The URL can be used to link to this page

Home My Public Portal About9440 LEMON AVE_Mechanical__ WORKER'S COMPENSATION DECLARATION 200046 DPW 9/89 APPLICATION FOR PERMIT LIME GREENi 76A364C ' I hereby affirm that I have a certificate of consent to self Insure, ora certificate of Worker's Compensation Insurance, or a certified ,'HEATING 7NENTILATING -AIR CONDITIONING copy tfiereof(Sec. 3800 Lab.C.) - u Pohcy'No. Company• COUNTY OF LOS ANGELES, DEPT'OF;PUBLIC-WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby.furnished '+ ❑, Certified copy is filed with the county g inspection ection FOR APPLICANT TO FILL IN BUILDING department. p (PRINT OR TYPE ONLY) ADDRESS LOCALITY V Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE' ` CERTIFICATE.OF EXEMPTION FROM WORKERS" NEAREST ' CROSS ST COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed If the work involved by the MAP BOOK �% PAGES/,44 PARCEL�,S permit is for one hundred dollars(5100)or less.) AIR HANDLING UNIT,CFMDISTRICT No PROCESSED BY I certify that in the performance'of the work for which this permit is Issued;'l'Shall not employ any person-in any manner so as to BOILER,BTU become subject to the Workers'Compen on Laws COMPRESSOR,BTU _ APPROVALS. DATE INSPECTOR'S SIGNATURE . Date' z Applicant VENTILATION SYSTEM NOTICE T '•A PLICANT: If,,after•mIS Certificate of ROUGH Exemption,you should,become subject tot orkers'Compensation EVAPORATIVE COOLER y 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 DECLARATIONFLOOR BTu VALIDATION I hereby affirm that 1,am.licensed under provisions of Chapter.9• SUSPENDED UNIT ' '(commencing with Section 7000) of Division,3 of the Business and / HEATER:" O c WALL �� Professions'Code, and my license is in-full force and effect; r ` License Number Lia Class , a Contractor" k Date S , t U ❑ Plan check fee I am exempt under Sec." B BP.C.for this reason PERMIT ISSUING FEE $ O Date. TOTAL FEE © W Signature a OWN L R DECLARATION PLAN CHECK APPLICANT coZ I hereby affirm that I am xe t from the.Contractor's License Law NAME , d for the following reason (Section.703 1.5, Business and,Professions Ivy/ - Code): % ADDRESS ACCT.e EJI, as owner of the property, or my'employees with wages �1 as their sole,compensation, will do the work and the CITY TEL.NO. 337 5t3■cc, structure Is not Intended or offered for sale (Section 7044,, ,. 1' ITEM thpro property, am exclusively Contracting Professions.Code). OWNER" T1 1, as owner of MAIL TOTAL'- _ c' with licensed contractors to construct the project (Sec-' ADDRESS !1� y tion 7044,'Business and Professions Code) TY TEL"NO. r CHE`K + CONSTRUCTION LENDING AGENCY i� � I hereby affirm that there is a construction lending agency for CHANGE` ..00 I he performance of, the'work for which this permit Is issued CONTRACTOR- (Sec.3097, Civ C>. ` ADDRESS t�•tyft•r��r� L _ .7•._ `i] Lender's Name G r/ - 0000-L0OD1' i'�yf 7� CITY TEL-NO�44V104 '« - AMIO:20 Lender's'Address STATE LIC• t 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 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 Y SIGNATURE OF APPLICANT OR AGENT DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1011020001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID I BUILDING ADDRESS. 1 ON FILE 9440 LEMON AV I I IFEE DESCRIPTION: QUANTITY. UOM: AMOUNT: 1 TEMP CA 917801302 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15382-014-023 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: Jl LOCALITY: TEMPLE CITY, Cl 102 COMPRSR < 100 KBTU 1.00 COM 27.00 1 ITENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 11SSUED ON: PROCESSED BY: PLAN BY: I I TOTAL FEES 81.80 111/02/10 SR 1 (OWNER: TEL. N0: F AL TE l FIN Y: CODE: I ITAKEMARA, JOHN •- I IU 19440 LEMON AV _ ITEMP 917801302 1 1 E GRIP ION OF WORK V1 I (l) REPLACE FURNACE 100K BTU (1) REPLACE A/C 5 TON 16 SEER 1 1APPLICANT: TEL. NO: I I IZAMORA, CARLOS (818) 735-7876- I I t 15858 DOVETAIL DR. i iSPECIAL CONDITIONS: IAGOURA HILLS I I 1 1 I I (CONTRACTOR: TEL. N0: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IGENERAL HEATING AND A, C (626) 358-0022- 1 1 11310 S. MYRTLE AVE LIC. NO 1 IFAU/WALL FURNACE I ' I IMONROVIA CA 91016 469166020 i I I I I ICOMBUSTION AIR OPENINGS 1 I I I � ARCHITECT OR ENGINEER: TEL. NO: i' IDUCT WORK I I I I I I LIC. NO: i - 1AC/COMPRESSOR I 1U ITHERMOSTAT I I - IFIRE DAMPERS I I I 1 ISMOKE DETECTION DEVICES I I I I I ICOMMERCIAL HOOD I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 1 I I I I I I I I I