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Home My Public Portal About5128 ROSEMEAD BLVD_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA$6 g(2,80) /PIII U-" If— L� C AT�O U V FOR R If� E USS M QT I hereby affirm that I have a' certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or HEATONG-VENTILATING-AIR C®RIDIT ®R9ONG "fl a certified copy thereof.(See.3800. ab.C.) Policy No 63-71 553p ly Ins. Co. West 45 Bldg 1. Certified copy is hereby furnished. `— `--- COUNTY OF LOS ANGE�S �. BUILDINGS AND SAFETY Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING depart a t ADDRESS 5128 Rosemead Blvd. Date 1—� �Applicant (PRINT OR TYPE ONLY) LOCALITY 1e City CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF.APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } CL (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. d 6 by the permit is for one hundred dollars ($100) oI less.) DISTRICT NO, WO ;SEB V 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 r v so as to become subject to the Workers' Compensation Laws. BOILER, BTU ~ �lt��v APPROVALS D, INSPECTOR•SSIGNAT E W Date Applicant ! COMPRESSOR,BTU 4 oeK, 7 0d -� ROUGH � _ �. J( fe t d Z NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM i s �A _ 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 �l''' VALIDATION deemed revoked. i/ FURNACE: FAU RAVlTY (� 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-'' Lie.Class C.20 Contractor Circulating Mgt 1—�5-82 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 EEE $ � {� Lie.or Reg..No. Date TOTAL FEE ,6�2 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 9 3 4 2 8 A I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section CITY TEL. NO. o 0 o o o 8 7044, Business and Professions Code). OWNER 2'- �' 2 8 5 C M I, as owner of the King Luk Assoc property, am exclusively contracting Assoc* • with licensed contractors to construct the project MAIL o (Section 7044, Business and Professions Code). ADDRESS 5525 Huntington Dr. o - r1OG $ Jr O y CONSTRUCTION LENllING AGENCY CITY L.Ae .. TEL.NO. 223,4311 0 a G•9"8 2 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.). Lender's Name ADDRESS 7.412 Fulton . Lender's Address CITY N.H. TEL.N(983-0775 I certify.that I have read this application and state that the STATE 240778 LIC. C2 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 Cour y to enter on the above-mentioned pr perty for ius a,tion.purpose. P Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76A364C /8\ I hereby affirm that I have a' certificate of consent to self OE-818(2-80) If— L��G �� Q II�l USS l!� USS UVII �� insure,or a certificate of Workers'Compensation Insurance,or b�Q�oc��-� ��Ia�aTII�I�-GaIf2 ��I`��I�rI�II�c a certified copy thereof(Sec. 3800,Lab.C.) Policy No._3.8.1.1.5.7.ompany-State-Fund City. of Temple City Certified copy is hereby furnished., - COUNTY OF LOS ANGELES BUI LIQ#iMGs AHD SAFETY CX Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS department ADDRESS Date 3-5-82 Applicant Calmex Fireplace (PRINT OR TYPE ONLY) 5-1.2-8—Ro.s_emead_B.1vd-. LOCALITY NO.�TYPE CERTIFICATE OF EXEMPTION FROM WORKERS' APPLIANCE OR EQUIPMENT FEE Temple City COMPENSATION INSURANCE NEAREST CROSS ST. a (This section need not be completed if the work involved ABSORPTION UNIT, BTU Bro-adwa_y p by the permit is for one hundred dollars (SI00) or less.) DISTRICT NO, -Es-_O aY I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM /7.f� permit is issued, I shall not employ any person in any manner G9 O so as to became subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S S4 ,aATURE U W Date_3-5-8.2kpplicant_Calmex-Ei.re.p.l.ac.e_ COMPRESSOR,BTU ROUGH ' w Via.. Cn NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM a Z Exemption, you should become' subject to the Workers` FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLERP,. IDATI/ON with comply with'such provisions or this permit shall be �'O7� 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. 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-' D.e.c.o.r.ative-Gas L-og 4-5_. OA License Number 274078 Lic,Class C-20 Fireplaces ContractorCdlmeX ... Date 3-5-82 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 EEL $___a_150 Lic.or Reg.No. Date TOTAL EEL 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 0 1, as owner of the'property, will do the work and the structure is not intended or offered for sale (Section CITY TEL. NQ. 7044, Business and Professions Code). $ o to 0 0 0 8 I, as owner of the property, am exclusively contracting OWNER RosemeadVilla 3 5 0 with licensed contractors to construct the project MAIL .21-1-5 (Section 7044, Business and Professions Code). ADDRESS 5.5.2-5_N-.-Hung-to"n-Dr. �;�'53.5015 CONSTRUCTION LENDING AGENCY CITY Los Angeles, TEL.NO. 222-2008 I hereby affirm that there is a construction lending agency 011 2-82 for the performanceofthe work for which this permit is CONTRACTOR Calmex Fireplace issued(Sec. 3097,Civ.C.). Lender's Name None ADDREp4.Q._B.O.X 4-1.7 Lender's Address None CITY Buena Park, CaUL.NO. 694-6427 I certify that I have read this application and state that the STATE 274078 LIC. C-20 above information is correct.I agree to comply with all County LICENSE NU. 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 property for !�inspec*toonn�purposes. Signature of Permittee Date