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Home My WebLink About1287A (6)WORKERS'COMPENSATION DECLARATION 76A364C 1 hereby affirm that I have a certificate of consent to self CE - 818 (2 -80) - insure, or a certificate of Wnrkers' Compensation Insurance, o'r a certified copy thereof (Sec. 3800, Lah. C.) Policy No. 306-82 Company State Comp. Ins. Fund Certified copy is hereby furnished. Certified copy is filed with the county building inspection der rim nt. Date 8F/10h Applieant--SUfim:Lt--$('f.£E: pfPhal Co CERTIFICATE OF EXESIPTION FRO9I WORK1SItS' COMPENSATION INSURANCE.. (This section need not be completed'if the work involved by the permit is for one hundred dollars (SI00) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate. of Exemption, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. - LICENSED CONTRACTORS DECLARATION I herebv affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. License Number 195932 Lia Class_C-43 c Summit S/M 8/16/83 C^.on traClnr D2IC ,,,Nam exempt from the licensing requirements as 1 am a licensed architect lir a registered professional engineer acting in my professional capacity (Section 7051, Bus- iness and Professions Code). Lic. or Reg, No. Date HOME OWNER-RUILDER DECLARATION I hereby affirm that I am exempt from- the Contractor's License Law for the following reason (Section 7031.5, Busi. ness and Professions Code): IDL as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code), CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for nhich this permit is issued (Sec. 3097, Civ. C.), Lender's Name Lender's Address 1certify that I have read this application and state that the above information is correct. 1 agree to comply with all County ordinances and State laws regulating Heating. Ventilating and Air Conditioning, and hereby authorise representatives of this County to enter ua,i,4)8/16183 above-mentioned properly for in�pectiun purposes. tg "or of Permittee Data APPLICATION FOR PERMIT HEATING -VENTILATING -AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY Tract 32576 Lot 18 FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) BUILDING ADDRESS 1907 Peaceful Hills Road NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY ABSORPTION UNIT, BTU NEAREST CROSS ST. AIR HANDLING UNIT, CFM DISTRICT NO: PROCESjED eV U BOI LE R, BTU COMPRESSOR, BTU APPROVALS DATE 11 'cc R'SSIGNATURE ROUGH FINAL � VALIDATION 21 28.7 A #... g I - 3 1� 5 0 �.� ' ° �f• 081 9-83 4 VENTILATION SYSTEM 00 EVAPORATIVE COOLER FURNACE: FAU GRAVITY— RAVITYFLOOR: BTU FLOOR:— HEATER: SUSPENDED UNIT WALL Plan check fee 25% of above. PERMIT ISSUING FEES 10 50 TOTAL FEE 34 0 PLAN CHECK APPLICANT NAME Surmdit Sheet Metal Co., Inc. ADDRESS 21811: Belshire St. - CITY Iiawaiian Gardens TEL. No. 527-8863 OWNER M. J. Brock & Sons, Inc. MAIL ADDRESS 1698 Greenbriar-Lane; f?74 CITY Brea TEL. NO. 529-8170 CONTRACTOR Summit Sheet Metal Co. Inc. ADDRESS 21811 Belshire St. - CITY Hawaiian GardealffEL.ND. 527-8863 STALICFNSE No. 195932 c Ss- C-43 SEE REVERSE FOR EXPLANATORY LANGUAGE. 11 } O U 2 W Ea. o O N k(a " � o C �y � ^• �_. c � i; �. '� i` c C c. cR-. 'f-. � =C �..«• �= •" f' ^'�' � ,�rt,, is � - r G v « '^ r o�;a;.,u _ _ -•• Q. ^ � H �. c � y c �^„� � o »'c' _ o o V C rR. Q-: C 4..+ i "., �: b G. IC ^ �N i•:-. flew O ^.• O ^.. C .... R:s •' t. N � �� % � D• f'> W rj ::... r: �. f: "` ^ O � R � i� O R y, C nC p. F. '«, « h Z' n'' 7 C:� O C � `c ��U C+..Y.' t:.11 n � _ ^ C G C' �. � C_ ^ .R h np O-"'•" ^ O n �, _ .,^. ^.6 �.``••"• p pn• `� j «"' wGw t'c CSO t �O �i. i� n k(a " � o C �y � ^• �_. c � i; �. '� i` c C c. cR-. 'f-. � =C �..«• �= •" f' ^'�' � ,�rt,, is � - r G v « '^ r o�;a;.,u _ _ -•• Q. ^ � H �. c � y c �^„� � o »'c' _ o o V C rR. Q-: C 4..+ i "., �: b G. IC ^ �N i•:-. flew O ^.• O ^.. C .... R:s •' t. N � �� % � D• f'> W rj ::... r: �. f: "` ^ O � R � i� O R y, C nC p. F. '«, « h Z' n'' 7 C:� O C � `c ��U C+..Y.' t:.11 n � _ ^ C G C' �. � C_ ^ .R h np O-"'•" ^ O n �, _ .,^. ^.6 �.``••"• p pn• `� j «"' wGw t'c CSO t �O �i.