HomeMy Public PortalAbout10302 LIVE OAK AVE_Mechanical__ Wl3"KER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 ���������®� ®� �����g
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I hereby-YtflItm tfrgt I have a certificate of consent to self insure, U
� -• GREEN
or a certrficate of worker's Compensation Insurance, or a cerufled' HEAT4NGr YINTILATING-AIR CONDITIONING
copy thereof(Sec 3800 Lab 'C)
,policy No Company ,COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY,DIV.
Certified copy is hereby furnished
r❑
-
Certified copy Is fled with the'count buildingInspection - FOR APPLICANT TO FILL IN BUILDING
department
/
department - y ' (PRINT OR TYPE ONLY) ADDRESS Sol,Q ' O v . 04k ry y C
Date Applicant LOCALITY " rt ��LQW/,J
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OFrEXEMPTION FROM WORKERS' NEAREST
• _ CROSS ST
COMPENSATION INSURANCE'. ABSORPTION UNIT,BTU _ ;
This section need,not,be;com leted if the work mvolved'b the a ASSESSOR
(,. P Y
MAP BOOK PAGE' PARCEL
permit is for+one hundred,dollars($100).or less.) AIR HANDLING UNIT,CFM ?
-' DISTRICT NO PROCESSED BY
I certify•that,in'the performance of the work for. Ich this pe ;
is issued,,.) shall not employ any.person In a ann s t BOILER,BTU n jj I 7,
become subject to the Workers'.0 pen I n s !/ Q
1-5f:
COMPRESSOR,BTU' ' L%Y
3'-Z /-.$J • APPROVALS DATE INSPECTOR'S SIGNANRE
"Date / Applic 't VENTILATION SYSTEM' _
NOTICE'TO,APPLICANT If, a er ma Cert ficate of ROUGHV.
Exemption,you should become subject to the Workers'•Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith,comply with such FINAL
provisions or this permit.shall be deemed revoked FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU V ATIO' N
I hereby affirm'that I am licensed under provisions of Chapter 9 HEATER NDE 1�11T
(commencing with Section 7000)of Division 3,of,the Business and WALO:'
Professions Code,and my`Ilcense Is In full force and effect
License Number ,�D S Lic Class
0
Contractor,` S Date l_ w
I am exempt under Sec
Plan check fee ' .`:
B 8P C for this reason PERMIT ISSUING-FEE$ g" 1 Gbh_' - O'
Date. 7 TT OTAL FEE
_ i !iI i ti1_ � mc•". c dV
'
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT —t�,,"� 4 • ;: (/�
hereby affirm that I am exempt from the Contractor's License Law NAME D I r9i ii3C a.f II
for the following reason-(Section 7031 5, Business and•Professions _
Code) . ,• ADDRESS 1 �•` i
d
�f
❑ I, as owner of the.'Property,tor my employees with wages
as their sole compensation, will do the work and the CITY' TEL NO
structure is not intended or offered for sale (Section 7044,
Business and Professions Code) OWNER ' `�^f G P ,
❑. I, as owner of the property, am exclusively contracting MAIL
o with licensed,contractors to construct the project (Sec- ADDRESS Q 30 Z L/V(✓ '014r!� ''✓ Y '
tion 7044, Business and Professions Code) _ /� �1 -
CITY 7�j '��L L� l"=//,i. TEL NO.�/� Y'tk-0 OSf
CONSTRUCTION'LENDING AGENCY < '
I hereby affirm that there is a construction lending agency for
the performance of the work.for which this permit �T
isued CONTRACTOR L},fE //L' f�- &v-7
(Sec 3097,Civ C)
'ADDRESS /3a'2� /VjOti ✓/�� 7P'�"' '� „'r.,,•, •-�•
Lender's Name At
p r ;
. .. CITY Vnl�'� '�/P` TEL NO
Lender's Address
STATE �y q q "LIC "•-
I certify that I have read th il.,cate 'and state that the above LICENSE NO C'l� /�'/j CLASS
information is correct ,I ree t ly th all County ordinances
and State laws relatin o uI ns ction,and hereby authorize
re enta o y- en r upon-the above-mentioned
pr arty for s tionp s s
SEE REVERSE FOR EXPLANATORY LANGUAGEsr
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QeT^OF APPL ANT OR AGENT • DATE �
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0304240026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 10302 LIVE OAK AV E
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCD CA 910078400
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN
8586-014-005 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXP WS .
30 AIR INLETS/OUTLETS 10.00 UNI 43.50 04/24/03 JK 10/21/03
TOTAL FEES 125.25
OWNER: TEL. ALAT F AL CODE:
PAN LISA (626) 447-6660- ,Q�
10302 LIVE OAK AV
ARCD 910078400 06SCRTPTTO"N OF WOR
INSTALL HVAC SYSTEM
APPLICANT: TEL. NO:
NORMAN LIU SERVICE CORP (626) 579-1559-
4901 ARDEN DR SPECIAL CONDITIONS:
TEMPLE CITY 91780
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATUTE
NORMAN LIU SERVICE CO. (626) 579-1559-
4901 ARDEN DR LIC. NO / ALL FURNACE
TEMPLE CITY, CA 91780 559374C-20
COMBUSTION AIR OPENINGS
ARCHITECT � y' �- 'i��� %�` DUCT WORK
LIC. N0:' �' �� AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS DETECTrOff DE
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508