I I I I I i i I I I I I I I ) I I I I I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 I I I I i