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Home My Public Portal About9655 LIVE OAK AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C p o no p p (off n0 2 0 �/� I hereb affirm that I have a' certificate.of consent to self CE -818(2-80), Q P If— lam- .0 Q T 0 O N FOR If—L— R U�%p T insure, or a certificate of Workers'Compensation Insurance,or HEATING-VIENTIL.ATING_AlR' COWDITIOIr ONG a ce fie_ ,o f(Sec: 3800,I to i INo -1th�:,re�� om ny- COUNTY OF LOS ANGELE BUILDING AND SAFETY Certified copy is hereby furnished. . LI Certified copy is sled with the county,buildi nspection FOR APPLICANT TO FILL IN / BUILDIN FF �Ie 1rDteA ucant ( — (PRINT OR TYPE ONLY) ADDRESSy_1\_ LOCALITY .CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST CROSS ST. !f2 a (This 'section need not be completed if the 'work involved ABSORPTION UNIT, BTU —_ 0 by the permit is for one hundred dollars (5100) or less.) DISTRICT NO. PRO "f ED ev U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM permit is issued, I shall not employ any person in any manner b _ so as M becomes s,susect to the Woorrkerr�ss''"C:- ensatipn Laws`. BOILER, BTU :.E Date �1 "A licant APPROVALS DATE INSPECTOR'S SIGNAT U W .p C'OMPRESSOR,BTU ROUGH a' / to, NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM z FINAL .Exemption, you should become subject to the Workers' — Compensation provisions of the Labor Code, you must forth- EVAPORATIVE,COOLER —'7/r/� VALIDATION with comply With such.provisions or this permit shall be <(� ) deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU Thereby affirm that I am"licensed under provisions of Chapter HEATER USPENDE- UNI 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions C� e. and my license is in full force and effect. - License Nj� e._� Lic.CI-_-s_ _ Contract( Date I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan checkfee 25%of above. acting in'my professional capacity (Section 7051, Bus- iness and Pro essions Code). PERMIT ISSUING FEE $ II Lic.or Re'$.No.. Date%_A � TOTAL FEE �- � - HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 3A.. 1 hereby affirm that I am exempt from- the Contractor's NAME '# o{ofo o'o License Law for the following'reason (Section 7031.5, Busi- . 2 or o 27.00 : ness and Professions Code): 'ADDRESS I, as owner of the property, will do the work and theo;o o'23,0 0 structure, is not intended 'or offered fur sale (Section CITY TEL: NO. S 7044, Business and Professions Code):' : OWNER . 9 1 1 $. I, as owner of the.property, am exclusively contracting with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code).. ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL.NO. I hereby affirm that there is a construction lending agency for the performance of the work for which. this permit is " CONTRACTOR issued(Sec.3097,Civ.C.). Lender's Name ADORES Lender's Address � CITY j � TEL. ' a I certify that I'have read this application and state that the STATE LIC. aboye information is correct.I agree to comply with all County LICENSE NO. _ CLASS ordinances and State laws.regulating Heating, Ventilating and Air Conditioning, and.hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE " '-ounty to enter the above-mentioned property 'f r i.S ,c1.c r oses.. i,.at re of Permittee COUNTY OF LOS ANGELES TEMPLE CITY # 0508 - MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1308200001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 6561 LT: 550 UN: .002 1 1 9655 LIVE OAK AV 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802501 (ASSESSOR INFORMATION NUMBER: I 1 NEAREST CROSS STREET: CAMELLIA 1 18587-022-027 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI 1 141 VENTILATION FAN 1.00 FAN 15.80 (TENANT: I TOTAL FEES 43.60 11SSUED ON: PROCESSED BY: PLAN BY: 1 1 1 108/20/13 SR I I I I 1.OWNER: TEL. NO: I IFINP-L DATE FI AL BY: CODE: 1 ITHEILACKER MARLON S;GAYLE C (626) 285-6555- 1 1 15702 CAMELLIA AV I��/ ITEMP 917802501 1 1 SCRI TIO OF WORK 1 I (INSTALL ONE FAN IN MASTER BATHROOM 1 I I I I (APPLICANT: TEL. NO: I. ITHEILACKER, MARLON (818) 516-9694- 15702 CAMELLIA AVE I ISPECIAL CONDITIONS: 1 (TEMPLE CITY CA 91780 1 1 I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1FJ CONSTRUCTION (818) 516-9694- 1 11058 HORMEL AVENUE LIC. NO IFAU/WALL FURNACE I ILA VERNE, CA 91750 7823J-O II L I I ICOMRUSTION AIR OPENINGS I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: 1DUCT WORK 1 LIC. NO: I 1AC/COMPRESSOR I I ITHERMOSTAT I I _ I_ I I IFIRE DAMPERS I I I I ISMOKE DETECTION DEVICES 1 1 I I 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 I I I I I I I I I I I I I I I I i I 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 0703230006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ' ILEGAL ID: 1 FEES PAID - I BUILDING ADDRESS: 1 ITR: 6561 LT: 550 UN: .002 I I 9655 LIVE OAK AV 1 1 IFEE. DESCRIPTION: QUANTITY: UOM:' AMOUNT: ( TEMP CA 917802501 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: CAMELLIA 1 18587-022-027 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl 1 102 COMPRSR < 100 KBTU 1.00 COM 27.00 1 (TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I (HILL, DAVID 130 AIR INLETS/OUTLETS 10.00 UNI 43.50 103/23/07 JK 09/19/07 1 1 141 VENTILATION FAN 1.00 FAN 15.75 1 (OWNER: TEL. NO: I TOTAL FEES 141.00 I INAL AT FIN CODE: 1 THEILACKER MARLON S;GAYLE C (818) 285-6555- 15702 CAMELLIA AV I 1 ITEMP 917802501 1 INSCRIPTION OF WORK 4I • (INSTALL AIR CONDITIONING AND HEATING SYSTEM I I I I I (APPLICANT: TEL. NO: - 1 ISAME AS OWNER - I I ISPECIAL CONDITIONS: 1 ICONTRACTOR: TEL. NO: 3JAPPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I' 1 I LIC. NO I IFAU/WALL FURNACE I I I I I I 1 ICOMBUSTION AIR OPENINGS 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK I I I LIC. NO: I IAC/COMPRESSOR 3-IS�I /) 1 `I al ITHERMOSTAT 1 1 I I I I IFIRE DAMPERS I I I I I i 1 ISMOKE DETECTION DEVICES I I I I I 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 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 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 1 IREPORT ID: DPR264 ROUTE TO: BS0508 I I