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Home My Public Portal About9647 WOOLLEY ST_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION' FOR PERMIT I hereby affirm that I have a certificate of consent to self �; k insure, or a c rfificate oS Wotker$'Compensation Insurance, 76A964C HEATING - VENTILATING - AIR CONDITIONING or a certified c thereof(Sec. 3800, Lab. C WCP1 Cita 'on CE-818(REV. 10/81) policy No. any Certified copy is hereby f d. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is f' with the u ilding nspec- FOR APPLICANT TO FILL IN BUILDING tion departm (PRINT OR TYPE ONLY) ADDRESS 9647 W22Lley St. Dote – –�i�licanr LOCALITY Temple City NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE i CROSS ST. (This soction nood not ba complotod if the work invONG y ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY the pormit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM 0 . permit is issued, I shall not employ aln!y per n in any manner BOILERBTU so as to become subject to the War ,C pensation Laws. APPROVALS DATE INSPECTOR'S SIGNATURE Date19--121-0 pplicant COMPRESSOR,BTU – ROUGHep NOTICE TO APPLICANT: If, after maling this Certificate of VENTILATION SYSTEM FINAL Z Exemption, you should become subject to the Workers' + Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FA LICENSED CONTRACTORS DECLARATION FLOOR I hereby affirm that I am licensed under provisions of Chapter 9SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business HEATER: WALL and Professions Code,and my license is in full force and effect. License Number 468609L ic. Class C 2 0 t]}. Contractor Irvine W Date 10-15-90 011. 0 I am exempt under Sec. Plan check fee B.BP.C. for this reason PERMIT ISSUING FEE$ — n" Date: W Signature TOTAL FEE U) OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS f,,.,.. L wages as their sole compensation,will do the work and F -G, o a CITY TELNO the structure is not intended or offered for sale(Section . . �LC7 -7.1311 7044, Business and Professions Code).❑ _TE f`_'.p OWNER Mrs. Mr. S irov 1 1 I, as owner of the property, am exclusively contracting T ,t–, with licensed contractors to construct the project (Sec- MAIL ADDRESS TOTAL NL. a o �u tion 7044, Business and Professions Code). – CONSTRUCTION LENDING AGENCY CITY TEL. NO. C'HE ' K ,t•'.11D 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORIrVine West Heating & Air ® CHARGE °013 (Sec. 3097, Civ. C.). Lender's Name ADDRESS 638 Southern Ave.i �I�i�i_)��(I,1 CITY Orange TEL. No. 921 -0800 STATE LIC. ,�,? (�N1laiV Lender's Address I certify that I have read this application and state that the LICENSE NO. 468609 LASS C20 above information is correct. I agree to comply with all County or finances and State laws relating to building construction, a h authori a representatives of his Count to enter i u e on property for a ion SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agen Date • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT :-� DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ME 0508 97055060O1-_4 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL D: FEES PAID . Q ON FILE 96.47 WOOLLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801444 ASSESSOR INFORMATION R: NEAREST CROSS %IREE : BARELA 5383-013-025 01 PERMIT ISSUANCE FEE 27.75 L H:bUS-PAGE:-596 GRID: J1 LOCALITY: TEMPLE CITY 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 4.00 UNI 17.40 05/13/97 TC05/ /98 TOTAL FEES 99.15 OWNER: TEL. 0: FINAL DATE FINAL B CODE: SPIROV IVANCO;VERA - Z 9647 WOOLLEY ST TEMP 917801444 DRUMION OF WORK IV REPLACE EXISTING HEATING AND AIR/COND. SYSTEM AND 4 NEW DUCTS APPLICANT: TEL. 0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO FAU/WALL FURNACE COMBUSTION AIR OPENINGS ARCHITECT OR E VIGEN GHARIBIAN (818) 249-4017- P.O. BOX 11086 LIC. NO: AC/COMPRESSOR GLENDALE, CA 91226 2783 THERMOSTAT FIRE DAMPERS SMOKE Dc ON E C S COMMERCIAL HOOD REPORT ID: DPR264 ROUTE TO: 9S0508