HomeMy Public PortalAbout5619 CAMBURY AVE_Mechanical__ 76 A364 CE 818-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING ) Ga /i / �`
DEPARTMENT OF COUNTY ENGINEER ADDRESS ` '
BUILDING AND SAFETY DIVISION LOCALITY
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CROSS '
CROSS ST. �
FOR APPLICANT TO FILL IN OWNER r ,n 1 //�^I
(PRINT OR TYPE ONLY) - k�^..L)' , Fo
TYPE A SIZE OF EQUIPMENT MAIL r
NO. FEE. ADDRESS -✓��� -�� ,(j L(,/'I'
SEE BACK OF APPLICATION
CITY 67 -TEL NO.
FORCE AIR FURNACE, BTU lCL70 G y�J
CONTRACTOR �
COMPRESSOR, BTU 7 O Jp
ADDRESS g�,G/ / -5
VENTILATION FAN .�� / y ? y
._ CITY �/7sT /�' TEL.
LIST ALL OTHERS.BELOW STATEI, LIC.
. - LICENSE NO. L� L A� CLASS
DISTRil. NOt GROUP I ZONE PNO[ESS ED BY
J5. 6U
_ INSPECTION RECORD
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Plan check fee. See reverse.
Ylal>n'r l.tit:u•r. F'IS h; a
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TELA.NO. .
I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO-COMPLY - -
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE' INSPECTOR'S SIGNATURE
LAT IN6. AIR GONG ITI ONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9,.DIVISIOJC !�g ESS AND PROFESSIONAL FINAL -•�,�
[DOE OF THE STATE OF Ir
sIGHAT URe PERMIT VALIDATION. EK.1 M.o.' CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.D. CASH -
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