The URL can be used to link to this page

Home My Public Portal About5126 ROSEMEAD BLVD_Mechanical__ WORKERS'COMPENSATION DECLARATION 76A364C 11 o 0UCA0 0IIVI}QT I hereby a;ffirdi that I'hate' a' certificate of'consent•to' self CE-818 (2-80) If— Lf— � p�1 I� insure, or a certificate of Workers'Comp"e nsatiori Insurance,or H EAT ONG_V IENTILATING-AIR COf 611T1ONINGi a certified conn thereof(See. 3900,Ib.C.) 'fl 163-71 5+53-1 Ins. Co. West # 6145 Bldg. #2. Policycompan Certified copy is hereby furnished.y COUNTY OF LOS ANGELES BUILDING AND SAFETY �.r� e � MCet0fied,sopy is filed with the county building inspection BUILDING department. FOCI APPLICANT TO FILL IN ADDRESS 5126 Rosemead Date_1�2.5=82_ Applicant (PRINT OR TYPE ONLY) LOCALITY __G1� CERTIFICATE OF'EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST (This section need not be completed if the work involved ABSORPTION UNIT,BTU CROSS ST. d by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PRO "ED BY O 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM permit is issued, I shall not employ-any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATU E V Date Applicant COMPRESSOR,BTU 1 ��1 ROUGH lL NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEMFINALIt?'` 2 .Exemption, you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forth- EVAPORATIVE COOLER /�{ /% VALIDATION with comply with such provisions or this permit shall be /!)� '��1 deemed revoked. C�f/y � FURNACE: FAU RAVITY /j . LICENSED CONTRACTORS DECLARATION FLOOR BTU 0,000 I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. ' License Number 2'+'077$ Lic.Class C20 Circulating Air 1-25-82` Contractor Date I 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$ Lic.or Reg.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 3 4 2 7 A #�0 0 0 0,0 8 I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5,`Busi- 2 ° ° 9'a'5 0 ness and Professions Code): ADDRESS y EJ I, as owner of the property, will do the work and the ° °;° 9a505 structure is not intended or offered for sale (Section CITY TEL.NO. 7044, Business and Professions Code). 3,29.-8 2 ' OWNER King Luk ASSOC. _ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL 2 Huntington Dr. - (Section 7044, Business and Professions Code). ADDRESS 5525 CONSTRUCTION'LENDING AGENCY CITY LA.A -TEL.NO.223-4311 I hereby affirm that there is a construction lending agency CONTRACTOR Circulating Air Inc.for the performance of the work for which this permit is issued (Sec. 3097,Civ.�.). Lender's Name ADDRESS 7412 Fulton Lender's Address CITY N H TEL.NO. 983-0775 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'. 0378 CLASS C20 ordinances and State laws regulating Heating. Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE C�auyjy�up '•e-mentioned pr petty for i { y f 75ignature of Permittee Date WORKERS'COMPENSATION DECLARATION 76A364C � (off no p �p • o (o I hereby affirm that I have a' certificate of consent to self CE -818 (2-80) G 1 I� VF ILS C Ir-�l T�O J V FOR FIE USS M �T insure,or a certificate of Workers'Compensation Insurance,or HEATING—VENTILATING—AIR CONDM®G` gHG a certified copy thereof(Sec. 3800,Lab.C.) �J Policy No._3,8-1.1.5_7company State—'Fund City of Temple. City Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING ARCO SAFETY �. Certified copy is filed with the county building inspection BUILDING X d?pay*mrntFOR APPLICANT TO PILL IN ADDRESS 5126 Rosemead Blvd Date 3-5-82 Applicant 'Ca1meX F1repl i.c (PRINT OR TYPE ONLY') • LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE Temple Cl t�7 COMPENSATION INSURANCE NEAREST } CROSS ST. O. (This section need not be'completed if the.'work involved ABSORPTION UNIT, BTU B:ro.ad—w. p by the permit is for one hundred dollars ($100) or less.) DISTRICT No. PROCESSED P' V I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM' 11 permit,is issued, I shall not employ any person in any manner _ _ _ 0 so as to become subject to the Workers' Compensation Laws. BOILER, BTU U APPROVALS DA.c INSPECTOR'S SIGNA .RE Date 3-5-82Applicant. Calmex Fireplace N COMPRESSOR, BTU ROUGH I r NOTICE TO APPLICANT: If, after making 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: FAU GRAVITY r%=! � 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—2-7-4-0-7-8- Lia Class.C.-2-0 ContractorCalmeXDate 3=5-82 Fireplaces aI 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 ISSUING FEE and Professions Code). 8-.5-0— Lie. -.5.0Lie.or Reg.No. Date TOTAL FEE 53 J50 ;3 2 6.131A HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT # o}o o o o 8 I hereby affirm that I am exempt from-the Contractor's NAME 2'0?0 5 3 5 0 License Law for the following reason (Section 7031,5, Busi- ness and Professions Code): ADDRESSo=0 0'5 3.50=0 0U F] 1, as owner of the property,will do the work and the s structure is not intended or offered for sale Section CITY TEL. NO. ( � 0 3, 1 2`•-8 2 7044, Business and Professions Code). El OWNER Rosemead Villa I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL (Section 7044,Business and Professions Code). ADDRESS 5525�N_._Hungton_Dr_. CITY TEL.NO. CONSTRUCTION LENDING AGENCY LOS_Angel_e_s_, CA-. 2-2.2=2-0-0.8 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR Calmex Firep.laCe issued (Sec. 3097,Civ.C.). Lender's Name —None ADDRESS P.O. Box 4.1.7 , Lender's Address None CITY Buena Park,' TEL.NO. 694-6427 I certify that I have read this application and state that the STATELIC• above information is correct.I agree to comply with all County' LICENSE NO. 274078 CLASS C-2 ordinances and State laws regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter up the above-mentioned property for inspec':on pu"pases. 3=5=8.2 Signature of Permittee Date