HomeMy Public PortalAbout9173 WOOLLEY ST_Mechanical__ WORKERS'CU,9IYENSA'PION DECLARATION CE 81 C �6A I�lid II CAT�ON FOR
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rl eigby l of irm that I have a' certificate of consent to se)f CE-818 (2-80) bbl lr I!— L� CI If If`!; fr L�If 6 U�7U
inburZ,or certificate of Workers'Compensation Insurance,o}. HEATING-VENTILATING-AIR CONDITIONING �.
a certified copy thereof(Sec. 3800,Lab.C.)
Pdlicy,No. Compan y
•Oercifieu�c� iAffle�y furnished. , COUNTY OF LOS A ELES BUILDING AND SAFETY
r
® Certified copy is filed with the county building inspection
de rtmenFOR APPLICANT TO FILL IN AD ESS Q L L EX
Date_Z=/_16: +�u Applicant— ,...,,,ppp Q� (PRINT OR TYPE ONLY)
CERTIFICATE OF EXEMPTION FROM WORKERS' LOCALITY .—r—� .
NO. TYPE OF APPLIANCE.OR EQUIPMENT FEE I � I
COMPENSATION INSURANCE NEAREST
(This section need not be completed if the work involved' ABSORPTION UNIT, BTU CROSS ST. a
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROC SS BY O
I-certify that in the performance of the work for which this AIR HANDLING UNIT,CFM
permit is issued, I shall riot employ any person in any manner , \
so as to become subject to the Workers' Compensation Laws. BOILER,BTU
• APPROVALS 1. DAYE INSPECTOR'S SIGAKATURE V
Date Applicant COMPRESSOR,BTUROUGH 4 40
�j .� _ .✓ d
NOTICE TO APPLICANT: If, after making this Certificate of N
Exemption, you should become subject to the Workers' VENTILATION SYSTEM FINAL 6 ��Z Z
Compensation provisions of the Labor Code, you must forth- I
with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION
deemed revoked. FURNACE: FAU I
GR VITY
LICENSED CONTRACTORS DECLARATION FLOOR: BTU -
1 hereby affirm that I am licensed under provisions of Chapter HEATER: SkD UNIT , Q/
9 (commencing.with Section 7000) of Division 3 of the Busi- 3 WALL i
ness and Professions Code,and my license is in full force and'
effect.
License Number &47!7 Lic.Class fC'r��e? C
Contracto __ Date
I am exempt from the Zensing requirements as I am al
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). I
Lic.or Reg.No. Date TOTAL FEE -
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
I, as owner of the property, will do the work and the TY TEL.NO.+-��G�3y.
structure is not intended or offered for sale (Section CI �/9 Ziy t <
7044, Business and Professions Code).
OWNER �J4GJ1Fa tt0
I, as owner of the property, am exclusively contracting ;
with licensed contractors to construct the project MAIL �QOLLtrjl/ I
(Section 7044,Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY C TEL.N0. 8 L OR 1 8 1,9 A
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR �yr 1-3l V-1 tis # o 0 0 0 4 1
issued(Sec. 3097,Civ.C.).
Lender's Name ADDRESS ZZ E
aoTPJri-" 2 - - 37.00
Lender's Address I CITY TEL.NO.
I certify that I have read this application and state that the STATELICENLIC.
above information is correct..I agree to comply with all County I SE NO. CLASS G 0820
ordinances and State laws regulating Heating, Ventilating and v
Air Conditioning, and hereby authorize representatives of this j SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned property for
inspection purposes.
y 8d
Signature�r ermittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0710240007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID BUILDING ADDRESS: [
ITR: 14396 LT: 46 [ I 9173 WOOLLEY ST [
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917801351 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: ENCINITA [
15382-016-026 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I 108 FURNACE/HEATER <100 1.00 UNI 27.00 I I
(TENANT: I TOTAL FEES 54.75 [ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
10/24/07 SR 04/21/08
(OWNER: TEL. NO: I FINAL DATF oolr CODE: I
IRACHFORD THOMAS;MARYANN TRS (626) 286-5416- I I '� I
19173 WOOLLEY ST I I I
ITEMP 917801351 I IDASCRIPTION OF WORK uI
IREPLACE EXISTING GAS WALL HEATER
I
(APPLICANT: TEL. NO:
SAME AS OWNER
ISPECIAL CONDITIONS:
I I I I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
SAME AS OWNER
LIC. NO 1 FAU/WALL FURNACE I I I
I (COMBUSTION AIR OPENINGS I I I
[ARCHITECT OR ENGINEER: TEL. NO: I (DUCT WORK I I
LIC. NO: I IAC/COMPRESSOR I I I
I I I I I
I I ITHERMOSTAT I I I
IFIRE DAMPERS I [
ISMOKE DETECTION DEVICES I I I
1 (COMMERCIAL HOOD [ 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 I I I I
IREPORT ID: DPR264 ROUTE TO: BS0508 [ I I I
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0904070003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID BUILDING ADDRESS: I
ON FILE I 1 9073 WOOLLEY ST
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT-1 TEMP CA 917801348
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15382-019-030 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
141 VENTILATION FAN 2.00 FAN 31.50 1 I
ITENANT: I TOTAL FEES 59.25 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
I I 104/07/09 SR 10/04/09
(OWNER: TEL. NO: IFINAL WE FINAL BY: CODE: [
IWEAL GEORGE L;JOANNE M (626) 285-3796- I 13�6� 1
19073 WOOLLEY ST I 1 I
ITEMP 917801348 ON OF WORK 4I
1 I 12 VENTILATIONS FANS FOR BATHROOMS REMODEL I
APPLICANT: TEL. NO: I I I
HOME CARE & DESIGN (888) 580-5557- I I 1
110680 W. PICO BLVD. I ISPECIAL CONDITIONS:
ILOS ANGELES CA 90064 1 1
I I I I
I I I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IHOME CARE AND DESIGN (888) 580-5557- 1 I 1
110680 W PICO BLVD LIC. NO I IFAII/WALL FURNACE I I I
(LOS ANGELES/CA/90064 820230
I ICOMBUSTION AIR OPENINGS I
(ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I I
I - I I I I
I LIC. NO: I IAC/COMPRESSOR I 1
ITHERMOSTAT 1 1
I IFIRE DAMPERS I 1
I I I I I I
I ISMOKE DETECTION DEVICES I I 1
I I I I I I
I (COMMERCIAL HOOD 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 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
I I I I I I
1 [REPORT ID: DPR264 ROUTE TO: B80508 I 1 I I
I I I I I I