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HomeMy Public PortalAbout9600-9602-9604 LAS TUNAS DR_Mechanical__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Workers' Comperlsation Insurancvo,-• . '76A364C HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec 3800, Lab )L , h. Policy No Company sT.�1TF p-0046 DPW 9/88 ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY rVertified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department ADDRESS a O C _ (PRINT OR TYPE ONLY) Date 2 Applicant "�� �^�� LOCALITY S7/1/�Gj/ NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM O�ERS'p,� NEAREST COMPENSATION INSURANCE CROSS ST �E/`9 C� G/T /r�C(!✓? (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PRO c ED BY the permit is for one hundred dollars ($100) or less.) in I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM b permit is issued, I shall not employ any person In any manner BOILER, BTU so as to become subject to the Workers' Compensation Laws APPROVALS TE I In CeOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT If, after making this Certificate ofVENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER V I A I with comply with such provisions or this permit shall be deem- ed revoked FURNACE FALL GRAVITY , LICENSED CONTRACTORS DECLARATION I 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 /✓ N �{ IL License Number Z Lic Class7 C 2d , O rsXTT�Sieu l�1 esr �R U Contractor Date1111V —A&It a / O ❑ j am exempt under Sec Plan check fee U W B&P C for this reason Date PERMIT ISSUING FEE $ Z Signature TOTAL FEE R Ou", OVIFT1 R-BUILDER DECLARATION PIAN 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) ADDRESS I, as owner of the property, or my employees with wages as their sole compensation, will do the work and Fi':i .g the structure is not intended or offered for sale (Section CITY TEL NO j `� r_ 7044, Business and Professions Code) . OWNER x,07 ,U_? j, as owner of the property, am exclusively contracting 1 T EMw with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code) ADDRESS TOTAL 17 ®00 CONSTRUCTION LENDING AGENCY CITY TEL NO L1 I hereby affirm that there is a construction lending agency for CHEZ X f.131: the performance of the work for which this permit is issued CONTRACTOR CHANGE, ,It (Sec 3097, Civ C ) ADDRESS Lender's Name _ CITY TEL NO 13OW-0610 I e8/ 9 f Lender's Address I cern that I have read this application and state that the STATE LIC qqp •q� 1 a�' certify PP LICENSE NO CLASS '{l IF-� 1 a I [1 •,1 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 above-mentioned property for inspection purposes _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ©s WORKERS'COMPENSATION DECLARATION 76A364C ��� ,,� _,� �> �1 �� �'�� I hereby affirm that I have a certificate of consent to self CE -818(2.80) II sure, or a certificate of Workers'Compensation Insurance,of 0C)K 7 r-^ ( .er�d co- fhP—of(Sec. 3800.Lab Cep) IhVI PolicyoNo ( CompanEl y ��1<�a!'?�' �:= ��Al� ciWw� �_�✓� �Js �u ti� r�t��Q'h:'Sf Certified copy is hereby furnished. T Certified copy is filed with the county building inspection _ -- —� ax �+ _o r BUILDING g�0� ��� Y FOR �_��0aI�1 : .v � :� ADDRESS Y department ' ^ ^ w Date.•`✓ 1. Applicant "�` K i- �ct/� (PRINT OR TYPE ONLY) LOCALITY~ -/ CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE CROSS ST�/�Q� j d (this section need not be corlpietee f the work involved ABSORPTION UNIT, BTU ___�_ _ — //-- _ — 0 by the permit is foa o-ne hur-dred dol'Us (�:CC) or :ess.) DISTRICT NO Pa �,Ess° P- -----— U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM Cj� cc permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNAT"+E (� W Date Applicant COMPRESSOR,BTU ROUGH jj N NOTICE TO APPLICANT If, after making this Certtficate of VENTILATION SYSTEM i' ' Z Exemption, you should become subject to the Workers' FINAL — Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall he deemed revoked. FURNACE. FAU GRAVITY— LICENSED RAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the busi- WALL Hess and Professions Coda, and my license is in full force and ;�� � � ^ _ �/_ � effect t�`,'n-,-.`i[_l License Number Lic Class Contractor Date ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer plan check iee 25%o.above. acting in my professional capacity (Section 7051. Bus- iness and Professions Code) - -= w Lie or Reg No. Date 'r. HOME OWNER-BUILDER DECLARATION 'PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's NAMES fI�G d License Law for the following reason (Section 7031 5, Busi- ness and Professions Code): ADDRESS,!!5-- 3-2 1, as owner of the property, will do the work and the IC17� TEL. NO ( ❑ structure is not intended or offered for sale Section 7044, Business and Professions Code). I 217 9,,0 A QOW N E R I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ;'MAIL G /� 'i # o o o o 0 8 (Section 7044, Business and Professioas Code). ADDRESS �jlJ`p liyti`C 2 1 ,700 CIT" TEL NO�_2O / CONSTRUCTION LENDING AGENCY C� 7e_� 501 I hereby affirm that there is a construction lending agency o o 0 1 ],0 0•' for the performance of the work for which this permit is CONTRACTOR issued(Sec 3097,Civ.C.) � 1,02-81 Lender's Name ADD RESS J ! 2 —1 e�J=�► /.. L / Lender's Address I C� TEL NO. I certify that I have read this application and state that the ;iSTATE / �` LIC above information is correct.I agree to comply with all County �ICENSE_NO: /_Z-� v __ _ CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection purposes. 0- K �k m-0.- r(0 Signature of Permtttee Date WORKERS'COMPENSATION DECLARATION CEA 818(2-80) G d �L�U�G�1 0 O If FOR P E R UG11 T I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab C.) Policy No Company ��®$ COUNTY OF LOS Certified copy is hereby furnished. �'���LES ����®A��sSAFETY Certified copy is Bled with the county building inspection FOR APPLICANT TO FV LL CN BUILDING /��61a ✓� � department ADDRESS j G �as Date Applicant (PRINT OR TYPE ONLY) LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE / COMPENSATION INSURANCENEAREST r �� } (This section need not be Completed if the work involved ABSORPTION UNIT, BTU CROSS ST ��7yc��� �� t O by the permit is for one hundred dollars ($100) Or less.) DISTRICT NO PR SSE 0 I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM O permit is issued, I shall not employ an person in any m r O so as to be nine subject to the Wor s' Ompensatio L vs BOILER, BTU APPROVALS DATE INSPECTO SIGNATURE V Date—� 31,pplicant_ COMPRESSOR,BTU�� t1 ROUGH U) NOTICE TO APPLICANT- If, fter making this Certificate of VENTILATION SYSTEM FINAL ` Z Exemption, you should be,ome subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be I �� �k/ deemed revoked. FURNACE FAU_ VITY z LICENSED CONTRACTORS DECLARATION FLOOR BTU 09-6,61-7 I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. License/Numr _ r ic.Class _ t9ContramateI mpt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. II acting in my professional capacity (Section 7051, Bus- iness and Professions Code). Ptiz$MBT 0$$UNQa FE E �� Lic.or Reg No. Date TWAL FEE ' >1�' 570,6 A PLAN CHECK APPLICANT HOME OWNER-BUILDER DECLARATION # 00000g I hereby affirm that I am exempt from- the Contractor's NAME 1' License Law for the following reason (Section 7031.5, Busi- 2 0 - 30.50 ness and Professions Code) ADDRESS 1, as owner of the property, will do the work and the❑ °r° ° 3 0,5 0 F�structure is not intended or offered for sale (Section CITY TEL. NO. 7044, Business and Professions Code). ,9 3 0—8,3 OWNER ,/f � I, as owner of the property, am exclusively contracting �m @� ��� with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS W -� s,D lei' 71y 4 CITY r TEL.NO. gyp/ CONSTRUCTION LENDING AGENCY fOR I hereby affirm that there is a construction lending agency CONTRAC i for the performance of the work for which this permit is issued (Sec.3097,Civ.C.). Lender's Name I ADDRESS Lender's Address CITY TEL.NO y �((�/�I� Q CQ /C1 — — — �7`3 1 certify that I have read this application and state that the STATE r LIC. r� above information is correct.I agree to comply with all County I LICENSE O " CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County o .nter upon above-mentioned property for utspect n arposes. / D anature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0503040010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEB PAID BUILDING ADDRESS: TR: 6561 LT: 579 9600 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802108 NEAREST CROSS STREET: TEMPLE CITY 8587-018-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C 30 AIR INLETS/OUTLETS 20.00 UNI 87.00 TENANT: 41 VENTILATION FAN 2.00 FAN 31.50 ISSUED 0 : PLAN Y: EXPIRES ON: HAPPY SMILE DENTAL CARE INC. 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 03/04/05 JK 08/31/05 TOTAL FEES 173.25 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: HAPPY SMILE DENTAL CARE INC. (626) 379-6696- 9600 LAS TUNAS DR. TEMPLE CITY CA 91780 DESCRIPTION OF WOR EXPEND DUCT SYSTEM TENANT IMPROVEMENT FOR DENTAL OFFICE APPLICANT: D T K CONSTRUCTION (323) 261-1388- 2580 CORPORATE PL SPECIAL CONDITIONS: MONTEREY PARK 91754 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE D T K CONSTRUCTION (323) 261-1388- 2580 CORPORATE PLACE LIC. NOFURNACE F-103 A C36 MONTEREY PARK, CA 91754 EOMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO:POLY DESIGN GROUP (626) 679-5238- DUCT R PO BOX 6854 LIC. NO: AC/COMPR5SSOR ALHAMBRA, CA 91801 NONE THERMOSTAT IRE DAMPERS SMOKE DEVICE9- CMAERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0403090003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES D BUILDING ADDRESS: TR: 6561 LT: 579 9604 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802108 ASSESSORINFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 8587-018-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 30 AIR INLETS/OUTLETS 11.00 UNI 47.85 41 VENTILATION FAN 1.00 FAN 15.75 ISSUED ON: PROCESSED BY: EXPIRES . JADE ESCROW 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 03/09/04 VG 09/05/04 TOTAL FEES 118.35 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: BENAL CO., LLC (626) 292-1078- 41247 N. ROSEMEAD BL ROSEMEAD, CA 91770 DESCRIPTION OF WOE EXTEND DUCTS FOR T.I. APPLICANT: TEL. NO: MARISSA LITTLE (KLAWITER & ASSOC) (213) 225-1851- 626 WILSHIRE STE 555 SPECIAL CONDITIONS: LOS ANGELES 90017 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE MAK EDWARD TING (626) 864-0452- 8906 BENTEL AVE LIC. NO WALL FURNACE ROSEMEAD, CA 91770 774980-8 COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. DUCT WORK KLAWITER AND ASSOCIATES, INC. (213) 622-1855- 626 WILSHIRE BLVD LIC. NO: AC/COMPRESSOR SUITE 555 NONE LOS ANGELES, CA 90017 THERMOSTAT FIRE DAMPERS SMOKE DETECTION COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508