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HomeMy Public PortalAbout5013 SANTA ANITA AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION I CE 75(2-80) MISCELLANEOUS APPLICATION I I hereby affirm that I have certificate of consent to self ! COUNTY OF LOS ANGELES '`- %'' BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance,or ' •�r` �� a certified copy thereof(Sec.3800,Lab.C.) ! BUILDING Policy & + ✓, No. FOR APPLICANT TO FILL IN ADDRESS ••� �,��' ••'f r'''' te -^ ❑ Certified copy is hereby furnished. BUILDING f{ + 1r .l y) / SS 7 /.f ! /, ' I1�, f I f �+ry LOCALITY r-1 �f` ,,•• f `f .•�'�� Certified copy is filed with the county building inspection ADORE ✓ -•-+ NEAREST �;r•,_ i department. LOCALITY .� (.�.� /C C, CROSS ST. r•;�/;'.rr ,r .--`• .....��''{, Date Applicant I NEAREST gj >/C~ DISTRICT NO. G�O U� TYPE PROCESSED B1F_;- CROSS ST. G r f f '�f ..•+, CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q COMPENSATION INSURANCE DESCRIPTION LOT NO. LK I BLOCK MAP Gf f HIGHWAY STATE MAJOR SECOND L CAL a NO. OF BLOGS. NO.• (CIRCLE) A (This section need not be completed if the work involved TRACT ) _) NOW ON LOT 04 U ,d R 77NE SPECIAL CONDITIONS W by the permit is for one hundred dollars ($100) or less.) use of ?- J SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER a;=3�•� 1 +��¢�' / i .•-s so as to become subject to the Workers'Compensation Laws. MAIL [ OCCUPANCY GROUP Date Applicant ADDRESSff 17 /r � I O CL NOTICE TO APPLICANT: If, after making this Certificate of CITY / 1 r ! .! OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLI ATION FOR EXIT HARDWARE: LL Compensation provisions of the Labor Code,you must forth- I-- with comply with such provisions or this permit shall be t TRAILER USE GEOLOGY deemed revoked. "INSPECTION Q No Spec. Knowl. ❑ ❑ LICENSED CONTRACTORS DECLARATION i OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and ° ? r ; r � "`�•s..—+.. PARKING effect. SPACES REQ'D PROVIDED License Number - Lic.Class—'f�� /-' I' `� LIMITED TIME USE Contractor Date ' / DATE DATE ❑ ' PROM: TO: I am exempt from the licensing requirements as I am 1 ! licensed architect or a registered professional engineer SIZE 9F NO. OF INSPECTOR'S SCtIRg In Illy professional capacity (Section 7051, EXISTING BLDG. STORIES SIGNATURE Bus- iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL �- /.-� Lic.or Reg.No. Date / I NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING SPACES PROVIDED 9I, as owner of the property, will do the work and the H� structure is not intended or offered for sale (Section • 71'6".A• 7044,Business and Professions Code). PROPOSED USE OF BUILDING a'O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency , I for the performance of the work for which this permit is 'Q:)a!°.�l Q�` issued(Sec.3097,Civ.C.). , t .: t •' Lender's Name PROPOSED MAX. OCC. `N �' q 1, .•t' Lender's Address PERMIT FEE I certify that I have read this application'and state that the ! above information is correct.I agree to comply with all County ISSUANCE FEES r.•�`r. ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upo¢ :�mgl Ei�- ro pert -,for.inspection purposes. SEE REVERSE FOOR EXPLANATORY LANGUAGE .�.;.,. .f 4� :�;i� Signature of Permittee Date �' WORKER'S I have a certiIONficate of consent to 76AM DPW 9/89 APPLICATION FOR PERMIT LIME GREEN, 7f1A364C 1 hereby affirm that I have a certificate of consent to self insure, ' or a certificate of Worker's Compensation Insurance, or a certified 1- copy,,thd'reof(Sec.3800 Lab.C.) HEATING-VENTILATING-'AIR CONDITIONING Policy No.&WAZIL Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ * Cfftified copy is hereby furnished. Certified co Is filed with buildingI action FOR APPLICANT TO FILL IN BUILDING i^O, d n tPy r (PRINT OR TYPE ONLY) ADDRESS d LOCALITY 'I Date Applican NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ��`' I /GATE OF EXE ON FROM WORKERS' 69' NEAREST If OMPENSAT INSURANCE CROSS ST. ABSORPTION UNIT,BTU ASSESSOR (This sect) n need not be completed If the work Involved by the MAP BOOK PAGEMq PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED SV I certify that in the performance of the work for which this permit , \ is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. OMPRESSOR,BTU =F- APPROVALS , DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'CompensationEVAPORATIVE COOLER provisions of the Labor Cade,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and : W LI 1 ' Professions Code,.and my license is in full force and effect. I Ih,J r �g v License Numb er LID.Class t/ Contractor Date , C ❑ I am exempt under Sec. Plan check fee B.&P.C.for this reason PERMIT ISSUING FEE$ C Ir- Date: TOTAL FEE U u Sign a i� Y o PLAN CHECK APPLICANT 8, U 11 WNER-BUILDER DEC ATI 0'2'* ,2* 3 ,� 9 I hereb affirm th I am exempt from th Contr ctor's License Law NAME ► for the Ilowin eason(Section 7031.5, ness and Professions n Co e )' ADDRESS 3 7, 9 0 V W I, as owner of the property, or my employees with wages 2 7 4 as their sole compensation, will do the work and the CITY ' TEL.NO. u structure is not Intended or offered for sale (Section 7044, 7r 7 2 5 Business and Professions Code). • OWNE9T f ❑ I, as owner of the property, am exclusively contracting MAIL �'vvvv Q 5.- 20 - 93 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). C5 CONSTRUCTION LENDING AGENCY CITY 1 TEL.NO. 7 Z Ihereby affirm that there is a construction lending agency for ' CONTRACTOR , the performance of the work for which this permit Is Issued `� (Sec.3097,Civ.C.). ADDRESS /6 Lender's Name CITY TEL.NO. Q—;53 1/ Lender's Address STATEv,v cc77"�77� LIC. I certify that I have read this application and state that the above LICENSE NO. iJ ,Y!/TJ CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building con uction,and hereby authorize resentatives oft ' County to ter upon the above- entioned pro fo� ion purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE !� SIG TORE OF APPLICANT ORA rNT DATE • — I WOthat I have a certiIONficate of cLARATION 7BA34aDPWel99 APPLICATION FOR PERMIT LAME GREEN 78A364C I hereby affirm that I have a certificate of consent to self insure, or a certificate,of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy.,th�of(Sec. 800 Lab. .) ~ Policy N v mpany COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑�,,^p-Ctrtified copy is hereby furnished. LJ�rtlfiedd with the cou ty building inspection FOR APPLICANT TO FILL IN BUILDING }J f,'(PRINT OR TYPE ONLY) ADDRESS J j(H(/LOCALITY DatApplicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST .1 CROSS COMPENSATION INSURANCE OR ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARC permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. „A I/,C —Alto l to �(J` COMPRESSOR,BTU �j APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,.you must forthwith comply with such FINAL / provisions or this permit shall be deemed revoked. / FURNACE: FAU GRAVITY i r- LICENSED CONTRACTORS DECLARATION FLOOR BTU Ito G o I VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. YL , License Number Lic.Class`7-br C ) % _ 13 Contractor V Date 13 �� C ❑ I am exempt under Sec. Plan check fee a B.&P.C.for this reason PERMIT ISSUING FEE$ I- at : TOTAL FEE 30 G Signatur (� OWNER UILDER DECLARATION PLAN CHECK APPLICANT # 0 . V 6 I hereby a rm that I IS from the Cc itrac or' !cense Law NAME I1 for the foil win on (Section 7031.5, Business and Professions 0 2 5 0 3 0 Code): ADDRESS ❑ I, as owner of the property, or my employees with wages 5 0 3 0 u F as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, 2 Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL ` ! / 2 3 7 7 z with licensed contractors to construct the project (Sec- ADDRESS S©/ L• 0 2,�' tion 7044,Business and Professions Code). 2 1 e 9 3 CONSTRUCTION LENDING AGENCY CITY J LoOi TEL.NO. X00 I hereby affirm that there is a construction lending e for CONTRACTOR , the performance of the work for which this permit Iss issued (Sec.3097,Civ.C.). ADDRESS Lender's Name i CITY TEL.NO. Lender's Address STATE LIC. g I certify that I have read this application and state that the above I LICENSE NO. j 7/� CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,a d hereb authorize repre ativ of this Co ty to enter on t above mentioned pr erty f in ec!on rposes. f SEE REVERSE FOR EXPLANATORY LANGUAGE SIGN/nuRiz,r P. R AGENT ATE ION DECLARATI WORKER'S I have a certificate of consent to 7.W66DPW9/e9 APPLICATION FOR PERMIT LIME GREEN. 78A364C I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) f Policy No. "MI Company tP`F�t 1LOIcc COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ed copy is filed With the county building inspection FOR APPLICANT TO FILL IN BUILDING SS de artn ant. AW—TW (PRINT OR TYPE ONLY) Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed If the work involved by the MAP BOOK PAGE PARCEL elf permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to BOILER,BTU ® become subject to the Workers'Compensation Laws. Co L) COMPRESSOR,BTU at APPROVALS DATEINSPECTOR'S SIGNATURE DateApplicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of I ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. / FURNACE: FAU GRAVITY J VALIDATION LICENSED CONTRACTORS DECLARATION ( FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license Is in full force and effect.�• /V v License Number 2gB �D Lic.Class —_2C) Contractor A I F=-` 'LuDate 12 19( v ❑ I am exempt under Sec. Plan check fee U �/ Q B.&P.C.for this reason PERMIT ISSUING FEE$ & 7� O Date: TOTAL FEE D /D LL Signature 0. PLAN CHECK APPLICANT U, OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law NAME ' Q for the following reason (Section 7031.5, Business and Professions _ Code): ADDRESS ACC,I e 4' I, as owner of the property, or my employees with wages :+)')+ '{ILIe 1{_I as their sole compensation, will do the work and the CITY TEL.NO.fqd4l, `'"_Ii structure is not intended or offered for sale(Section 7044, 1 ITEM_, Business and Professions Code). OWNER 0 t ❑ I, as owner of the property, am exclusively contracting MAIL �( IOIAL 11 0iar`10 with licensed contractors to construct the project (Sec- ADDRESS t Z CHECK jivel!I tion 7044,Business and Professions Code). .— CONSTRUCTION LENDING AGENCY CITY TEL.NO. CHANGE o 00 I hereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit Is issued (Sec.3097,Civ.C.). n _ _/ _ ADDRESS t',3� s t,r00I-0001 7f 21J�j1._, Lender's Name / A 1{{ ❑ CITY v� TEL.NO. � 0840 1 7:49 Lender's Address STATE /7 LIC. I certify that I have read this application and state that the above LICENSE NO. G CLASS 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 abov .mentioned pro r&f ,insp ction pur sas. SEE REVERSE FOR EXPLANATORY LANGUAGE �5 SIGNATURE OF ArYGAT OR AGENT DATE •, COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0012190006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILD NG ADDRESS: TR: 13363 LT: 18 5013 SANTA ANITA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803618 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GRAND 8574-009-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY 08 FURNACE/HEATER <100 1.00 UNI 27.00 TENANT: TOTAL FEES 54.75 ISSUED ON: P OCESSED BY: PLAN BY: EXPIRES ON: 12/19/00 UT 06/18/01 OWNER: TEL. NO: FINAL DATEFI L BY: CODE: MOYERS LYNN D;SCHILDT DAVID R - Y W 5013 SANTA ANITA AV TEMP 917803618 FE-SCRIPTION OF WORK INSTALL GAS FORCED AIR WALL UNIT APPLICANT: TE 0: AIR-TRO HEATING AND AIR COND. (626) 357-5311- 1630 S. MYRTLE AVE. SPECIAL CONDITIONS: MONROVIA, CA 91016 _ .r.��. ��•..ter CONTRACTOR: TEL. NO: ii;.;+t, ��• �" APPROVALS DATE INSPECTOR SIGNATURE AIR-TRO INC. (626) 357-5311- 1630 S. MYRTLE AVE. LIC. NO :°• fes•; "' _ _ FAU/ ALL FURNACE MONROVIA, CA 91016 258228 C20 COMBUSTION AIR OPENINGS ARCHITECT OR GINEER: TEL. NO:-- \A 0: \A DUCT WOR LIC. NOM __ !_!_ ' � AC/COMPRESSOR ----! - --� -' -- �'� THERMOSTAT 1 i;1,= !'f, �., i ,; �•=;; 4 FIRE DAMPERS - - y SMOKE DETECTIOW DEVICES COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508