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HomeMy Public PortalAbout9708 LEMON AVE_Mechanical__ WORKERS' COMPENSATION DECLARATION I APPLICATION FOR PERMIT •,Ithereby affirm that I have a certificate of consent to self ' t ii�.s&e, or a certificate-tof Work4irs' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING df a r�rtifred copy thereof (Sec 3800, Lab C ) 76A364C ' P-) -y Nn Company 20-0046 DPW 9/88 . Cdrtified 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 tion department ADDRESS (PRINT OR TYPE ONLY) ^ ' Date' Applicant LOCALITY '-T NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST j yn (This section need not,be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO J PROCESSED BY the permit is for one hundred dollars ($100) or less.) C +C� AIR HANDLING UNIT, CFM I certify that in the performance of the work'for which this n G permit is issued, I shall not employ any person in any manner (JQ so as to become*subject to the Workers'Compensation Laws BOILER, BTU A OVALS DATE INSPECTOR'S SIGNATURE , Date Applicant COMPRESSOR, BTU ROUGH .. i NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL 2 Exemption, you should become subject 'to the Workers' Compensation:provisions of the'Labor Code, you must forth- EVAPORATIVE COOLER VA 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 9, HEATER SUSPENDED UNIT- (commencing with Section 7000)of Division 3 of the Business' WALL O and Professions Code,and my license is in full force and effect License~Number Llc Class , Contractor Date ❑ - - 0 " I am exempt under"Sec V Z. • • -A" • Plan check fee W B&P C for this reason H Date PERMIT ISSUING FEE $ p.� Z ov Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License pop for the following'reason (Section 7031 5, Business and • NAME i Professions Code) I, as owner of the'property, or my employees with ADDRESS . . wages as their sole compensation,will do the work and - CITY TEL NO tai-4 tris the structure is not intended or offered for sale (Section 7044, Business and Professions Code) ❑ i ��f �•a - tlt` I, as owner of the property, am exclusively contracting OWNER 223 i with licensed contractors to construct the project (Sec- MAIL i 1 : �•� tion 7044, Business and Professions'Code) ADDRESS r _ �-y�--`�• CONSTRUCTION LENDING AGENCY CITY TEL NO O l H'L 1 s= (30 I hereby affirm that there is a construction lending agency for rt; s,l 4 rtc�iTl the performance of the work for which this permitos issued CONTRACTOR - (Sec 3097, Civ C pop :•iii ADDRESS - - - • Lender's Name ' s •- ' Lender's Address CITY TEL NO TATE, LIC I certify that I have read this application and state that the SCENSE'NO CLASS z a, -i=t- above information is correct I agree to comply with all County ordinances and State laws relating to building constrbction, and hereby authorize representatives of this County to enter upon the above-m i ed property for Inspection urpo s - SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatu of AppiAntlor Agent Da ©s .. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0102080011 BUILDING-AND-SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE . 9708 LEMON AV E FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCD CA 910077868 INFORMATIONASSESSOR R: NEAREST CROSS STREET: GOLDEN WEST 5383-016-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY 08 FURNACE/HEATER <100 1.00 UNI 27.00 TOTAL FEES 54.75 ISSUED 0PROCESSED : PLAN-BY. EXPIR . 02/08/01 UT 08/07/01 OWN EL. 0: FINAL DA FINAL B CODE: SHU QIN (626) 574-0233- 9708 LEMON AV -lb ARCD 910077868 SCRIJON OF WORK C/O SINGLE WALL FURNACE APPLICANT: TEL. NO: MARAVILLA FOUNDATION (323) 721-8883- 5729 UNION PACIFIC SPECIAL CONDITIONS: COMMERCE, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE MARAVILLA FOUNDATION (323) 721-8883- i 5729 UNION PACIFIC LIC. NOFURNACE COMMERCE, CA 90022 622969 C36 COMBUSTION AIR OPENINGS ARCHITECT OR � �� _) Lv� �� / �'�1';� U K LIC. NO: �I---�-•� �� ` 111111,`, AC/COMPRESSOR 1 THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508