Loading...
HomeMy Public PortalAbout5543 RYLAND AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION 7i5A364C w ®® �@ !� ®---PER I hereby affirm that I have a certificate of consent to self CE-BIB(2-60) A- f1� ��ti'9�I N' Y9— O R P�� IT - I or a.certificate of Workers'Compensation Insurance,or I-I.EATING-!VENTILATING-AIR CONDITIONING a cer ' 'ed; g-thereof(Sec.3800, aba..Cdasulaty 'lndem �i,ty, Polk man & ' y ergs p y COUNTY OF LOS ANGELES ( �' , BUILDING AND SAFETY ' Certified copy Whereby furnished.. v © Ce'rtified copy is filed with the county building inspection BUILDING d��par�tm��e zU. FOR APPLICANT TO FILL IN ADDRESS 5543 N. Ryland Date u_v� Applicant .E. L.• PAYNE I (PRINT•OR,TYPE ONLY) CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Temple City COMPENSATION INSURANCE NEAREST CROSS ST. Lower Azusa Road o (This section 'need°not be completed if the work involved ABSORPTION UNIT,BTU by the permit is for one hundred dollars ($100.) or less.) DISTRICT NO. PRO ss Y U I certify that in the performance of the work,for which this AIR HANDLING UNIT.,CFM ��' 00 permit is issued, I shall not employ any person in any manner - so as to.become subject to the Workers'Compensation Laws. BOILER,BTU APPROVALS DATE INSPECTOR'S ATURE tL Date .'Applicant. N COMPRESSOR,BTU ROUGH NOTICE TO APPLICANT'. If, after'.making this Certificate of'. ' •VENTILATION SYSTEM Exemption, you- should become subject to the Workers' 1 FINALCom withcomply provisions. of the Labor Code,you must forth- " EVAPORATIVE COOLER LIDATION with comply with such provisions or this permit shall-be �, deemed revoked. I . FURNACE: FAU GRAVITY. LICENSED CONTRACTORS DECLARATION FLOOR: BTU I hereby affirm that I am ficensed under provisions of Chapter 4 HEATER:. SUSPENDED UNIT' ! ; 9 (commencing with Section 7000)of Division 3,of the.Busi• �. WALL ness and Profession Code, and'my license.is in full force and 1. effect. License Number Lic.Class 120-- ! •.C'20 I; ' Contractor' F 1 PAVN F Date • 4-30-82 0 1 am exempt from the licensing requirements as I am.a licensed architect bi• a registered professional engineer q . � p g } Plan check fee 25%of above. - acting,in my'.professional capacity=(Section 7051, Bus• I iness and Professions Code.). PERMIT ISSUING FEE$ $. 5. 7 Lic,or Reg.No. ' Date: TTOTAL FEE 23 150 i• HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm. that I am exempt from-the' Contractor's 1; NAME ;?,390. 1 A ' License Law for the following reason (Sebtion.'7031.5, Busi- dness and Profession's Code): I ADDRESS #l0 0 0 0 0•8 11, as owner of the property, will do the work and the it structure is not intended or offered for sale (SectionIL CITY TEL.,NO. 2 - o23,50 r ' 7044,Business and Professions Code). o o'o OWNER 23,50' I,, as owner of the property, am exclusively contracting Mr. and Mrs:'Tial Hadden with licensed contractors to construct the project MAIL 05.06-82 (Section 7044,Business and Professions Code): ! ADDRESS R land : CONSTRUCTION LENDING AGENCY CITY TwRle City JEL.N0579-1083 I hereby affirm that there, is a construction lending agency for the performance of the work for which this permit is. CONTRACTOR E. L. PAYNE ,COMPANY „ issued;SSec.3097,Civ.C.). + Lenders Name" j ADDRESS 166 W. Live Oak Avenue .I Lender's Address I CITYArcadia TEL.NO. 446-6118 II certify that I have read this application and state that the STATE 120228 LIC. 120 Sabove information is correct.I agree to comply with all County LICENSE NO. CLASS ordinances and State laws regulating Heating, Ventilating and I ++Air Co oning,and her authorize representatives of•this SEE REVERSE FOR EXPLANATORY LANGUAGE ICoun t enter up t e above-mentioned property for 111111 purposes. ! 4-3o-82 i ature'of Per 'ffa Date k- - _ - - _ -_ -- - - - p g �/� WORKERS'COMPENSATION DECLARATION 7GA364C CE-818(2-80) �P P� C A T�O t7 'If�2®R PERMIT I hereby affirm That I have a' certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a cerYi77f a7.r 77 (dbc7 �(Sec.3800,Lab.C.) Policy No. //77U ,, Company Ca Casualty I ndemn i �/ ❑ Certified copy is hereby furnished. COUNTY OF LOS A GE BUILDING ARID SAFETY Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BU.ILDI e artment. 5543 N- Rylnnd Date —2 —80 Applicant E. L: PAYNE C MPANY, (PRINT OR TYPE ONLY) ADDRE I CERTIFICATE OF EXEMPTION FROM WORKERS' N LOCALITY Temple City O. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved ABSORPTION UNIT,BTU CROSS ST. La Rosa IZ by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCES 0 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM // © y permit is issued, I shall not employ any person in any manner ; lJ so as to become subject to the Workers' Compensation Laws. BOILER,BTU 0 ' t� 1 ����n���� I APPROVALS' DATE INSPECTOR'S SIGNAT E V Date�y�ZO,Lpplicant_E.. L. PAYNE COMPANY COMPRESSOR,BTU ROUGH d NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEMN Exemption, you should become subject to the. Workers' FINAL /Z-fo / _Z Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDUATIO with comply with such provisions or this permit shall be Vp deemed revoked. FURNACE: FAU /� LICENSED CONTRACTORS DECLARATION 1 FLOOR: BTU �SJULI;�S 10 00 , I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions'Code, and my license is in full force•and effect. License Number 120228 Lic.Class- C-20 Contractor.E L PAYNE Date 11-20-80 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan Check fee 25%of above. acting-in my professional capacity (Section 7051, Bus- iness and Professions Code). Lic.or Reg.No. —�'26�2$—'--"—Gale �6= 6' TOTAL FEE 1.] 00 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from-the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS 1, as owner of the property, will do the work and the CITY TEL. NO. structure is not .intended or offered for sale (Section 7044, Business and Professions Code). FJI, as owner of the pk9perty, am exclusively contracting OWNER MC• and 'Mrs. T. Hadden c 3.1 7,7 P, with .licensed contractors to construct the project MAI L (Section 7044, Businesi and Professions Code). ADDRESS 5543 N. Ryland + o 0.0 0 4 1 CONSTRUCTION LENDING AGENCY CITY Temple City TEL.NO. 579-1083 2 17 OC I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR o a c ! 1 p p E L. PAYNE COMPANY C issued(Sec. 3097,Civ.C.). Lender's Name I ADDRESS1•` 6„IW Live Oak Avenue 1 I,2.1 -8 0 'Lender's Address I CITYACCad i a TEL.NO. 446-6118 I i 'certify that I have read this application and state that the STATE 1 20228 LIC. C-20 Move information is correct.I agree to comply with all County , LICENSE NO. CLASS ediriances and State laws regulating Heating, Ventilating and i Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE b ty to enter upon to above-mentioned property for l i' tion ptR• oIL ,. 1-20-80 Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT 0£ PUBLIC WORKS 9701 LAS TUNAS ME 0508 0801230003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I ! BUILDING ADDRESS: I ITR: 16957 LT: 97 I I 5543 RYLAND AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT.[ TEMP CA 917802724 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18586-018-019 101 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, Cl I 102 COMPRSR < 100 KBTU 1.00 COM 27.00 1 1 ITENANT: I TOTAL FEES 54.75 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 101/23/08 SR 07/21/08 1 (OWNER: TEL. NO: 1 [FINAL DAT BY: CODE: (POWERS, HALEY (626) 574-2940- I I 1 15543 RYLAND AVXffl ITEMP 917802724 I [DESCRIPTION OF WORK 1 I I IC/O A/C 1 I I (APPLICANT: TEL. NO: I I IIWAI COOLING & HEATING (626) 932-1163- 1 [ 1848 S. MYRLE #2 I ISPECIAL CONDITIONS: (MONROVIA, CA 91016 I I 1 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I IIWAI COOLING AND HEATING, INC. (626) 932-1163- I 1 [ 1848 S MYRTLE #2 LIC. NO 1 [FAU/WALL FURNACE I [ IMONROVIA CA 91016 778839 C20 I I I I I ICOMBUSTION AIR OPENINGS I I [ARCHITECT OR ENGINEER: TEL. NO: I IDUCT WORK I I I LIC. NO: 1 IAC/COMPRESSOR 1 1 1 I 1 ITHERMOSTAT I I 1 1 (FIRE DAMPERS 1 ISMOKE DETECTION DEVICES I I I I 1 (COMMERCIAL HOOD I 1 I I I I I I I I I I 1 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 II I I I (REPORT ID: DPR264 ROUTE TO: BS0508 I I I I I . I I I I