HomeMy Public PortalAbout9815 LAS TUNAS DR_Mechanical__ WORKERS'COMPENSATION DECLARATION - CEA 81 8C(2-80) A P P L;e CAT 0 O �I FO P E R 11�7U T
I hereby affirm that I have a' certificate of consent to self [�
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONINGU
a certified copy thgeof(Sec.3800,Lab.
o icy No� '
Certified copy is hereby furnished. ,,
COUNTY OF LOS ANGELES / `1 BUILDING AND SAFETY
ertified copy is filed with the cq�nt uildin �}�il
q pelt _enti „R(/i/f FOR APPLICANT TO FILL IN BUILDING
ADDRES [O
Date -[ Applicant (PRINT OR TYPE ONLY)
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS'
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE I NEAREST CROSS ST. CU d
( This section need not be completed if the work involved t ABSORPTION UNIT,BTU O
by the permit is for one hundred dollars ($100) or less.)( DISTRICT NO. PROCESSEDBY V
I certify that in the performance of the work for which this,. AIR HANDLING UNIT,CFM cc
permit is issued, I shall not employ any person in any manner !�9 Q
Za
so as to become subject to the Workers' Compensation Laws. I BOILER,BTU 'S It
+• l. �^� APPROVA DAT INSPECTORGNATURE
Date Applicant COMPRESSOR,BTU (J
ROUGH '.
coo-
NOTICE TO'APPLICANT: If, after-making this Certificate•of' VENTILATION SYSTEMFINAL .. J Z
.Exemption, you should become 'subject to the Workers'
Compensation provisions• of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAUR ITY
LICENSED CONTRACTORS DECLARATION ` FLOOR: B.TU 6
/
I hereby affirm-that 1 am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi-, WALL
css eand Professions Code, and my license is in full force andl.
effect. c.'� /
License Number Lic.Claassss
Contracto Date IfJ 7S
I am exempt from the licensing requirements as I am a
licensed architect ora registered professional engineer Plan Check fee 25%Of above.
acting in my professional capacity (Section 705.1, Bus-
iness and Professions Code). l PERMIT ISSUING FEE$
Lic.or Reg.No. Date I TOTAL FEE
HOME OWNER-BUILDER DECLARATION
PLAN CHECK PPLICANT -
'I hereby affirm' that I am exempt from-the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): 1' ADDRESS Q'
El I, as owner of the property, will do the work and the TEL.NO.
structure is not intended or offered for sale (Section CITY Q
7044, Business and Professions Code). 0 2.Q 3.A
OWNER
1, as owner of the property, am exclusively contracting
with •licensed contractors. to construct the, project MAIL / # o'o,o,o 4,1
(Section 7044,Business and Professions Code). ADDRESS L
CONSTRUCTION LENDING AGENCY. CITY 17 TEL.NO. ;?;° °,2 7 O U
I hereby affirm that there is a construction lending agency' CONTRACTOR +0 0 0 2 ] Q C r?
for the performance of the work for which this permit. is
issued SSec.3097,Civ.C.). 0 6 1 ,5-8.1
Lender s Name ADDRESS tfa .7
Lender's Address CITY TEL.NO.
I certify that I have read this application and state that the STA E 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 0ent u on Vthe %w7e- antioned property for S
inspec ' pu le
Signature of Permittee _ Date +
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PMEGHANI;CALVrP:E.RMIT�,,..
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS s-ME"05.08"000601p019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
EG ID: FEES PAID BU DI G_ADDRESS.:._. _
TR: 6561 LT: 73 815 LAS TUNAS DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA Si17802209"-
11
ASSESSOR INFORMATION UMBER: NEAREST CROSS STREET: GOLDEN WEST
8587-026-014 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
08 FURNACE/HEATER <100 1.00 UNI 27.00
TENANT: 30 AIR INLETS/OUTLETS 9.00 UNI 39.15 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
37 AHU > 10000 CFM 1.00 AHU 65.40 06/01/00 UT 11/28/00
TOTAL FEES 159.30
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
BEATTIE H K -
9815 LAS TUNASkDR b"��
TEMP 917802209 DESCRIPTION UF WOR
CHANGE OUT OF FIRE DAMAGED A/C UNIT AND DUCT WORK
APPLICANT: TE 0:
JAMES KONTOS -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0: r ';�°`. APPROVALS DATE INSPECTOR SIGNATURE
TEMPERATURE EQUIPMENT CORP (818) 368-5749- ,'�� y3� ,r ti��
10667 LOUISE AVE LIC. NO �'�:;r J✓ �f' ��•� / AL FURNACE
GRANADA HILLS CA91344 517612 C20 ;;�
.`.
COMBUSTION AIR OPENINGS
RCHITECT OR ENGINEER: TE . N0: - r+ i 1 r tib \� DUCT WORK /
LIC. NO:' I 1 y AC/COMPRESSOR !
P'LL- -� --- — '- - -� ��i THER OS AT
Vs --- - - - - - -- - ---- -
F r �� �!1 r7�f�i j 1147
1 ? �(v~ FIRE DAMPERS
�•
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
````\, Ate`% � ,,`�1���` /.�';•
REPORT ID: DPR264 ROUTE TO: BS05O8