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Home My Public Portal About5122 ROSEMEAD BLVD_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA 8648(2-80) Q p p�OCA QT I]O N FOR pC R MIff I hereby affirm that I have a• certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,of HEATONG-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec. 3500, Lab. C.) Policy No.lf/W g7I�,0�nl,Iny—��Cy(� Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING�1{!®$R�I�rEY�( �( Certified copy is filed with the coo-nty building inspection BUILDING department. r FOR APPLICANT TO FILL IN ��p�� N ' /` ex"gRV Date Applicant__ &, �� (PRINT OR TYPE ONLY) ADDRESS LOCALITY � - e �� CERTIFICATE OF EXEMPTION FROM WORKERS' NO. ITYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST >_ CROSS ST. d (This section need not be completed if the work involved ABSORPTION UNIT, BTU O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED BY (� I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �4� tr permit is issued, I shall not employ any person in any manner �/ V i O O so as to become subject to the Workers' Compensation Laws. �. BOILER, BTU TV��-Q -O ~ Date-k-1-942-Applicant APPROVALS DATE INSPECTOR'S,pSIGNATURE IU COMPRESSOR,BTU LL ROUGH Q ��" �ly�-^--+� NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL -/ '�3 Cl-{�-�� 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: FAU GRAVITY— LICENSED RAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU -- I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 7 9 (commencing with Section 7000) of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. ��// // 22 License Number-T92®fo®•Z_ Lie.Class �J Contractor,Sq/;.V2/g Date I am exempt from the licensing requirements as I am a F,ansed architect or a registered professional engineer Plan check fee 25%of above. ig in my professional capacity (Section 7051, Bus- r_„and Professions Code). PERMIT ISSUING F�� t'S Li_. -110. Date TOTAL FEIE `.OWNER-BUILDER DECLARATION PLAN CHECK A PLICANT I 'ierti,\ :r that I am exempt from the Contractor's NAME Lic n- a following reason (Section 7031.5, Busi- — nesb::,,4 1';^'"r-,',...: Code): ADDRESS _5 7 3 3 A 0 1, ::s ,, _ e property, will do the work and the I CITY stric'u-, intended or offered for sale (Section TEL. NO. # 0 0 0 0 0 8 704-'- ? .,I• and Professions Code). /J I, as c _r of the property, am exclusively contracting I OWNER /✓N� � ¢' /�` s5c��'%�Q f(�� 2 0 o'5'8,Or O with licensed contractors to construct the project MAIL C•/ / r /� /� (Section 7044, Business and Professions Code). ADDRESS �) OZ 7 � ly��v�� /n A /' 0 0 o 5 0 CONSTRUCTION LENDING AGENCY CITY TEL.NOa�3�f�L,�r/ OR 1 9`-8 2 I hereby affirm that there is a construction lending agency for the performance- of the work for which this permit is CONTRACTORLro ec issued(Sec. 3097,Civ.C.). Lender's Name ADDRESS 6117 ��SE'/f� ��✓/� Lender's Address CITY ��'P�/¢ TEL. NO.?yJ`:-/f/ I certify that I have read this application and state that the STATE LIC IC above information is correct.I agree to comply with all County LENSE NO. ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection- rposes. Signature of Permittee Date WORKERS''COMPENSATION DECLARATION CE 81 C o n0 n0 p FOR n0 0 (�/� I hereby affirm that `I' Ha`6e•-a certificate of consent to self CE-B18{2-8°' �I� I! �U�� l�/� I��UVIi insure, or a certificate of-Workers'Coiiipensa6on Insurance,or HEATING-VENTILA' ING-All R CONDITIONING a certified cpy thereof(See 3800 Lab.C) u E 3_7 5 5 Co. West # Policy No. Co pany #6 ldg. Certified copy is hereby furnished, /J COUNTY OF LOS ANGELES BUILDING BUILDING AND$AEETV Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN `-�BUILDING deoartmen• ADDRESS 5122 Rosemead Blvd. Date 1-25-82 Applicant (PRINT OR TYPE ONLY) CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY• '�+ e Ci tY COMPENSATION INSURANCE NEAREST CROSS ST. >_(This section need not be completed if the work involved ABSORPTION UNIT, BTU a. by the permit is for one hundred dollars ($100) or less.) DISTRICT PROC ED 0 I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ;" l � permit is issued, I shall not employ any person in any manner 1� Q so as to become subject to the Workers' Compensation Laws. BOILER, BTU 6, voo APPROVALS DATE NSPECTOR'SSIGNA-S11), TLrE f- ; iii. _ U Date Applicant . COMPRESSOR,BTU- • I�k.XJ �' > CW ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEMFINAL " e- Z Exemption, you should become subject to the Workers' - ' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER (DATION with comply with such provisions or this permit shall be GS deemed revoked. FURNACE: FAU �iAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. p License Number 240778 Lic._Class_.C20 Circulating Air I-25-82 Contractor Date ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Pian check fee 25%of above. acting in my professional capacity (Section 7051, Bus- � — iness and Professions Code). PERMIT ISSUING FEE $' v�f -2 3 4 2 5 A i't> Lic.or Reg.No. Date T'ON'AL FEE � � o•o o.o 8 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 2'o;o 9 a 5 0 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 'o O'0'9El505 F1I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section CITY TEL. NO. Q 3291-82 7044, Business and Professions Code). ❑ OWNER King Luk Assoc. - I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL Huntington Dr. (Section 7044, Business and Professions Code). ADDRESS • 5525 g CONSTRUCTION LENDING AGENCY CITY L A. TEL.NO, 223-4311 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR Circulating Air Inc. issued Sec. 3097,Civ.C:). Fulton s Name ADDRESS 7 Lenders Address CITY TEL. NO.. 983-0775 I certify that I have read this application and state that the STATE N.H.24078 LIC. C20 above information is correct. I agree to comply with all County LICENSE NO. 7CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Coin ty to enter upon the above-mentioned property for in a tion purposea. _ 3 Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION• 76A364C PFPp p (gip PE p/� I hereby affirm that I have a certificate.of consent to self CE -818(2-80) Q li— ffJ L�il�h1 p V �O l� LS I1VI1 �� ,insure, or a certificate of Workers'Co mpensationlnsurance,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. 3$115 c,43any State. Fund City. of Temple City Certified copy is hereby furnished, COUNTY OF LOS'ANGELES BW LMNG AND SAFETY Certified copy is filed with the county building inspection BUILDI-NG XI denartment FOR APPLICANT TO FILL IN ADDRESS 5122 Rosemead Blvd. Date 3-5-82 Applicant Calmex Fireplace (PRINT OR TYPE ONLY) ` LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE gF,APPLIANCE OR EQUIPMENT FEE Temp.l.e_Cit_y COMPENSATION INSURANCE NEAREST } R'OSS C 'ST. (This section need not be completed if the work involved ABSORPTION UNIT, BTU Bro_adwOa_y by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED'.r- U 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM 5 // C/�� e'� cc permit is issued, I shall not employ any person in any manner CJX -so as to become subject to the Workers'Compensation Laws. BOILER, BTUF" ' APPROVALS DATE -tN5PEC70R'S SIGNATURE (-) ' Date-3-=5=8-2-Applicant_Calmex FireplaceCOMPRESSOR,BTU � � U) ROUGH _ NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM r� Z Exemption, you should become" subject' to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- with,comply with such provisions or this permit shall be EVAPORATIVE COOLER q —VAL1DATI0N deemed revoked.' FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDEDUNIT .• 9,(commencing with Section 7000)of Division 3 of the Busi- WALL :,—ness and"Professions Code,and my license is in full force and effect. 4 De (Iratiye GaS LQS License Number 2 7_4_0 7 8 Lic.Glass C-20 ContractorC.almex Date 3�5-82 Fireplaces— 6_0_. 0.0 QI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. 'acting, in my professional capacity (Section 7051, Bus- inessPERMIT and Professions Code). Lie.or Reg.No. Date TOTAL FEE 68. 50 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 El I, as owner of the'property, will do the work and theCITY TEL.NO. z 3 26 5;A structure is not intended or offered for sale (Section # o�o'o o'0 8 7044, Business and Professions Code). O I, OWNER Rosemead Villa as owner of the property, am exclusively contracting 2'0,9'F b&5 0 with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESSo�o to'6 8..5 0 V 5-5.2.5-N-.—H.u-ngto-n—D-r TELNo213 CONSTRUCTION LENDING AGENCY CITY . Los_Angeles_,G.a_. . 2.2.2-=2-0-0-8- 0 3„1 2-8 2 1 hereby affirm that there is a construction lending agency for the performance of the worts for which this permit is CONTRACTOR issued SSec. 3097,Civ.C.). - None Calmex Fi.re.p.lace Lender s Name ADDRESS P•O — -4�-7 None BOX 21-3 Lender's Address CITSuena Park, Ca. TEL'NO. 694-6427 I certify that I have read this application and.state that the STATE LIC• above,information is correct.I agree to comply with all County LICENSE NO. 274075 CLASS .0-20 ordinances and State laws regulating Treating, Ventilating and Air Conditioning,and hereby authorize representatives of this SEE.REVERSE FOR EXPLANATORY LANGUAGE County to enter upon t4-1., above-mentioned property for -i9pneacti� purpous.s m ate .�C G