The URL can be used to link to this page

Home My Public Portal About9854 WENDON ST_Mechanical__ � 1(VORKER'S COMPENSATION DECLARATION 76A36n DPW ele9 " �� I hereby affirm that I have a certificate of consent to self Insure, APPLICATION FOR PERMITLAME GREEN or,a ce;tlfl`ate of Worker's Compensation Insurance,or a certified HEATING-VENTILATING-AIR CONDITIONING Fopy thereof(Sec.3800 Lab.C.) I F1Policy No.bJeA111 2 332 Company ,I-,k o 1, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished, Q�. Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING departme . /// I (PRINT OR TYPE ONLY) ADDRESS Data Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CE IFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCECROSS ST. ABSORPTION UNIT BTU ASSESSOR (This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING ONIT,CFM DISTRICT NO. PROCESSED SY I certify that in the performance of the work for which this permit is Issued, I'shall not employ any person in any manner so as to BOILER BTU become subject to the Workers'Compensation Laws. 140COMPRESSOR BTU Date ` Applicants' e'y C VENTILATION SYSTEM APPROVALS DATE INSPECTOR'S SIGNATURE NOTICE tO A PLICANT: If, after maks g this Certificate of ROUGH Exemptiond,you should become subject to the Workers'Compensation EVAPORATIVE COOLER .provisions of the Labor Code,you must forthwith comply with such FINAL ell provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that.I am licensed under provisions of Chapter 9 BUSPEND�D UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL [CEJ Professions Code,and my license is in full force and effect.- License Number .Z 6? g 1p% Lic.Class Or > p�mc � 6l /f , l C Contractor -+� o I C ❑ Plan check fee- 1 am exempt under Sec. I. Q� B.&P.C.for this reason I PERMIT ISSUING FEE$ p-p I.- �te: TOTAL FEE D� a Signature PLAN CHECK APPLICANT EL OWN - UILD LARA ON 2�E Z I hereby affirm that I am exem rom the Contractor's License Law NAME for the following reason(Section 7031.5, Business and Professions Coe): ADDRESS ArEl .(.T e a I, as owner of the property, or my employees with wages as'their sole compensation, will do the work and the CITY TEL.NO. 17 =:ojs1� structure is not Intended or offered for sale(Section 7044, / / Business and Professions Code). WNER v: A 'C��G�/ Ol0 1 �r EMS ❑ I, as owner of the property, am exclusively contracting MAIL TO_AL 25.00 with licensed contractors.to construct the project (Sec- ADDRESS •fj $r+/ L,J C-L, r tion 7044,Business and Professions Cade). CITY ti TEL. O" `' E~i4 .t5st)c I CONSTRUCTION LENDING AGENCY C Ie C �`` 8 b 9' � swV I hereby affirm that'there is a construction lending a ency'for CONTRACTOR CHANGE the performance of the work for which this permlt is Issued � (Sec.3097,Civ.C.). Lender's Name /`� i ADDRESS$o'm .ec. 00,00-0001 ,• 6/�. CITY — TEL.NOZ '7451 .r- f. Lender's Address I certify that I have red this application and state that the above LICENSE NO. 2 T Sir 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 ounty to enter upon the above-mentioned prop rc'ty for inspen purposes. SEE REVERSE.FOR EXPLANATORY LANGUAGE G;PME'6F,7KIOANT OFt AGENT COuNTY OF LOS ANGELES TEMPLE L1I► # 051.0 AFCNANICAL PERMIT DEPART'IFNT OF PUBLIC WORKS 9701 LAS TUNAS +p ^50B 0409140008 BUILDING AND SAFETY / LAND DEVELOP14ENT TEMPLE CITY CA 91780 PHONE: tL; L) 285-0488 EXT: LEGAL ID: LT: 9 BL: g EES ID BUILDING ADDRESS: • 9854 WENDON ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 9178n1726 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5385-025-009 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C 02 COMPRSR < 100 KBTU 1.00 COM 27.00 TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 30 AIR INLETS/OUTLETS 13.00 UNI 56.55 09/14/04v 03/13/05 _ TOTAL FEES 138.30 OWNER: TEL. NO: FINAL DAT NAL Y CODE: ARREDONDO RICHARD;REBECCA M (626) 286-8849- 9854 WENDON ST TEMP 917801726 CR IO F W0. NEW HVA SY EM APPLICANT: TEL. NO CONNOR AIR (626) 286-3151- 4931 ENCINITA AVE SPECIAL CONDITIONS: TEMPLE CITY,CA 91789 CONTRACTOR: TEL. NO: I APPROVALS DATE INSPECTORSSIGNATURE CONNOR AIR CONDITIONING (626) 286-3157- 4931 ENCINITA AVE LIC. NO FAU/WALL FURNACE TEMPLE CITY, CA 91780 403735 C20 COMBUSTION AIR OPE IMC! ARCHITECT OR ENGINEER: TEL. OCT WORK LIC. NO: l AC COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES- COMMERCIAL EV CESCOMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: BS0508