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Home My Public Portal About9703 WEDGEWOOD ST_Mechanical__ WORKERS'COMPENSAVON cerci DECLARATION I APPLICATION .FOR PERMIT I hereby affirm that 16tave a certificate of consent to self , insure, or a certificate of Workers'Compensation Insurance, I HEATING - VENTILATING - AIR CONDITIONING o er ifi (�gpyrth�rr T(Sec. 3800 Lab. 76ACEj 81 C L IPV(p �CE O 818(REV. 10/81) oliEy o. COmpanX&L 011 ❑ 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 p rt r ADDRESS LOCALITY �j�✓ ( (PRINT OR TYPE ONLY) Dat e Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (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 lV/UU permit is issued, I shall not employ any person in any manner BOILERBTU so as to become subject to the Workers'Compensation Laws. , APPROVALS DATE I CTOR'S SIGN TURE Date Applicant COMPRESSOR,BTU Lo DID ROUGH A � 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 VALIDATI N with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY 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 - WALL and Professions Code,and my license is in full force and effect. t � O License Numbel Lic. Class E. U Contractor o ❑ I am exempt under Sec. tJ 6tt Plan check fee m- H B.BP.C. for this reason' ^ � Date: PERMIT ISSUING FEE 5 LJ TOTAL FEE Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 2 7 1 9 O p' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME # 0 0 0. o o Professions Code): ❑ I, as owner of the property, or my employeeswith ADDRESS 1-.o'- 2225 • wages as their sole compensation.will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section - - 222535 7044, Business and Professions Code). OWNER ,� A. �-� El I, as owner of the property, am exclusively contracting 06o8--.-87 with licensed contractors to construct the project (Sec- MAIL t� tion 7044, Business and Professions Code). ADDRESS V l� CONSTRUCTION LENDING AGENCY cITY EL. •1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). EL-, ADDRESS � A Lender's Name � -� CI TEL. N Lender's Address STATE / IIC. I certify that I have read this application and state that the LICENSE NO.( CLASS 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 t e above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I Signature of Applicant or Agen Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1310170032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: IITR: 21833 LT: 15 I 1 9703 wEDGSWOOD ST 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 917802536 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18588-011-007 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI 1 108 FURNACE/HEATER <100 1.00 UNI 27.00 I I (TENANT: I TOTAL FEES 54.80 ISSUED ON: PROCESSED BY: PLAN BY: 1 110/17/13 SR (OWNER: TEL. NO: 1 IF AL TE F AL HY: CODE: 1 INAKAGAWA DAVE Y;HELEN Y ( I I I 19703 WEDGEWOOD ST 1 I l 1 ITEMP 917802536 I ID SC'RIPTION OF WORK1 I I ICHANGE OUT FURNACE 80,000 U 80t IN ATTIC 1 (APPLICANT: TEL. NO: 1 I 1 IJACOBY ( 1 1� 1 I 1 I I I 1CONTRACTOR: TSL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 (AMERICAN AIR CONDITIONING (310) 419-6304- I I 110716 GREVILLEA AVE LIC. NO 1 1FAU/WALL FURNACE 1 I 11NGLEWOOD CA 90304 433868 I I ICOMHUSTION AIR OPENINGS I I I (ARCHITECT OR ENGINEER: TEL. NO: 11 IDUCT WORK 1 1 I I - ;II 1 I LIC. NO: 1 IAC/COMPRESSOR I I I I I 1 THERMOSTAT 1 I I I I I I IFIRP DAMPERS I I I I I I ISMOXF DETECTION DEVICES I 1 I I 1COMd9ERCIAL HOOD I 1 I I I I I I it I— I i* ADDITIONAL DATA ON FILE I I I I 1 1 I I I 1 ' I IREPORT ID: DPR264 ROUTE TO: BS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0506100002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 21833 LT: 15 9703 WEDGEWOOD ST FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802536 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-011-007 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C 02 COMPRSR a 100 KBTU 1.00 COM 27.00 TENANT: TOTAL FEES 54.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 06/10/05 JK 12/07/05 OWNER: TEL. NO: FINAIi��_ FINAL BY: CODE: NAKAGAWA DAVE Y;HBLEN Y ( 9703 WEDGEWOOD ST TEMP 917802536 DESCFIPTION OF WORK AIR CONDITIONING REPLACEMENT APPLICANT: TEL. NO: ZAMORA ( SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE AMERICAN AIR CONDITIONING (800) 321-9494- 10716 GRAVILLEA LIC. NO FAU WALL FURNACE INGLEWOOD CA 43386BC20 COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK LIC. NO: AC COMPRESSOR THERPiOSTAT FIRE DAMPERS SMOKkl DETECTION DEVICES COMMURCIAL HOOD * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508 i I