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HomeMy Public PortalAbout6103 MUSCATEL AVE_Mechanical__ ION WORKER'S J.have a certificate of consent to 7BP68DPW9,R9 APPLICATION FOR PERMIT LIME GREEN, 7eA364C f-herebylafftrm that J.have a certificate of consent to self insure, or a certificate•af:Worker's Compensation Insurance, or a certified I HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) I u Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. gyp�) /'//�– ❑ Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN ADDLDING RESS /� �� J'/V�'-•4 department. (PRINT OR TYPE ONLY). Date ApplicantLOCALITY L t �9•-' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE Y1 CERTIFICATE OF EXEMPTION FROM WORKERS' NEARi COMPENSATION INSURANCE CROSESTS ST. ����-�•� ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed If the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to BOILER,BTU v become subject to the Workers'Compensation s. COMPRESSOR,BTU Date �! Applicant VENTILATION SYSTEM APPROVALS DATE INSPE RssIGNATURE NOTICE O A PLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL 13-2 provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. n S License Number LID.Class OA;Ijr" -Toce&. r _ Contractor Date V J r_1 c I am exempt under Se Plan check fee �,;••r•-- C B.&P.C.for this reason PERMIT ISSUING FEE$ n" _ W' C Date: TOTAL FEE Signature (! PLAN CHECK APPLICANT I�'•'_I .—<-•, OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law NAME rG � G/lf7N , _ , for the folowing reason (Section 7031.5, Business and Professions -] """' `L'``' ode ADDRESS I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY et TEL.NO. structure is not intended or offered for sale (Section 7044, "" Business and Professions Code). OWNER _ ' '- ❑ 1, as owner of the property, am exclusively contractingry` 3 MAIL "•�.—•:• Pet l with licensed contractors to construct the project (Sec- ADDRESS /y. t/S tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CIN GLlj�i( I� EL.NO. SAL I hereby affirm that there is a construction lending agency for CONTRACTOR 0111'.the performance of the work for which this permit s issued (Sec.3097,Civ.C.). ADDRESS Lender's Name t' CITY TEL.NO. Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. CLASS information is corm Iagree to comply with all County ordinances and State I lating building construction,and hereby authorize represent i of this ounty to enter upon the ab ve-mentioned property f inspect:" purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a2 SIGNATURE OF APPLICANT OR AGEN DTE HWORKER'SCOMPENSATION DECLARATION 48DPW 9/89 APPLICATION FOR PERMIT LIME GREEN I h76A384C hereby affirm that d have a certificate of consent to self insure, 78A3 or a certificate of'WorkerNs Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sac 3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. r�U_JL1 El copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADD_ss ��3 /I/_ (/ r L DING department. (PRINT OR TYPE ONLY) Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST n COMPENSATION INSURANCE 1 CROSS ST. ABSORPTION UNIT,BTU ASSESSOORR f (This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL / permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that In the performance of iv is permit Is issued, I shall not employ any pso es to BOILER.BTU become subjec to the Workers'Com l 2 I( /J COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date ( 1 LApplicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT- (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. License Number Lic.Class , `q' _ /r �y ACCT e 4 a Contractor Date 6)C)1 L /� J` :_, 7 0 e I)? o ❑ Plan check fee I am exempt under Sec. 1 ITEMS IZ B.&P.C.for this reason PERMIT ISSUING FEE$.^ ft7 3 Q Date: TOTAL FEE �, TOTAL 40-07 ~ U CHECK 40.0-1 w Signature 0. OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CHANGE a t�i1 I hereby affirm that I am exempt from the Contractor's License Law NAME for the followin reason (Section 7031.5, Business and Professions /� �y ry{�r`i { r i /{� J 010. C de• ADDRESS 0 JC A �,S � 1900-0011 2 .2•-1!7 is I, as owner of the property, or my employees with wagesir iZan � as their sole compensation, will do the work and the CITY ,` f TEL.NO. b �ds71 1 Ate ■ .� structure is not intended or offered for sale(Section 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL1 with licensed contractors to construct the project (Sec- ADDRESS Q 3 J.SC4-7,_ [� tion 7044,Business and Professions Code). Gh cITY�A A( O' -'C)-tJ'! �bS CONSTRUCTION LENDING AGENCY ✓�+v I hereby affirm that there is a construction lending,agency for CONTRACTOR oil.the performance of the work for which this permit Is issued (Sec.3097,Civ.C.). ADDRESS Lender's Name CITY TEL.NO. Lender's Address STATE LIC. I certify tha a read this application and state that the above LICENSE NO. CLASS inform n is rrect. I agree to comply with all County ordinances and St to la relatin to building construction,and hereby authorize repres t es of thi County to enter upon the ab Is toned props ti n urposes. /Z 2r SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT DATE t,s WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT k'�"l,her'e�'affirm that I have a certificate of consent to self iTisure; or'a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or ci cerfified copy thereof(Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) Policy N� CompanyR*+Ub_1 i n Tn en it3T r COUNTY OF LOS ANGELES BUILDING AND SAFETY Certi ied copy Is ereby furnished. © Certified copy is filed with the county I i ng inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS 6103' Muscatel Date1284 Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ;an Gabr7UP-1 CERTIFICATE OF EXEMPTIO FOM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved byABSORPTION UNIT, BTU DISTRICT NO PROCESSED the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM �)� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner r — ,BOILERBTU so as to become subject to the Workers'Compensation Laws. APPROVALS DATE IN TO 'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Al C 4— Exemption, you should become subject to the Workers' t7 Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY !;-_;- 1 2 7.5 A LICENSED CONTRACTORS DECLARATION FLOOR BTU 3 5M # o o'o o o S I hereby affirm that I am licensed under provisions of Chapter 9HEATER: SUSPENDED UNIT 1000 ° ° 2 0,5 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. s o 0 o20,5Q� 0 License Number 386678 Lic. Class(:711 ► 1228-64 as Contractorgnivers al P1bgate 17-17-84 ❑ I am exempt under Sec. AU Plan check fee tCL o B.BP.C. for this reason PERMIT ISSUING FEE $ Date: v. Signature TOTAL FEE 120 150 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): ❑ 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). OWNER 1:1 1, 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). 61-03 xusGatel CONSTRUCTION LENDING AGENCY CITY San Gabriel TEL. No. 257-8043 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). Universal Plumbing ADDRESS Lender's Name Lender's Address CITY S. E1 Monte TEL NC575-3460 STATE o LIC. I certify that I have read this application and state that the LICENSE NO. 3866Z8 CLASS C,20 above information is correct. I agree to comply with all County ordinances and St a laws relating to building construction, and hereby auth i representatives of this County to enter the ciove noon d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 12-12-84 Sign re of Applicant or Ag Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1209120010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: [ ITR: 5903 LT: 51 I 1 6103 MUSCATEL AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 [ (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15386-009-046 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY, Cl 1 141 VENTILATION FAN 3.00 FAN 47.40 I 1 TENANT: [ TOTAL FEES 75.20 [09/12/12N: PROCESSED BY: PLAN BY:SR [ [OWNER: TEL. NO: I IFI AL DATE FINAL BY: CODE: [ [WONG, DAVID (972) 623-7820- ] [ [ 16103 MUSCATEL AVE 1 [ [ TEMPLE CITY CA 91780 [ 1DR-StR115TION OF WORK u1 I I 13 VENTILATION FANS FOR BATHROOMS REMODEL [ [APPLICANT: TEL. NO: I [ [ ISAME AS OWNER I ISPECIAL CONDITIONS: ] I � I ICONTRACTOR: TEL. NO: ] [APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER - I I . [ LIC. NO [ [FAU/WALL FURNACE I I [ [ ICOMBUSTION AIR OPENINGS I I I ]ARCHITECT OR ENGINEER: TEL. NO: [ IDUCT WORK I [ I I LIC. NO: IAC/COMPRESSOR I I [ I [ [THERMO3TAT � I 1 1 [FIRE DAMPERS [ 1 ] I I SMOKE DETECTION DEVICES [ I I I [ [COMMERCIAL HOOD [ ] I I ] I I I [ I ] I I I I I I I I I [ I [ I [ 1 [ [ 1 [ I I I I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 [ 1 I I