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Home My Public Portal About5124 ROSEMEAD BLVD_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA 818 (2-80) /iQ If— Uf LLQ C AT�OD U V , FSU./VIS lr"E R IIGU T I hereby affirm t4at I havea7 certificate of_consent.,t,o self insure, or a certificate of Worke.ts'Compensation Insurance,or HIZATINCai_V ENTILAT1NG-Alfa CONDITIONING a certified copy thereof(Sec. 3800,Lab.C.) Policy No.i63-71 C5?},53,Y1 INS. Co. West tAjLDG # 3 Certified copy is hereby furnished. / %•— OU ' COUNTY OF LOS ANGELES -, BUILDING ,ARID SAFETY Certified eopy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING Date 1- dear*ren'25-8Applicant (PRINT OR TYPE ONLY) ADDRESS 5124 Rosemead Blvd. 2 CERTIFICATE OF EXE&1PTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Ample City COMPENSATION INSURANCE NEAREST d (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. O by the permit is for one hundred dollars ($100) Or less.) DISTRICT NO. PRO ED V I certify that in the performance of the.work for which this AIR HANDLING UNIT,CFM % M permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU H APPROVAL$ DA E INSPECTOR'S SIGNAT' W Date Applicant COMPRESSOR,BTU. t0,Dt7J r d ROUGH Cn Z NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Exemption, 'you should become subject to the Workers' FINAL � Compensation provisions of the Labor Code, you,must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. 1) FURNACE: FAU03 a 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. Q License Number .240778 Lic.Class— C20 Circulatng Air 1-25-82 Contractor Date F1I 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- iness and Professions Code). PERMIT ISSUING FEE $ L s Lic.or Reg.No. DateTOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT -23426A I hereby affirm that I am exempt from the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- # 0 0 0 0 0 8 ness and Professions Cods): ADDRESS 1, as owner of the property, will do the work and the 2 0.,0 9 8,5 0 structure is not intended or offered for sale (Section CITY TEL. NO. _ 7044, Business and Professions Code). 0 0 ,0 9 8,5 0 L5 OWNER King Luk Assoc. I, as owner of the property, am exclusively 'contracting0 32 9—$2 with licensed contractors to construct the project MAIL Huntington Dr. (Section 7044, Business and Professions Code). ADDRESS 55'L 5 g CONSTRUCTION LENDING AGENCY CITY L.A. TEL.NO. 223-43U I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR Cir�nla issued(Sec.3097,Civ.C.). b ng Ai r Lender's Name ADDRESS 7412 Fulton Lender's Address CITYN:H. TE L.N0.983-0775 I certify that I have read this application and state that the STATE240778- LIC. above information is correct.I agree to comply with all County LICENSE NO. CLASS 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 /prop rly for iI, Lection purpos— 3(f/ Signature of Permittee Date �� WORKERS'COMPENSATION DECLARATION CEA 818(2-80) Q G p UC Q T�O N FOR PERM M I hereby affirm that I have a' certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or G IC /1�-00�1�-d LG�TOL�1�Ou^�1�-GaoG�? ��fn1DD O�O�O`�00`vC� a certified copy thereof(Sec: 3800,.Lab. C.) Certified copy s City of Temple City Policy No.3 d opy is Company hereby furnished.State Fund_ COUNTY OF LOS ANGELES BUI LDlNG AMD SAFETY � -�� IR Certified copy is filed with the county building inspection FOR APPLICANT TO FILL ON BUILDING department. ADDRESS 51.24_Roseme_ad_B-1-v_d. Date 3-5-82 Applicant C:.almeX_Fixe.p.l.ace_ (PRINT OR TYPE ONLY) CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Temple City COMPENSATION INSURANCE NEAREST CROSS ST. >a ('This section need not be completed if the work involved ABSORPTION UNIT, BTU Bro:ad—w O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO,. PROCESSED (� I certify that in the performance of the work for which this AIR'HANDLING UNIT,CFM permit is issued,•I shall not employ any person in any manner O so as to become subject to the Workers' Compensation Laws. BOILER, BTU 1— APPROVALS DATE NSPECTOR'S SIGNAATURE U LU Date 3-5-82 ApplicantCalmeX Fireplace COMPRESSOR,BTU Q�/� ROUGH Cn NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER �0T_ VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. 3 Decorative Gas_Log 4.5-.-0.0 License Number-2 74.0-�8- Lic.Class—C=2-0 Fireplaces Contractor Calmex Date-3-m5=8-2 13 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). P{ERMOT OSSUONG FEE$ $ , 50 Lic.or Reg.No. Date TOTAL FEE 53 . 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 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section CITY TEL. NO. 7044, Business and Professions Code). z.3 2 b A OWNER I, as owner of-the property, am exclusively contracting Roseme.a.dVel.l.a # 0'o'o o o 8 with licensed contractors to construct the project MAIL . . . . Section 7044, Business and Professions Code).) ADDRESS 5 5-2-5-N,--H u-ng to r1-Dr---;-2-1:3 2 0 to 5 3,5 0 TEL. CONSTRUCTION LENDING AGENCY CITY LOS Angeles, Ca. NO-222-2008 '0! O.222-2008 `o'o'o� 3:I hereby affirm that there is a construction lending agency ,5 3,5 0 v for the performance of the work for which this permit is CONTRACTOR . -1-a-ce issued (Sec. 3097,civ.C.). Calmex_F-i-r-rep2,-- Lender's Name None ADDRESS P.O. BOX 417 Lender's Address None CITY TEL.NO. 213 Buena Park, Ca. 6.9_4_6_4.2-7 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. 274.078 CLASS C=2:0 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 i1;SA urposes. X -5-82 a Date