HomeMy Public PortalAbout9470 LAS TUNAS DR_Mechanical__ WORKER'S COM PEN SATIOMDECLARrTION 20-0046 DPW 9,.89 APPLICATION FOR PERMITLIME G
I hereby affirm that I have a certificate-of consent to self insure, 76A364C
or a certificate,of Worker's Compensation Insurance, or a Certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab. CJ I h'
Policy No. -Company tbw XNomN/'rl LLL'lll '
' COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY'DIV.
❑ Certified copy is hereby furnished. F-KP 'I'-/p Z
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS 970
department. /yL�w (PRINT OR TYPE ONLY) GAO
Date CZ-9_y Applicant rfr'/"t LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
-CERTIFICATE OF EXEMPTION.FROM WORKERS' NEAREST ;
COMPENSATION INSURANCE CROSS ST.
' ABSORPTION UNIT,BTU
(This section need not,be completed if.the work involved by the ASSESSOR
permit is for.one hundred dollars $100 MAP BOOK PAGE • PARCEL
P dollars.($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws. /i 0
COMPRESSOR,BTU )�� <% .Z3'a� •76 75
t— APPROVALS - .,DATE INSPECTOR'S SIGNATURE
Date Applicant 77(DO1� Q*4b-SD 32S 5O
NOTICE TO APPLICANT: If, after making this Certificate of tt ' ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
,provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commenci.ng with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license is in full force and effect.. �,�•
License Number ���� I Lic.Class C
-39
CL
Contractor I ll )'EEL" ftM6Date12-1-24 0
❑ I am exempt under Sec.
Plan check fee �� U
B.&P.C.for season PERMIT ISSUING FEE$ /�� Q
ate: �Z'g /` Ir-
TOTAL FEEV
O(7 °1,, LU
Signature _//• 0-
PLAN CHECK APPLICANT CD
0NER-BUILDER DECLARATION _11OQQ 3` Z
I hereby affirm that am exempt from the Contractor's License Law NAME H -MD� ,
for.the following reason (Section 7031.5, Business and Professions F-
Code): ADDRESS ,
I, as owner'of the property, or my employees with wages 4tIo �►ddJ�i 40
`
as their sole compensation,.will do the work and the CITY /� / %e I E .NO.
�� 5-2r�r
structure is not intended or offered for sale (Section 7044, rGT
Business and Professions Code)- OWNER
t ❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors.to construct the project (Sec- ADDRESS'
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY TEL.NO.
hereby affirm that.there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued
(Sec.'3097,Civ.C:). , r-
ADDRESS
Lender's Name
CITY TEL.NO.
Lender's Address STATE LIC. ._
certify that I have read this application and state that the above LICENSE NO. CLASS
information is correct. 1 agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
repr,g Is ative f his ounty to enter upon the above-mentioned
pr y for i s C,* purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
NA7 E5 APPLICANY OR AGENT DATE
-' WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/69 APPLICATION FOR PERMIT LIME GREEN
76A364C
I hereby affirm that 1 have a certificate of consent to self insure,
ora certificate of worker's,Compensation'Insurance, or a certifiedHEATING -VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab. C.)
Policy No/Lcompany _ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
Certified copy is filed with the cou�bild'ngFOR APPLICANT TO FILL IN BUILDINGd artm nt. I n (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
Date Applican NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS'if f
NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved b the / b ASSESSOR
( p Y ��..;;---- �9/� � MAP BOOK � � PAGE PARCEL
permit is for one hundred dollars($100)or less.)• / AT HADLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU 00 060 /Mo OE10 OD
become subject to the Workers'Compensation Laws. Q
COMPRESSOR,BTU��� OL10 -/000-Gt00 p7J
y APPROVALS DATE INSPECTOR'S SIGNATURE
TILATI S
Date Applicant VENTEM /moo , /D DO -
NOTICE TO APPLICANT: If, after making this Certificate of_ ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER �/
provisions of the Labor Code, you must forthwith comply with such 70 Dn FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
VALIDATION
I.hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code,'and my license is in full force and effect. -
.License Number Jr I Lia Class C20 G1pcp
}
Contractor ^ Date Q y D , 0
❑ I am exempt under Sec. Plan Check fee IY
B.BP.C.for this reason PERMIT ISSUING FEE$ A O
Date: TOTAL FEE
U
W
Signature a
PLAN CHECK APPLICANT, V)
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.
Code):
ADDRESS f_h s,;,-,1;
❑ I, as owner of the property, or 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). 0DWNER
❑ I, as owner of the property, am exclusively contracting V I-= CZ,I I
MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). � I •� ; '.wE
CITY m (�/ TEL.NO. J)�{
CONSTRUCTION LENDING AGENCY GO ITi-• r4-69
; -fit.-
I hereby affirm.that there is a construction lending agency for /� t`tY€HL 4 L
the performance of the work'for which.this permit Is issued CONTRACTOR
(Sec.3097,Civ.C.).
ADDRESS
Lender's Name
CITYMaDwilz
TEL.NO.
Lender's Address STATE A f LIC.
I certify that I have read this application and state that the above LICENSE NO. ocl_u CLASS _z '-1UI 1
information is correct. I agree to comply with all County ordinances
tiit A111and State laws relating to building construction,and hereby authorize 1 - Ct a
r ;I
representatives of this Coun!th to enter upon the above-mentioned
prop fo nspec ses. SEE REVERSE FOR EXPLANATORY LANGUAGE
G WKrURE APPLICAtff OR AGENT DA
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
�.`;•he;olyy affirm that I have a certificate of consent to self
'insure. or a ceb!ificate of Workers' Compensation Insurance, 7eA364c HEATING - VENTILATING - AIR CONDITIONING
or a cirtified copy thereof (Sec. 3800, Lab. C.)
CE-818(REV. 10/81)
Policy No. Company
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 / �, i—
tion department. (PRINT OR TYPE ONLY) ADDRESS 1
� ,4s .S
Date Applicant LOCALITY 1,<—A,016
Gr
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE 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. PROCESSED B
the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM V
I certify that in the performance of the work for which this 1 U
permit is issued, I shall not employ any person in any manner BOILERBTU
so as to become subject to the Workers"Comp S. ,. APPROVALS DATE . I SPECTOR•S Ic ATURE
+ COMPRESSOR, BTU ROUGH /
Date2 Applicant I "
NOTICE O AP LICANT: If, after .king this Ce ti icate of VENTILATION SYSTEM FINAL f
Exemption, you should become subject to th orkers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000) of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
License Number °T2_O1191z Lic. Class c413 . , U
/ p �
Contractor;�s � �✓ Date � 0.
❑ I am exempt under Sec. g 7 7 9$ A tw
Plan check fee
e.&P.C. for this reason PERMIT ISSUING FEE a �U #,o!o o,o o $
Date:
Signature TOTAL FEE '7 -1•'.o .2-0.5 0
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT o,o a 2 a 5,0
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): 0$3'1 +$7
❑ I, as owner of the property, or my employees with 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). j
❑ I, as owner of the property, am exclusively contracting OWNER /� M
with licensed*contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY A, TEL. NO.
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR �6`T poll.(Sec. 3097, Civ. C.).
• ADDRESS -
Lender's Name ex " 7
CITY TEL. NO. 293_J✓ 1-1_11
Lender's Address
STATE LIC
I certify that I have read this application and state that the LICENSE NO. 0 CLASS -
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby-authorize representatives of this County to enter
upon the abo, e-menW'oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Si n Lure of Applicot r Agent Date -
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1212130009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 8526 LT: 713 9470 LAS TUNAS DR
_(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 91780
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18587-009-025 101 PERMIT ISSUANCE.. FEE . 27.80 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl
1 _140 EVAPORATION COOLERS - 1.00 UNI 21.90
TENANT: TOTAL FEES 49.70 JISSUED ON: PROCESSED BY: PLAN BY:
112/13/12 SR
I I I I
10WNER: TEL. NO: 1 IFINU DATE FINAL BY: CODE: 1
IRALPHS GROCERY CO. (626) 286-0898- 1
19470 LAS TUNAS DR.
ITEMPLE CITY CA 91780 (DESCRIPTION OF WORK
(SERVICE REPLACEMENT CONDENSER LIKE FOR LIKE
APPLICANT: TEL. NO: I
IKRENGEL, KEN (909) 590-4910- I
113770 RAMONA AVE ISPECIAL CONDITIONS:
ICHINO CA 91710
ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1
IHUSSMAN SERVICES CORPORATION (909) 590-4910- I_
113770 RAMONA AVE LIC. NO IFAU,'WALL'FUPNACE I I I
(CHINO CA 91710 966312 I I I I
I 1 1CON13USTION AIR OPENINGS 1 1
(ARCHITECT OR ENGINEER: TEL. NO: I _ IDUCT WORK I I
LIC. NO: XPIRED IAC/COMPRESSOR
I THERMOSTAT
I I I 11f t 1_ 1 1 I
I I IFIR2 DAMPERS
SMOKE DETECTION DEVICES
I I I I I I
I ICOK4ERCIAL HOOD
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I i I I I I
I t I I I I
I I I I I I
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I i I I I I
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IREPORT ID: DPR264 ROUTE TO: BS0508
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1107270045
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: 1 FEES PAID BUILDING ADDRESS: 1
ITR: 8526 LT: 713 1 I 9470 LAS TUNAS DR 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18587-009-025 101 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl
1 102 COMPRSR <,100 KBTU 1.00 COM 27.00 I I
(TENANT: 136 AHU 2001-10000 CFM 1.00 AHU 38.80 (ISSUED ON: PROCESSED BY: PLAN BY: 1
I 1 TOTAL FEES 93.60 107/27/11 SR 1
I I I I
(OWNER: TEL. NO: 1 1 DATECODE: I
IRALPHS GROCERY CO. (626) 286-0898- 1 1
19470 LAS TUNAS DR. F I
(TEMPLE CITY CA 91780 1 CR PTIOA OF WORK 1
I I (INSTALL MINI SPLIT SYSTEM COMPUTER ROOM 1
I I I I
1APPLICANT: TEL. NO: 1
(SOURCE REFRIGERATION AND HVAC INC. (714) 578-2300- I
1800 E. ORANGETHORPE I (SPECIAL CONDITIONS: 1
1ANAHEIM, CA 92801 I
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(CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1
(SOURCE REFRIGERATION & HVAC (714) 578-2341- 1 I
1800 E. ORANGETHORPE AVENUE LIC. NO I 1FAU/WALL FURNACE I I I
1ANAHEIM, CA 92801 800678 1 1 1 1 I
1 (COMBUSTION AIR OPENINGS 1 1
I I I I I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 1DUCT WORK I I I
I - I I I I
1 LIC. NO: I 1AC/COMPRESSOR 1
I I I I I I
I (THERMOSTAT I I I
I I I I
I- 1 (FIRE DAMPERS I I
I I I I I I
I (SMOKE DETECTION DEVICES I I I
I I I I I I
1 (COMMERCIAL HOOD I I I
I I I I I I
I I I I I I
I I I I I I
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I I f I I I
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1 1REPORT ID: DPR264 ROUTE TO: BS0508
I I I I I I
_ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF RUBlIC WORKS 9071 LAS TUNAS ME 0508 9808240003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 8526 LT: 713 9470 LAS TUNAS DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY
01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY
03 COMPRSR 101 500 KBTU 1.00-COM 52.20
TENANT: TOTAL FEES 79.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
RALPHS GROCERY 08/24/98 UT 08124/99
1-1
OWNER: TEL. NO: FINAL DATE FINAL BY CODE:
RALPHS GROCERY (818) 506-5447- i
9470 LAS TUNAS
TEMPLE CITY DESCRIPTION OF WORK
MECHANICAL WORK FOR TENANT IMPROVEMENTS
APPLICANT: TEL. NO:
LESTER PALEY ASSOCIATE (818) 506-5447-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
G H V REFRIGERATION INC (714)577-3950-
165 W. ORANGETHORPE LIC. NO FAU/WALL FURNACE
PLACENTIA, CA 92870 482844
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
LIC. NO: AC/COMPRESSOR
THERMOSTAT
�1 ��� n (� D 1 � ��vFIRE DAMPERS
U �——_--- -----�—i—� SMOKE DETECTION DEVICES
ij
COMMERCIAL HOOD
4YS4
REPORT ID: DPR264 ROUTE TO: BS0508