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Home My Public Portal About9822 RICHMOND WAY_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or, a cP.Ftificate of Workers' Compensation Insurance, �IffATING . l�ER�4I�ATING - AIR CONDITIONING Policy No. ompany or a certified c thereof (Sec. 3800, Lab. C.) 76A364C 7-0g��r159 STATE FUND 20-0046 DPW 9/88 C ❑ 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 9822 RICHP40ND WAY tion department. ADDRESS n (PRINT OR TYPE ONLY) Date-29-9 Applicant R° RO'.TAND LOCALITY MiLDLE CITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST r COMPENSATION INSURANCE CROSS ST. LWNER AZUSA RD. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY 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 so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE �- Date Applicant COMPRESSOR, BTU 60 4 000 ROUGH / NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL j Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER L D T O withcomp with such provisions or this permit shall be deem- ed revoked. 1 FURNACE: FAU FLOOR GIiAVSIjO� /� LICENSED CONTRACTORS DECLARATION VV UUyU 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. O License Number 5]-9622 Lic. Class C-20 0 O 0111. U ContractorR&F HTG & AIRDate 10-31-91 0 ❑ I am exempt under Sec. U Plan check fee w B.BP.C. for this reason PERMIT ISSUING FEE $ H Date: � TOTAL FEE Signature OWNER-BUILDER DECLARATION PIAN 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): L F] 1,I, as owner of the property, or my employees with A'I;M a wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 17 57.00 7044, Business and Professions Code). OWNER ?' F1 1, as owner of the property, am exclusively contracting fE'STO'O LAND �''0° I ti with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS 9088 -'.7. L .I TOTAL ITA- 5 7 = 010 CONSTRUCTION LENDING AGENCY CITY ,y T L. NO. tut.�iJ,[i11 I hereby affirm that there is a construction lending agency for TE IPLI' — the performance of the work for which this permit is issued CONTRACTOR R&F HTG & AIR C OND. I Nr�td1�E °l j0 (Sec. 3097, Civ. C.). ADDRESS 1504—B INDUSTRIAL PK. Lender's Name jell-JJIis)J;:3iy` 1 Lender's Address CIN COVINA TEL. NO. 966-0011 TE LIC. L4 i i 11].x, 1 certify that I have read this application and state that the LICENSE NO. 519622 CLASS C-20 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 upon the above-mentioned prop y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE `7 4PJ'tX ,D• PN6}r LM& Py 90 Signature of Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0202060013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 43136 LT: 1 UN: 5 9822 RICHMOND WY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803966 ASSESSOR FOR 0 NUMBER: NEAREST CROSS STREET: GOLDEN WEST 8589-020-083 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY 08 FURNACE/HEATER <100 1.00 UNI 27.00 TENANT: 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 USSUED ON: PROCESSED BY: PLAN EXPIRES ON: TOTAL FEES 81.75 02/06/02 JK 08/05/02 OWNER: TEL. NO: F NAL 11 g9�V2 TE FINAL BY: CODE: WILLIAM LIAN (626) 451-0938- .� �- 9822 RICHMONDHMOND CT TEMP 917803966 ESCR IO OF 0 C/O FURNACE AND REPLACE 12FT OF DUCT APPLICANT: EL. 0: MARK S GLOVER (909) 279-0604- 5030 VICEROY AVENUE SPECIAL CON ITIO S: NORCO 92860 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE AIR TRO, INC. (626) 357-5311- 1630 S MYRTLE AVE LIC. NO L FURNACE MONROVIA, CA. C36 C38 B COMBUSTION AIR OPENINGS ARCHITECT OR GINEER: TE NO: DUCT WORK LIC. NO: � AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE C ON E C S COMMERCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508