HomeMy WebLinkAbout15052 Edwards St - CofO (6)No.101381
CITY OF HUNT0NGTON BEACH
y- DEPARTMENTOF
2000 MAIN ST, COMMUNITY DEVELOPMENT
HINTINGTC?N BEACH, CA 92648 P.O. BOX 190•CALIFORNIA 02648
V (714)538.5241
A!_L INSPECTION REQUESFS MUST BE RECEIVED BY 4:00 P,M.
FOR THE --OLLOW ING DAY' S 01SPECT ION.
i
M i_ C H A N I C A L P E R M I T
Permit Numbers M-018576 PC ti R 139
Bldg. Address: 15052 EDWARDS ST Tract: NA Lot: NA Block: NA
EXIST. BLDG. Building Use: CON -ADD
Owner• Contractor:
BILL HANSHAW COOLING HEATING INTERNAY
13698 GOI_DENWEST 1377 S LILAC ST
WtSTMINSTER CA 92683 BLOOMINGTON CA 92376
Ph. (714)893-5067 Ph. 909-873-5451 Classes: C20
St.No. 590323 City Lic. A175766
Project Description: INSTALL NEW HEATING AND AIR CONDITIONING SYSTEM.
Ccc-_Grc�ue=_-----_--_---'�____-=Constr__Tyge:---_---- ----— — — — — — — — — — — — -___
AL2I•,DdtB_ 11./ 14/96- Aee1_ov_edg •-- ---- -- ----------------•--------
Processeci__iil1A/96 LE1 #lM-018576 Issued: 11A14/96_LCI------------------------
INSPECTION FEES
Description Qty Amount Description Qty Amount
Duct Extension/Relcc___1_ ler/Corneressor........ 1...... _2S,_00
* >k 9 PERMIT FEES fk * *
DF_SCRIP'TION AMOUNT ACCOUNT DESCRIPTION AMOUNT ACCOUNT
INSPECTION 45.00 RAACD25430900 ISSUANCE 20,00 RAACD23433200
PL9r,4HECk' 0.00 RAACD23430900 PENALTY 0.00 RAACD23430900
MICRO COPY 1.00 GUU 0002255a
TOTAL FEE 66.00✓
FINAL IN117I
INSPECTION:
Processed: w�H�Zri U, M9AA�oNbECL4AHATIA18576 Issued: 11/14/96 Lk
I hereby allirm under ponahy of perjury one al the Iallowitill declamllons: I horsey attire under punally of
L'I I have and will maintain a conlllcalo of consent to aalhmcum for workorw componeatlon, as prowdud la. by
Soellon 3700 0l the Lahr Code, for the PorfatntanCe of trio work for Welch tore permit la icaudd,
16 phave
dn malice loll h nworkforlwf which this permit la Issued, Monsinlon y asrequired
eom pa sdiion tion nsurance carrier
arr00 at the ti r drid Policy
number are:
Carrier „
Policy Number_ ..
(7 tia suction need not be completed if tiro permit is (stand hundred tlollmo lS100) or Iona
G I comfy that In the performance of trip work for which tills permit la Issued, I shall not employ any poroon In any
manner to as to became oubloct to the, orkeW compansatell Iowa of California, and dgrao that If I should become
subInt to the workers' componaetlon'rtovialons of Section 3700 of ilia Labor Coda, I shall forthwith comply with
those provisla .
Dalo4: - , ., Ap141canl, ,
WARNINal FAILURE TO SECURE wOnKEPS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
1451
am exempt I
asions Cede:
AL, r DOTE
.
�� �
AZ
N
In Conn
m ConlrocloPa IJconea Law for Iho foliowing
ny city or countyp which roqulroa 0 permit to
o, prior to Its Issuonco, also requires the
the to Itcanacd purauant to the praylslsne of
iiono Code) either ho or rno is vxompl moroirom m. ti v uu o ,• r,eva �""^r,�^"
Section 7031.5 by any applicant for a permit subincta 1tla appiinatil to d civil penally o1 not
iv6 hundred defeat (5500).):
,nor of Ilia property, or my omployoes with wa0oo no their solo compensation, will do the work,
ucturo to not intended or olfoyyrod for said,. (Con. 7044, Business and Prolosolone Codc, The
auth worLow
h mobil o�fhmcbll rorathrticnB hlapaephar own omlploynosm p o drill I"" Asa h
nla ore list Inlenddtl nr olforod for bale. IL howm•ar, Iho buldin0 nr Imprevoin to sold within
I r.�mplollen, Iho awas,
A7ulider will lava 'he
burden �r proving 'he
t 'to
or aria did eat bulid or
Iho inurpoas of aaie.)
an
I I'. of the prapnny, oat'_ aw5ivety non ranting with licensed oanlreclnra U eanstm I the
n tidy wha builds oNmurovaea"a. and whit conlroNs for such prn)cclo withata no,
cnntprlaclor(o)
SUBJECT AN EMPLOYER TO COMINAL PENALTIES AND CIVIL FINES UP, TO ONE HUNDRED THOUSAND (;I I am exempt undo( Son. ,
DOLLARS ($100,000), IN ADOITIO' TO THE COST OF COMPENSATION, DAMAGES AS PnOVIOED FOR IN B 6PC, lot this reason
SECTION 3700 OF THE [Anon COO,", INTERtST, ANO ATTOnNEY'S FEES, '
Gale. Owner T .. manic,
THIS BOX FOR REGISTER VALIOATfONilNLY CONSTRUCTION LENSING AGENCY
p I hereby allirm undo ponnlly or lDOUC that (hero m n nanoALcnbn leading aganny for rt padn munno 01
'pV►IV rin work for welch Ihln permit la Insuod (Elie 3087, Ctv C)
Lando" o Namn -..
r LendersAddtonn •�°- •- '
CERTIFICATE OF EXEMPTION Fir MWORKERB'COMpENSATIONINSURANCE
t;;•:, ,T�111SECTION NEED NOOTBe COMPLETE IF PERMIT IS FOR ONNEH-UNND,�R.ED DOLLARS ($100)
)r , . (y4... S?K�,"�LICENSED CONTRACTOP'S DECLAFlA IOry. NTO APPUCANr it after weking Ihfa CarIeyou ohduidlocomocbht1hereby Iiirnl under ponaky ei pndury Ihal I am iranood untie(provlol a chaplorp jcommoncin0 with Secltoa V Comps 6mtml provisions of Iho Labor Co ,you must lanhwith comply with Ruch provisle,ts or
7000) of talon o Ihn Businnos and Pr f000lons Code, and at Ilconsc a in full I rce and alloct this permit shall be doomed ravakod.
Licansa No . .. 2� :J.. Lice so Class x ^.�. I cadilY that I hacn road titta cpplicatlar and aisle that the above tnlarmallon la cancer, 1 dOtoo In nnmply
Conhaelnr, +r Qh,�!w. y1 . /]iW fez�.:..Lfl .. Dore .,. v ���_! ' yrf. —, wllh aI cIlly and county ordinenccs and 81010 laws rololtng to betiding Cnnli ust bit, and hsrnby ourhndzo
IJ I din oxn I Iron( IYWlicehsing os 1 Tm a Itcanacd d,cnitocl ar a rog,blar prelnaalonal engineer acting m my
oprcoo tiv o o this ounty to enter upon Ihn above mb ad prep y for mspaatian Paposea.
prolocaiMal nafnalty (Section 70.,1 Buslddaa and Proloaotons Code). ") 41 i!
Lin, or hog, No. ,�., ,. . _. DaI3-.. SI naturoor Appitcanl orA,gant Data
10181 If work Is not cn: arced 180 days II oat data of Isauo of this permit, or If work Is ,
abandoned k; mare than ISO days, this permit shall be null oa'1 void. N p
FORM 140�iav C40
Wi ;M:, COPY - FILE, BLUE COPY • COUNTY, CANARY COPY • OrFICE, GREEN COPY - APPLICANT, PINK COPY - TREASURER