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Home My Public Portal About9506 OLEMA ST_Mechanical__ 78A98=B: a Bta .--9"75 :,.APP-LIZATION'FOR•PERMIT .�':-• _ �y • " ' HEATING, -' VtN'4ILATING--- 'AIR 60N:01-TI.ONING BUILDING AND SAFETY VISION ~ F.OR.APPL-ICAN.T TO FILL.IN.', BUILDING (PRINT,OR TYPE ONLY).. ADDRESS - 9506 Olema t LOCALITY Temple City' P -NO. TYPE-O'F-APLIANC`EOR EQUIPMENT •''F"EE_ NEAREST t. CROSS ST. ABSORFTIOk.UNIT, BTU OWNER-' Mrs.--Pauline Hall AIR HANDLING UNIT, CFM MAIL ADDRESS .9506 Qlema 'B:OILER, BTUCITY Tem le Gtl p y TEL. NO. 225-8050 ]• -COMPRESSOR, BTU 3-t,8 } '.7. 50 CONTRACTOR B Vant.Heat.'&'Air Cond. - VENTILATION'SYSTEM : ADDRESS:1350'E. Las Tunas Drive EVAPORATIVE COOLER CI'T'Y 'San Gabriel - TEL.,NO., 286-1141' FURNACE: FAU_GRA }�Tj�Y� STATE. LIC. 1" FLOOR BTU_ 5 7 SO' LICENSE NO.- �- '2`21751 CLASS C20 HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE EBBED BY`- C WALL . , INSPECTION RECORD W L CL Plan'dheck fee 25%.of above.. Z.!"�s�% —= PERMIT ISSUING;FEE-$. 4 WO %Z 9 sc—:� • .C �2;' r`S%' %`�''��%�2 TOTAL.FEE ' - '19 '50 PLAN:,CHECK APR,LI•CANT, 6'< %D NAME .T/A✓/C- 'X�JYZ• /G✓si`.� ADDRESS CITY: TEL."6. I HEREBY AC RNOWtEDGE-THAT'I HAVE READTH15 APPLICATION-. J - AND STATE'THAT THE-ABOVE 15 CORRECT AND..AGREE TO-COMPLY ',WITH. ALL. ORDINANCES AND'LAWS,'REGULATING 'HEATING.; VENTI- - LATIG,AIR,'CONDITIONI I •HEREBY CERTI _HAT I AM•'NOT.ACTING VIOLATION - APPROVALS - `DATE.' •INSPECTORS SIGNATURE •• OF.CHAPTER 9, DIVI ,•OF THE BUSINESS ' D: FESSIONAL. CODE.OF THE STAT 0 I'FOR NIA. OUGH SIGNATURE - OF PERMITT• FINAL PLAN CHECK VA-L.IDATION'' ' .CKcASH' PERMIT'VAL'IDATION K. M.O. CASN :. GOMPEI`v➢ ATION w POLICY 241F:: 2 :: 1.. 9..5 0 ,08 HOLDER° ' POLICY'N.UIV1BERe. 10-9 WORKERS'COMPENSATION DECLARATION 9"7 P P I'!r/!T I p N FOR PERMIT I ffir�.-thar I shave a certificate of consent to self insi7� br a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a artified copy thereof(Sec. 3800, Lab. C.) 76A364C P� r�� CE-818(REV. 10/81) Policy O ll l Compa li!r IL Y '. Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. ��.,rr�� AE? ..t� �I.r (PRINT OR TYPE ONLY) ADDRESS Date� —5r� Applicanttii del • LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED B the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM �f I certify that in the performance of the work for which this C (/� permit is issued, I shall not employ any person in any manner 4 so as to become subject to the Workers'Compensation Laws. BOILER,BTU APPROVALS DATE INSPEC R'S SIGNATURE Date Applicant ' COMPRESSOR,BTU SOA& Qv ROUGHr NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER I ALIDAT ON f/ with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU L GwR,,VITY LICENSED CONTRACTORS DECLARATION FLOOR BTU !`T� �� I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect. License Number'.47-SA 12— Lic. Class Contractor VIM `ZE2; S• Date 9+ O to ❑ I am exempt under Sec. U Plan check fee It B.BP.C. for this reason Date. PERMIT ISSUING FEE$ 5 Signature TOTAL FEE (� 2 8 5 <<A OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT # o o o o o I hereby affirm that I am exempt from the Contractor's License ® 4 0 0 3 0 5 0 Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS 0 0 o 3 G 5 0 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. O a05-85 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS Q tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY' G TEL. NO I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTORKVE_S (Sec. 3097, Civ. C.). ADDRESS �° AV Lender's Name ° CIT TEL. NO. Lender's Address STATE LIC. �y ,, I certify that I have read this application and state that the LICENSE NO. ` d+� �. CLASS _Z-4D 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 -11pon the above-m t' d roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 11- oc1'S'857 Signature of Applicant or AgeKt Date c. WORKERS'COMPI'NSATION DECLARATION CE 81 S(2-80) *A&P P UC AT�O I`YI FOR P E R IMI T I nerehy affirm that I have-w certificate of consent to Af inure, or a certificate of Workers'Compensation Intimance,or I-9�gTING_yE NTILI��IR1C'v-ql� CONDITIONING.:;ertifie``d,,c��opy thereof(Lee.3800,Lab.C.) Policy NcY` Company fSSIU� �0-�S ,�,�3 y Certified copy is hereby furnished. COUNTY OF LOS ANES /f' BUILDING AND SAFETY Certified copy is filed with he c unt huilding inspection BUILDING art enc, --- FOR APPLICANT TO FILL IN y� v (PRINT OR TYPE ONLY) ADDRESS U3te Applicant. -- --- n LOCALITY + CERTIFICATE OF EXEMPTION FROM WORKERS' NO. I TYPE OF APPLIANCE OR EQUIPMENT FEF Q/)r7�Q�2fc� COMPENSATION INSURANCE CROSS ST. d _ (This section need not he completed if the work involved ]ABSORPTION UNIT, BTU by the permit is for one hundred dollars (SIQO) Or less.) DISTRICT NO PROCESS V (� I iertif• that in the erformance f the work for which this IAIR HANDLING UNIT,CFM— r/ permit is issued, 1 shat not em pi,y an perso in any manner � I �/Q d O sii is to beco a subject to the\'orker Com ensation Laws. 'BOILER, BTU— l— yy�� APPROVALS DATE INSPECTOR'S SIGNATURE W Date o7(pplicant COMPRESSOR,BTUN ROUGH _ NOTICE TO APPLICANT: If, after making this Certt ' to of VENTILATION SYSTEM �- or 1 _mption, you should become subject to the Workers' FINAL C,:mpenbation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION ,.ith comply with such provisions or this permit shall be d.;med revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU I hereby affirm that I am licensed under provisions of Chapter HE ER: SUSPENDED UNIT ') (commencing with Section 7000)of Division 3 of the Busi- WALL ne,s and Profession CC de, and my license is ' full force and I iceffect. �� 1V c� I cense Num Lic.Class 11 � 1 7934 Contractor Date�-f O , Vvv V " 0 0 0 04 1 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 2540 of above. 2 o o 27 r() acting in my professional capacity (Section 7051, Bus- iness and Professions Code). _PERMIT ISSUING FEE $ �— 0 0 ° 27 I ic.or Reg.No. Date TOTAL FEE 8 C HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that 1 am exempt from the Contractor's NAME I cense Law for the following reason (Section 7031.5, Busi- n•,b and Professions Code): ADDRESS {] 1, as owner of the property, will do the work and the CITY TEL.NO. y structure is not intended or offered for sale (Section 1 7 a 9 ' 7044, Business and Professions Code). OWNEt?� a4 0 0 0 �j L J I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL ,\ h (Section 7044, Business and Professions Code). ADDRESS TSV ` �1R ° 6 C L CONSTRUCTION LENDING;AGI'•, CY � _ TEL.NO. I hereby affirm that there is a cunstryction nd' g agency CONTRACT r for the part of e s for whic his rmit is issued(Sec.309 Lender's Name LF [ender's Address 1f TE .NO. I certify that I have read this application and state that the above information is correct.I agree to comply with all County CLASS ordina es d ate laws regulating Heating,Ventilating and Air C nditio g,and ereby authori/e representatives of this SEE REVERSE•.I.OR EXPLANATORY LANGUAGi Coon y to n r up n the above-mentRngd prpperty for intipe i o I,{ J Signature of Permittee Date