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HomeMy Public PortalAbout5402 LOMA AVE_Mechanical__ ION DECLARATI 20-D0 v WOf;hat I have a cNSATate of consent to 76A346DPW9/89 APPLICATION1. FOR PERMIT � UME , GREEN 76A364C �I �( u I hereby affirm that I have a ceEufecate of consent to self Insure, ora certificate-of Worker's Compensation Insurance, or a certifiedHEATING-VENTILATING-AIR CONDITIONING i copy,thereof(Sec 3800 Lab'C), . Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND,SAFETY DIV. ❑•{ Certdied copy Is thereby furnished ❑ Certified copy Is filed with the county building Inspection FOR APPLICANT TO FILL IN ADDRESS.54 2 © V . IN G department-, - (PRINT OR TYPE ONLY) Date Applicant LOCALITY`' pl ' NO TYPE OF APPLIANCE OR EQUIPMENT FEE Z2 CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST / �r CROSS ST * COMPENSATION INSURANCE ABSORPTION UNIT,BTU This`section need not be'com leted if the work Involved b ASSESSOR � ( P Y the '- F MAP BOOK y��d PAGB�TJ� PARCEtD� permit is for one hundred dollars(5100)or less.) AIR HANDLING UNIT,CFM - - DISTRICT NO PROCESSED BY , I'certify that In the pe'rformance of the wor f r w h this permit Is Issued, I shall not employ any person,In ny n so as to BOILER;BTU become subject to the Workers'Compensate ZD COMPRESSOR,:BTU Date •Applicant ? VENTILATION SYSTEM APPROVALS DnTE NSPECTOR S SIGNATURE f NOTICE TO APPLICANT',If, afte ma ng thes'Cer�tifZate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must'forthwlth comply,with such FINAL provisions or this-permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR ' BTU VALIDATION I hereby affirm that I am'licensed under provisions of Chapter 9 " SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and ! HEATER WALL Professions Code,and my license/Is In full force and effect License Number Llc Class Contractor Date 0 ❑ I am exempt under Sec Plan check fee gf? ` U Q B&P C for this reason PERMIT ISSUING FEE$ 0 H Date TOTAL FEE 3 d Signature PLAN CHECK APPLICANT OWNER-BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031 5, Business and Professions ,v e) ADDRESS 5 Q.� V I, as owner of the property, or my employees with wages _ as their sole compensation, will do the,work and the CITY ' i, TEL NO `)$�- ;�i 5-6, :1 structure Is not Intended or offered for sale (Section 7044, - v r s EM SL and Professions-Code) ' OWNER ' {J�� 7 _ �O 1 I sr'1 s+7 ❑ I, as owner of the property, am,exclusively contracting AIL .• 'V ' l .• 00, with licensed contractors to construct the project (Sec- ADDRESS" I+ITMr_ 53 o tion 7044, Business and Professions Code) CITY TEL NO CHECK -ii°I'I CONSTRUCTION LENDING AGENCY31 I hereby affirm that there is a construction lending agency for D :I"�fiNGE °II_ the performance of the work for which this permit Is issued CONTRACTOR (Sec 3097,Civ C) " ' ADDRESS Lender's Name .-if ,lei CITY + - '`TEL NO Lender's Address STATE LIC t�-�I 1 HSI I1; I certify that I have read this application'and state that'the-above LICENSE NO CLASS Information Is correct I agree to comply with all County ordinances ; and State ws lating to building construction,and hereby authorize represe tive r i h County to enter upon the above-meritioned proper f s I p s SEE REVERSE FOR EXPLANATORY LANGUAGE rT- 7_11 MITRVWE_0FrF L OR G NT DATE W0Qy'ERS'CO1vi'PENSATION DECLARATION 76A364C ' t - q !" �' v CE-818 (2-80) Lfl'1s��0r� 6yr��1 l7 C' �� �� MGT - I herebM•gff;rm` that•I have a certificate of corisent to self - insurrl or a certificate of Workers'C'ompensat;on Insurance os - HEATING-VENT ILATI NG-AlR CONDITIONING 4'= Ctcy;fied coftc thereof f Sic 3800,Lab. C) - ay'No.��.PO�(/Lompany S77—Ir- Certified copy,s hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY :ertified copy is filed with the -ountAldmg bn inspection BUILDING G e artment. /ltl� FOR APPLICANT TO FILL IN Applicant— (PRINT OR TYPE ONLY) ADDRESS _ VV LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST his section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST d by the permit is for one hundred dollars ($100) or less.) i DISTRICT NO PRO BV O I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ,. 0 Q cc permit is issued, I shall not employ any person_inany manner so as to become subject to the Workers' Compensation Laws ` BOILER, BTU 0 L }- APPROVALS .DATE INSPECTOR'S SIGNATURE V Date Applicant COMPRESSOR,BTU_!_? ^ b CIE> W ROUGHVJ Y. ^� C. ,NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL � f{ Z Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code, you must forth- t y with comply with such provisions or this permit shall be EVAPORATIVE COOLER ,Vi DATION deemed revoked. FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR. BTU_�jp_1► O �Z I hereby affirm that I am licensed under provisions of Chapter HEATER, SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Bust- WALL ness and Professions Code, and my license is to full force and f VN effect "�5ZG b /AJ License Number / Lic.Class Z� ; Contractor A0JV1EA ! Date I am exempt from the licensing requirements as I am a �• licensed architect or a registered professional engineer Plan check fee 25%of above. ; acting in my professional capacity (Section 7051, Bus- p iness and Professions Code) PERMIT ISSUING FEE $ 16) - r� �) Lic.or Reg.No. Date HOME OWNER-BUILDER'DECLARATION' PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME Lic6nse Law for the following reason (Section 7031 5, Busi- ness and Professions Code) ADDRESSAr'El 8 [, as owner of the property, will do the work and the CITY TEL. NO structure is not intended or offered for sale (Section - 7044, Business and Professions Code). / p' a EN ❑ OWNER A q 9 4L V Cit I-C,Ale I, as owner of the property, am exclusively contracting with licensed contractors to construct - the project MAIL C I _ .;� 4- 4 . 50 (Section 7044, Business and Professions Code). ADDRESS Sp r/ 0 L�JL— �(� CITY'r.F�i 1\ Cl TEL.NO, CONSTRUCTION LENDING AGENCY / ./ ;-L;:�.�_ I r the performance that there is a-construction leading agency CONTRACTOR C.�l/�teb Alk- ^�� for the erformance of the work for which this permit is H issued (Sec 3097,Civ.C.). Lender's Name ADDRESS D f-- i fv� r tG • fir< r+�} ,r, Lender's Address I ,r CITY O�� /"�- TEL NO. i i'!f, ` �:.,r I certify that I have read this application add state that the STATEN Z� LIC C2 C> `r it �3, above information is correct.I agree to comply with all County LICENSE NO ��2 CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Countyj enter up i the above-mentioned-property•for ' inspect i irpo�- � 7 Signatuf Permittee Date nWORKERS' COMPENSATION DECLARATION I here, fAPP GC n YMN FOR PERNT eicertificate of consent to self insure, actTficate of WorkesComPennsaton Insurance, HEATING VENTILATING - AIR CONDITIONING ;or a certified copy thereof (Sec 3800 Lab C •76A364C , P❑ollc�tlC� e r�ipony/ 200046 DPW 9/88 Cer fled 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 p d ent _- ADDRESS •, (PRINT OR TYPE ONLY) - Date- �AppllcanAil� NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY E I LATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST ' (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCE ED BY the'permit is for one hundred dollars (;100) or less.)' AIR HANDLING UNIT, CFM d I certify that in the performance of the work for which this permit Is Issued, I shall riot employ any person in any manner so as to become subject to the-Workers',Compensation Laws BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date A' cant COMPRESSOR, BTU ROUGH 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 VAL DATION with comply with such provisions or,this permit shall be deem- ed revokeda '- / FURNACE FAU 11 RA ITY LICENSED CONTRACTORS DECLARATION /' FLOOR BTU I hereby affirm that I amlicensedunder 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 force and effecty� O / License Number 5 3 Llc Class, —� D d j O Contractor -� ` Date v 99 ❑ I am exempt under Sec O Plan check fee 17u B&P C. for this reason / N• Date PERMIT ISSUING FEE $ a � Signature TOTAL FEE AA OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License D ' Law for the following reason (Section 7031'5,Business and NAME Professions Code) I I I I . _ j, as owner of the property, or my employees with ADDRESS1,. s wages as their sole compensation, will do the work and the structure Is not intended or offered for sale(Section CITY TEL NO _ 3 tt, yi i °•`,'i ,7044, Business and Professions Code) ❑'- I, as owner of the property, am exclusively contracting OWNER G L N with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code) ADDRESS (-� CONSTRUCTION LENDING AGENCY CI, L G TEL NO t•I�- •1: f° I hereby affirm that there Is a construction lending agency for 4. .,.. the performance of the work for which this permit is Issued CONTRACTOR Nag (Sec 3097, Civ C ) r ADDRESS _ Lender's Name +l"'' Lender's AddreCITY �Q ' TEL NO s � STATE LIC 7•,)z i' - ` •.t: s °' L E_ I c `'ertify that I have read this application and state that the LICENSE NO �y 7- CLASS above Information Is correct I agree to comply with all County ordinances and State jaws relating to building construction, and hereby authorize representatives of this County to enter upon Rtha�bge Cloned property for Inspect n p rposes 2 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Age n D e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1011080001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID I FEES PAID I BUILDING ADDRESS I ITR 7796 LT 21 5410 LOMA AV 1 I IFEE DESCRIPTION QUANTITY- UOM AMOUNT TEMP CA 917803003 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET OLIVE 1 15388-001-021 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID- H4 LOCALITY TEMPLE CITY, Cl 102 COMPRSR < 100 KBTU 1 00 COM 27 00 ITENANT 108 FURNACE/HEATER <100 1.00 UNI 27 00 (ISSUED ON. PROCESSED BY PLAN BY: I TOTAL FEES 81 80 111/08/10 SR (OWNER TEL NO F p FIN CODE IJACALONE MARK (626) 287-9830- 15410 LOMA AV I ITEMP 917803003 1 IDES IPTION OF WORK IREPLACE HVAC NEW FURNACE, NEW COMPRESSOR, NEW DUCTING REMOVE( I& RECYCLE PRIOR EQUIPMENT (APPLICANT TEL NO I ISAME AS OWNER - I ISPECIAL CONDITIONS I I I I I ICONTRACTOR TEL NO- I (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I LIC NO i iFAU/•,)WALL FURNACE ICOMBUSTION AIR OPENINGS (ARCHITECT OR ENGINEER TEL NOIDUCT WORK _ I I I LIC NO I IAC/COMPRESSOR j I I I THERMOSTAT FIRE,DAMPERS I I I ISMOKE DETECTION DEVICES I I 11COMMERCIAL HOOD I I I I I I I I I j i j I I II I I I I I I I I I IREPORT ID DPR264 ROUTE TO BS0508