HomeMy Public PortalAbout9647 LAS TUNAS DR_Mechanical__ WORKERS' COMPENSATION DECLARATION APPLECATION FOR PERMIT
I ,hereby affirm that I have a certificate of consent to self
14,pre, or a certificate of Workers' Compensation-Ansvrance, 76A364C IDEATING - VENTILATING - AIR CONDITIONING r
or.x certified copy thereof (Sec. 3800, Lab. C.)
t' ' 20-0046 DPW 9/88
Policy No. Company
❑ -Certified copy is hereby furnished. V COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL-IN BUILDING /�V7 `/es TCG��S
tion department. ADDRESS 9v
(PRINT OR TYPE ONLY) / ^ �
Date Applicant % C�
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE Ae
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. .S TiiG�J�•s ��r96t
(This section need not be completed If the work involved by ABSORPTION UNIT, BTU DISTRICT NO.� PROC BY
the permit is for one hundred dollars ($100) or less.)
AIR HANDLING UNIT, CFM n
I certify that in the performance of the work for which this d V
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 INSPECT 'S SIGNATURE
Date Applicant COMPRESSOR, BTU ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL II-z.f p kw)
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comp)y with such provisions or this permit shall be deem-
ed 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. / 30 ?"low 0j11AFeAV0. 2r. ov
License Number Lic. Class 'Cl01
® d
COQ n'1 ffi.� O
V
Contractor Date �
❑ I am exempt under Sec. O
Plan check fee U.
B.BP.C. for this reason w
Date: PERMIT ISSUING FEE $ 13, 99Vin
TOTAL FEE
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): 0
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and AGCT.g
the structure is not intended or offered for sale(Section CITY . TEL. NO. 33A7 37.00
7044, Business and Professions Code). OWNER
❑ I, as owner of the property, am exclusively contracting 0111r,077 C/'Inl+A &W101q IITEMS
'
with licensed contractors to construct the project (Sec- MAIL 9�ty7 S �fitil��+J TOTAL 37-00
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY T�Pi,H �G c.:I l TEL. NO. CASH '077.DO
I hereby affirm that there is a construction lending agency for I
the performance of the work for which this permit is issued CONTRACTOR /^ ® CHANGE vU{1
(Sec. 3097, Civ. C.).
Lenders Name Z
ADDRESS ? 7 7 CQ-02 �'y0Lr� 0 .L
CITY �,e STEL. NO.Am 7 �� C(VVV V4 1 �I � �{
Lender's Address 8114 1 AN11:5
1 certify that I have read this application and state that the
STATE LIC
NO.` -17 YYS— CLASS G`2
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
hereby authorize r sentatives of this County to enter
upon he above- Ione proper y for gopection p pos s.
� p SEE REVERSE FOR EXPLANATORY LANGUAGE
v O
S' ature Applicant or en Date
. COUNTY OF LOS ANGELES TEMPLE CITY .r#.050 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ME 0508,9705130005
BUILDING AND SAFETY / LAND DEVELOPMENT.. TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
EFEES L D S : ,
TR: 6567 LT: 139: BL: .001 9647 LAS TUNAS-DR
FEE DESCRIPTION: QUANTITY: UOM: - AMOUNT: TEMP CA 917802103
ASSESSOR 0 BER: NEAREST CROSS STREET:
X8,7-020-0 01 PERMIT ISSUANCE FEE. 27.75 THOMAS PAGE: 597 GR.ID:'A3 LOCALITY: TEMPLE CITY
+rx 37 AHU > 10000.CFM 1.00 AHU '65:25 1
p TOTAL FEES 93.00 ISSUED 0PROCESSED P S
-AMER N SAVINGS BANK i• 05/13/97 :TC 05/13/98••
OW TE O: FINAL DATE FINAL B COD
T0. ANCE'VICTOR J -
DESCRIPTION 0
ADDING AIR HANDLING UNIT TO EXISTI G SYSTEM-
APPLICANT:
BARR ENG, •t'. (310) 944-1722-' ,
SPECIAl CONDITrOTS,.
CONTRACTOR: TEL. 0: 190, PPROVALS DATE INSPECTOR SIGNATURE
BARR ENGINEERING, INC. (310) 944-1722- ,�+
12612 CLARK LIC. NO C �r /WAL
SANTA FE SPRINGS, CA 90670 C10 `
COMBUSTION AIR. OPENTRUS
ARCHITECT-OR ENGINEER: TEL. NOF DUCT-WORK
LIC: NO: '/. ` AC COMPRESSOR
TREMMAT
�i����C �-C IL K`1 IRE DAMPERS
MOKE ETE TIO DE C S .
r 1 � COMMS CI L HOOD
YJ
* ADDITIONAL. DATA ON FILE
REPORT ID: OPR264 ROUTE TO: 'BS0508
COUNTY OF LOS ANGELES TEMPLE CITY ## 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1209260015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: .6561 LT: 139 BL: .001 1 1 9647 LAS TUNAS DR 1
I IFEE DESCRIPTION! QUANTITY: UOM: AMOUNT:1 TEMP CA 917802103 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18587-020-037 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl
1 102 COMPRSR < 100 KBTU 2.00 COM 54.00 1 1
[TENANT: 130 AIR INLETS/OUTLETS 37.00 UNI 162.80 11SSUED ON: PROCESSED BY: PLAN BY:
ICHASE BANK 135 AHU < 2000 CFM 2.00 AHU 25.80 112/03/12 SR
1 ; 142 VENT SYSTEM (OTHER) 1.00 SYS 33.90 1 t 1
(OWNER: TEL. NO: 147 ALTER EXIST DUCT SYS 1.00 SYS 27.00 IFI DATE FI Y: CODE: 1
(CHASE BANK - 74 TI ENERGY W/O BL PMT 3973.00 SQ 108.00 I I
I ; I TOTAL FEES 439.30 I I
1 � I JDESCRIPTICN OF WORK I
ITI TO AN (E) BANK. DUCT WORK & ADDING TWO FAN GILLS & I
I ICONDENSING UNITS. I
(APPLICANT: TEL. NO: I I I
IMARK/JUDY YAM (626) 675-9882- 1 1 I
1392 N. LE MAY COURT I ISPECIAL CONDITIONS: I
IORANGE, CA 92867 1
I I I I
[CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
1DBSI INC (602) 264-7263- 1 1 1
16950 W MORELOS•PLACE LIC. NO [ IFAU/WALL FURNACE 1 1 1
ICHANDER AZ 85226 931142 * 1 1 I 1 1
I 1 .1COMBUSTION AIR OPENINGS i 1
(ARCHITECT OR ENGINEER: TEL. NO: I ]DUCT WORK I I I
[GENSLER, ERIC JAMES (949) 863-9434- 1 1 1 1 1
14675 MACARTHUR CT STE 350 LIC. NO: I IAC/COMPRESSOR [ 1 1
INEWPORT BEACH, CA 92660 NONE I I I '
1 I ITHERMOSTAT I
I I I I
1 1 (FIRE DAMPERS
1 1 ISMOKE DETECTION DEVICES 1 1 1
I I ICOMMERCIAL HOOD I I I
II I I I I
I I I 1 I I
I I I
I I I I I I
I I I I
[ 1* ADDITIONAL DATA ON FILE I 1 1
I I I I I
� iREPORT ID: DPR264 ROUTE TO: BS0508 i 1
I
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