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HomeMy Public PortalAbout9701 LAS TUNAS DR_Mechanical__ WORKERS'COMPENSATION DECLARATION I 76A364C ' ,Q� (��{ �Q (� J I hereby affirm that I have a• certificate of consent to self I CE-818(2-80) d^'V P N ll� C A T� O N FOR E R R 11 ,)insure,or a•certificate of Workers'Compensation Insurance,o'r HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800,Lab.C.) i Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES I BUILDING AND SAFETY- Certified copy is filed with thp cony build*ng' spectio FBUILDING r l d partme t. OR APPLICANT TO FILL IN j DateApplican (PRINT OR TYPE ONLY) ADDRESS LOCALITY r CERTIFICATE OF EXEMPTION FROM WORKERS NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST d (This section need not be completed if the work involved ABSORPTION UNIT,BTU CROSS ST. O by the permit is for one hundred dollars ($100) or.less.) DISTRICT NO. PROCESYED BY U I certify that in the,performance of the work for which this AIR HANDLING UNIT,CFM' I permit is issued, I shall not employ any person in any manner '+�• 0 so as to become subject to the Workers' Compensation Laws. BOILER; BTU Date Applicant I COMPRESSOR,BTU i_ r� 2D O ROUGH el C/ APPROVALS DATE INSPECTOR'S SIGN RE N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL — Compensation provisions of the Labor Code,,you must forth- t \with comply with such provisions or.this•permit shall be EVAPORATIVE COOLE i VALIDATION deemed revoked. Z FLOOR: FAUBTU RAVITY O DQ LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 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. 'y j TJ License Numbef� Lic.Classi ' �� y 12 9.7 p ! Contractor �S Date ;x– — I # 0 0 0 0'0 $ I am exempt from the licensing requirements as I am a `s licensed architect or a registered professional'engineer t Plan Check fee 25%of above. i acting in my professional capacity (Section 7051, Bus- iness and Professions Code). ) PERMIT ISSUING FEE$ J0 Lic.or Reg.No. Date TOTAL FEE 1 ° ° $Q 5 Q • I HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT o 0 0 $0.5 0 z I hereby affirm that 1. am exempt from-the Contractor's NAME $ Q 1,03a--85 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ' ADDRESS d S r I, as owner of the property, will do the work(Section the I CITY TEL.NO.d'j�3 �,3,s�/ structure is not intended or offered for sale Section i 7044,Business and Professions Code). 4 OWNER I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL /y (Section 7044,Business and Professions Code). ADDRESS `A VCZ711511 011I CONSTRUCTION LENDING AGENCY CITY TEL.NO. I hereby affirm that there is a construction lending agency CONTRACTOR issued y� S for the performance of the work for which this permit is I issued(Sec.3097,Civ.C.). Lender's Name 5, ADDRESS Lender's Address CITY TEL.NO. I certify that I'have read this application and state that the STATE LIC. above information is correct.I agree to comply with all County LICENSE NO. 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 up n the above-mentioned property for n ec urpos a-41 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION t 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 a certified copy thereof(Sec. 3800, Lab. C.) 76A364C ❑ r /17� � fE�818(REV. 10/81) Policy Noa2?�ComPan, �! /s COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ADDRESS y tion department. (PRINT OR TYPE ONLY) Date � �Applican LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXE ION FRO RKERS' NEAREST COMPENSATION INSUR CE 26 CROSS ST. (This section need not be completed if the work'involved by ABSORPTION UNIT, BTU •���© DISTRICT NO. PROCESSED BY Od the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM �s 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 become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE SPE TOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH ,I 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 GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR - BTU 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 forces and effect. License NumberLic. Iass�T'� III.) 0 Contr o e ❑ I am ex under Sec. V w Plan check fee CL BAP.C. 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 , 6 7 2 A Law for the following reason (Section 7031.5, Business and NAME Professions Code): 0 0 0,o o ❑ I, as owner of the property, or my employees with ADDRESS ° ° 3(k 5 0 wages as their sole compensation,will do the work and CITY TELNO the structure is not intended or offered for sale(Section . . 7044, Business and Professions Code). El 1, G`T //P ° ° 0 3 Q 5 I, as owner of the property, am exclusively contracting MAIL /, 0 with licensed contractors to construct the project (Sec- ADDRESS ` 4 '�'�r� tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR C,.df&/X/r(/��' , (Sec. 3097, Civ. C.). ADDRES,5Z?6 ,r Lender's Name CITY ,�/ '�{,l// (/t � a TEL. NOG'Q /Q' Lender's Address STATE ZiV~LIC. I certify that I have read this application and state that the LICENSE NO. o'er CLASS i above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authorize representativ s of is County to enter upon the ab ve- tioned proper fo ins menpection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nom ' �7 ignature of Ap nt or Agent Date • J s " COUNTY OF LOS ANGELES TEMPLE CITY 4. # 0r08 MEC('AN-rrAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS �ME 0508 0005110002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: r_ GA FEES PAID BUILDING ADDRESS,-, ON FILE 9701 LAS TUNAS_DR" FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: LCNT-C ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:• KAUFFMAN 01.PERMIT ISSUANCE FEE 0.00 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY 02-COMPRSR < 100 KBTU ADD COM 0.00 TENANT: TOTAL FEES 0.00 ISSUED 0 PROCESSED BY: PLAN BY: EXPIRES ON: 05/11/00 UT 11/07/00 OWNER: TEL. NO: FINAL DATE FINAL BY: DE: CITY OF TEMPLE CITY (626) 285-2171- 9701 LAS TUNAS DR. TEMPLE CITY, CAD SCRIPTIO OF WORK — - —.NEW—.2—TON ROOF-TOP-A/C-FOR FILE SERVED APPLICANT: TEL. NO: AIR TRO INC. (626) 357-5311- 1630 S. MYRTLE AVE SPECIAL CONDITIONS: MONROVIA, CA P�GELEs CO CONTRACTOR: TEL. NO: SOS U/p�j y APPROVALS DATE INSPECTOR SIGNATURE AIR TRO, INC. (626) 357-5311- 1630 S. MYRTLE LIC. NO FAU/WALL FURNACEFA/WA MONROVIA, CA 91016 258228 C10 COMBUSTION AIR OPENINGS i t � ARCH I T EC OR E G E : TEL. NO: - / DUCT ORK LIC. N0: 1111111 AC/COMPRESSOR THERMOSTAT �j='U[�LC W0���� FIRE DAMPERS !ur- (i.�=✓� L�u SMOKE DETECTION DEVICES 0 COMMERCIAL HOOD �- _ 0 D 46��c S�rv�e That��� * ADDI.TIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 A COUNTY OF LOS ANGELES. TEMPLE CITY # 0506" V-'ME�CHANICAL PERMIT DEPARTMENT OF`PUBLIC WORKS 9701. LAS.TUNAS i `\ME 0508_9907.21:0019 BUILDING AND SAFETY / LAND DEVELOPMENT* TEMPLE CITY CA 91780 PHONE:. (626) 285-0488' EXT: ' 1 LEGAL ID: FEES PID I G. DDRESS:. ON FILE• 'r-970'-LAS'TUNAS Di J". FEE:DESCRIPTION: QUANTITY: UOM: AMOUNT: -%-LCN:LCA=- ASSESSORI FOR TION ER: NEAREST CROSS STREET: KAUFFMAN 01 PERMIT ISSUANCE FEE 0.00 THOMAS PAGE: GRID: -' LOCALITY:.TEMPLE CITY 02 COMPRSR < 100 KBTU 6.00 COM 0.00' TENANT: 08 FURNACE/HEATER <100 6.00 UNI 0.00 ItSUED ON: PROCESSED BY: PLAN 8 IRES ON: 30 AIR INLETS/OUTLETS 7.0.00 UNI : 0:00 07/22/99 UT 01/18 0• 47 ALTER EXIST DUCT SYS 190.00 SYS 0.00 . OWNER:. TEL. 0: TOTAL FEES- 0.00 FINAL DATE FINAL BY: CODE: CITY OF TEMPL9.CITY•-. (626).285-2171- . 9701 E. LAS TUNAS DR . • e TEMPLE CITY, CA DES CRI 0 OR NEW HVAC SYSTEM FOR GOVERNMENT BUILDING i APPLICANT: TEL. O: ARMOND BAGHRAMIAN (818) 249-8852- 2315 MONTROSE AVE. SPECIAL CONDITIONS: . MONTROSE, CA p,1�GELES CO CONTRACTOR: TEL. 0: S �/� APPROVALS DATE INSPECTOR SIGNATURE ARMOND BAGHRAMIAN (818) 249-9751- 2315 MONTROSE AVE, #101 LIC. NO / A URN CE MONTROSE CA, 91020 559043 B CBUS ION AIR OPE I GS ARCHITECT OR ENGINEER: TE 0: - CT{ 0 LIC. N 1111111 C/COMPRESSOR THERTOSTAT . �f � AMPERSUo C W®� Q SMOKE � DETEC ON DEVICES , iJ COMMERCIAL HOOD • fK f%c �° cervica Thai REPORT. ID:. DPR264 ROUTE TO: BS0508 {