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HomeMy Public PortalAbout9083 OLIVE ST_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0607180003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11218 LT: 19 BL: D 9083 OLIVE ST FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803024 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5388-005-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE. 596 GRID: H4 LOCALITY: TEMPLE CITY, C 41 VENTILATION FAN 1.00 FAN 15.75 TENANT: TOTAL FEES 43.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 07/18/06 JX 01/14/07 OWNER: TEL. NO: FINAL D E FINAL BY: CODE: BRUGGER MARK E;LIA F (626) 287-5580- 6J o ,� W 9083 OLIVE ST 6 TEMP 917803024 DESCRJMTION UP WORK VENTILATION FAN APPLICANT: TEL. NO: L AND W KITCHENS & BATHS (626) 287-1131- 8812 LAS TUNAS DR. SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L AND W KITCHEN AND BATHS (626) 287-1131- 8812 LAS TUNAS DR. LIC. NO FAU WALL FURNACE SAN GABRIEL, CA 91776 205344E COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BSO508 - WORKERS'COMPENSATION DECLARATION - APPLICATION FOR PERMIT I hereby affirm that 4 heve (-certificate of consent to self insure;Ror 9 certificate,of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3300, Lab. C.) 76A364C �' d 20-0046 DPW 9/88 Policy'No. Company ❑ .Certi>,ied copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY II n ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDINGQ�� ()1e �� • tion department. . ADDRESS v( 1, (PRINT OR TYPE ONLY) Date Applicant LOCALITY CERTIFICATE OF EXEMPiION'FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST COMPENSATION INSURANCE CROSS ST. 3 LL Ran (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCE BY the permit is for one hundred dollars (;100) or less.) 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 so as to become subject to the Worley,Ay "/p satlo LLOWS BOILER, BTU APPROVALS DATE INSPE OR'S SIGNATURE 17'aDate-316/ Applicant /✓YG/yC 6/�_� COMPRESSOR, BTU n `� b� ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL �� L/ ri•� Exemption, you 'sh uId �e ome subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER )ATIOPf with comply-with such provisions.or this permit shall be deem- G ed revoked. 7 RNACE• FAU� VITY LICENSED CONTRACTORS DECLARATION c� RTU 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 WALL. and Professions Code,and my license is in full force and effect. n. License Number Lic. Class (rJTS ®0 pool. U Contractor Date oG ❑ I am exempt under Sec. U Plan check fee W B.&F.C. for this reason d PERMIT ISSUING FEE $ 'n Signature Date: Z TOTAL FEE ' 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 )/ Cm v u (ne-r— Professions Code): w ADDRESSd ACCT u s ❑ I, as owner of the property, or my employees with © 01 v�/ wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY I TEL. NO. 7 3307 91o1014 7044, Business and Professions Code). OWNER I, as-owner of the property, am exclusively contracting (('���� ��yy ru V° 1 ITEMS with licensed contractors to construct the project (Sec- MAIL ADDRESSR009 V I �1Gi TOT I +� m tion 7044, Business and Professions Code). �- CONSTRUCTION LENDING AGENCY CITY ( T00 . NOM 267 CHECK Q1,1�] I hereby affirm thcWthere is a construction lending agency for the performance of the work for which this permit is issued. CONTRACTORlop. CHANGE v110 (Sec. 3097, Civ. C.). ADDRESS Lender's Name 3` CITY TEL.NO. 0000-00010000-0001,-t�01 O! 2/90 Lender's Address ATE LIC. 2tsy1 Ali X07 1 certify that I have read this application and state that the Lj LICENSE NO. CLASS 5 above information is correct. I agree to comply with all County ordinances arld State laws relating to building.construction, and her y or' a representatives of this County to enter upon t a tinned property for ins ctio purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3 .L .o `--Sgnature of Applicant or Agent Date