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Home My Public Portal About10418 LIVE OAK AVE_Mechanical__ • -WORKERS'COMPENSATION DECLARATION n FPUCA7D0N FOR PERMIT 't I hereby'affrrm that I hove a certificate of consent to self /� �J insure, or a certk4pate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a cer v copy thereof (Sec 3800 Lab C') 76A364C /1 'CE-818(REV 10/81) 62 Palicy�[r L Compan El Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified.copy is filed co my ildi ins ec- FOR-APPLICANT TO FILL IN BUILDING �y O tion department (PRINT OR TYPE ONLY) ADDRESS�!/ Dare Applicant LOCALITY , NO TYPE OF APPLIANCE OR EQUIPMENT FEE 'CERTIFICATE OF EXEMP O ROM WORKERS' NEAREST COMPENSAT SURANCE CROSS ST e (This section need not be c plated 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 permit is issued, I shall not employ any person in any manner ^ f so as to become subject to the Workers'Compensation Laws BOILER, BTU APPROVALS ��ti D Tt tAAI �sP�e ORIS SIGNATURE Date Applicant COMPRESSOR, BTU v ROUGH f `� 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 rMVITY Q('� , LICENSED,CONTRACTORS DECLARATION FLOOR BT I hereby affirm that I am licensed under provisions of Chapter 9 HEAT"'ER SUSPENDED UNIT '(commencingWALL with Section 7000) of Division 3 of the Business and Professions Code, and,my license is in full force and effect _ D ACU.4F License Numbe Li Class -� CU.4F 3307 37.[111 8 Contract / Date tE �&P xempt under Sec 1 Plan check fee �I-t � '� ii. 00 "for this reason C:I ti:�! '77.00n PERMIT ISSUING FEE $ !� QCT Datet r R CHANGEdoffZ TOTAL FEE Signature ' pg ° fr. - �' 9 OWNER-BUILDER DECLARATION • PLAN CHECK APPLICANT ;�( - � 1 9/17/90 I hereby affirm that I am exempt from the Contractor's License T Law for the following reason (Section 7031 5, Business and NAME `,uq�J � 01 Professions Code) 1 1 ° ❑ j, as owner of the property, or my employees with ADDRESS' " wages as their sole compensatron,will do the work and the structure is not intended or offered'for sale(Section CITY TEL NO 7044, Business and Professions Code) OW ER _ ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL ,,rr�� J tion 7044, Business and Professions Code) , ADD (J• /l( 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 CONTRACT (Sec 3097, Civ C ) -- ADDRESS Lender's Name CITY a TEL NO�Q Lender's Address STATE LIC I certify that I have read this application and state that the LICENSE NO CLASS _ above information is correct I agree to comply with all County ordinance end S to ws relating to building c nsiruction, nd h re a it nz __Pr entad sof this Co ty to enter bo, - n ro ns��t on p po es SEE REVERSE FOR EXPLANATORY LANGUAGE _. nature of Applican or gent UX Da�/`� - WORKERS' COMPENSATION DECLARATION n nnp p �jaAYMN FOR NE' RNT I hereby affirm that I, have a certificate of consent to self IT 16 Lh ll Il Cl IT R 151Pb � insure, or a certificate of Workers Compensation Insurance, ' 76A364C HEATING - VENTILATING - AIR CONDITIONING .� or,a certified copy thereof (Sec 3800, Lab C ) W4 NL32690 -. Company HOME INSURANCE CE-818(REV ,ora,) _ K39686 ❑ '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 10418 L.i Ve Oak Avenue tion department _ ADDRESS (PRINT OR TYPE ONLY) Date 12-6—$3 Applicant E. L. PAYNE COMPAN LOCALITYTemple City NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST T WARREN WAY COMPENSATION INSURANCE CROSS (This section need not b' completed If the work Involved by ABSORPTION UNIT, BTU DISTRICT NO PRO D By the'permit is for one,hundred dollars ($100)or,less.) AIR HANDLING UNIT, CFM I certify that in the performance of the work for which this permit is issued,'l shall not employ any person in any manner BOILER, BTU so as to become-subject to the Workers'Compensation Laws APPROVALS DATE INS TOR'S SIGNATURE COMPRESSOR, BTU ROUGH Date Applicant _ NOTICE TO'APPLICANT "If, after making this Certificate of 'VENTILATION SYSTEM FINAL �� Exemption, you should become subject to the Workers' V 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 FAURAVITY - LICENSED CONTRACTORS DECLARATION 1 FLOOR - BTUjn on I hereby affirm-that I am licensed under,provisions of Chapter 9 _ HEATER SUSPENDED—UNIT— (commencing USPENDEDUNIT(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code, and my license is in full force and effect d 120228 0 License Number Lic Class C-20 D 7 7 4.7 A V E. L. PAYNE CO 12-6-83 # a e o o o g p Contractor Date ❑ 1 am exempt under Sec 2!- c 2 0,5 0 d Plan check fee H B&P C for this reason2 Q, rJ Z PERMIT ISSUING-FEE $ 1.10, 150, Date TOTAL FEE 20 50 Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT , I hereby affirm that I am exempt from the Contractor's License - Law for the following reason (Section 7031 5, Business and NAME Professions Code) ❑ 1, as owner of the property, or my employeeswith ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section CITY TEL NO 7044, Business and Professions Code) ET 1, Thies I, as owner of the OWNER Mr. and Mrs.property, am-exclusively contracting __ _ • with licensed contractors to construct the project (Sec- MAIL 10418 E. Live Oak Avenue tion 7044, Business and Professions Code) ADDRESS CONSTRUCTION LENDING AGENCY. CITY " TEL NO" 1 hereby affirm that the're is a construciion lending agency for - Arcadia 447-8753 the performance of the work for which this permit is issued-- 'CONTRACTOR - D (Sec 3097, Civ C ) E_ L_ PAYNE COMPANY — ADDRESS Lender's Name 242 Beverly- Blvd,. CITY. TEL NO . 446 Lender's Address — 6118 STATE , LIC C-20 I certify that I have read this application and state-that the LICENSE NO 120228 - CLASS ab e information is correct I agree to comply with all County \ or ina sand State laws relating to building construction, an reby authorize r esentatives of this County to enter po the ove-men ned projrerty for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE . 12-6-83 /ignature o pli a r Agent Date - \ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0501250008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: L ID: FEES PAID BUILDING DRE S: ON FILE 10418 LIVE OAK AV E FEE DESCRIPTION: � QUANTITY: UOM: AMOUNT: ARCD--CA 910078462 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALLOWELL 8586-013-030 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, C 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 08 FURNACE/HEATER'<100 1.00 UNI 27.00 ISSUED ON: PROCff§M BY: P XPI ON: 30 AIR INLETS/OUTLETS 4.00 UNI 17.40 01/25/05 JK 07/24/05 35 AHU < 2000 CFM 1.00 AHU 12.90 OWNER: TEL. NO: 41 VENTILATION FAN 1.00 FAN 15.75 FeAL TE FE: LIN, CHUNG-YIN (626) 254-1290- TOTAL FEES 127.80 l`) 10418 LIVE OAK AV ARCADIA, CA 91007 DESCRIPTION OF WORK AIR CONDITIONING AND HEATING SYSTEM. APPLICANT: T INFRA 8 ARCH DEVELOPMENT, INC (626) 458-8111- 1028 WESTMINISTER AV SPECIAL CONDITIONS: ALHAMBRA, -CA 91803 CONTRACTOR: TEL. 0: APPROVALS DATE IN P CTOR SIGNATURE INFRA AND ARCH DEVELOPMENT INC. (626) 458-8111- 1028 WESTMINSTER AVE. LIC. NO FAU/WALL FURNACE ALHAMBRA, CA 91803 767202B COMBUSTION AIR OPENINGS ARCHITECT G . N0: DUCT INFRA ARCH DEVELOPMENT, INC. (626) 458-8111- 1028 WESTMINSTER AVE LIC. NO: AC/COMPRESSOR ALHAMBRA, CA 91803 NONE ER IRE DAMPERS SMOKE DETEETIONCES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508