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Home My Public Portal About9110 WOOLLEY ST_Mechanical__ r WORKERS'COMPENSATION I have wti DECLARATION APPLICATION FOR PERMIT �{I(erm that I have a certificate of consent to self £ertifieate of Work&rs'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or 6 certi ed copy thereof'(5ec. 3800, Lab. C.), 76A364C • CE-818(REV. 10/81) Policy No. Company 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 department. ADDRESS (PRINT OR TYPE ONLY) Date Applicant LOCALITY G 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 Y the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM I certify that •in the performance of the work for which this (Ja permit is issued, I shall not employ any person in any manner so as to becorne subject to the Workers'Compensation Laws. . BOILER,BTU APPROVALS DATE P OR'S SIGNATU --Z pp =�_ �1' COMPRESSOR, BTU ROUGH Dat licant NOTICE TO APPLICANT: If, after-making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE.COOLER. VALIDA with comply with such provisions or-this permit shall be deemed revoked. i ,FURNACE: FAU ITY . LICENSED CONTRACTORS DECLARATION / FLOOR ." BTU O V V I hereby affirm.that I-am licensed under provisions of Chapter 9SUSPENDED UNIT `(commencing with Section 7000) of Division 3 of.the Business HEATER: WALL and Professions Code,and my license is in full force and effect. / , License Number y��/2 Lic. Class,®r. `®r �� G� I am exempt under Sec. II&I Plan check fee 9L B.BP.C. for this reason' - PERMIT ,� ;151 1,$A � Date: ISSUING FEE� # o o 0 0 0 Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ' 3Q50 I hereby affirm that I am exempt from the Contractor's License', o 0 05 Law for the following reason (Section 7031.5, Business and NAME 3 Q 5 0 Professions Code): El1, as owner of the property, or my employees with ADDRESS O 7.2 4 +$6 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 7044, Business and Professions Code). OWNER ❑ I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- MAIL. tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING.AGENCY. CITY TEL. NO. I hereby affirm that there is a construction lending agency for the performance of the work for which.tFiis permit is issued CONTRACTOR ® a (Sec. 3097, Civ. C). - - ADDRESS a Lender's Name CITY TEL. Lender's Address S ATE LIC. I certify that I have read this application.and-State that the -LICENSE NO. CLASS G 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 ;&ad= roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent 'Date - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0309260006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: TR: 12115 LT: 10 9110 WOOLLEY STS- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801349 ASSESSORNEAREST CROSS STREET: ENCINITA 5382-023-002 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 08 FURNACE/HEATER <100 1.00 UNI 27.00 TENANT: TOTAL FEES 54.75 ISSUED aN: PROCESSED 8 : PLAN BY: EXPIRESN: 09/26/03 JK 03/24/04 OWNER: TEL. N0: FI E FI COD HSU YUN LIN - /y 9110 WOOLLEY ST TEMPLE CITY 91780 D R N R C/O ATTIC FURNACE APPLICANT: 0• AIR TRO (626) 357-5311- 1630 S MYRTLE SPECIAL CONDITIONS: MONROVIA CA TE CONTRACTOR: L. N0: €L '^ APPROVALS DATE INSPECTOR SI AIR TRO (626) 357-5311- � SIGNATURE — AIR MYRTLE AVE LIC. NO MONROVIA CA 91016 258228C10j �� / L AC \'y COMBUSTION AIR OPENING 1 --- ARCHITECT OR ENGINEER: TEL. NO: - A/ r 0 LIC. NO:r — — i I ! I ` I AC/COMPRESSOR U. -- _� _� �__� �.I j o. THERMOSTAT �FF)- 1 rIj 7r� r` �. ` FIRE AMPERS u 11 L El C-7 1' �L-/ l�IJ�'1 '� q� SMOKE E C 0 D V C S -- COMMERCIAL HOOD J.J \�PVic * ADDITIONAL DATA ON FILE REPORT ID: DPR264 ROUTE TO: BS0508