HomeMy Public PortalAbout4919 CAMELLIA AVE_Mechanical__ B A3s<-17 B
I9f: STB APPLICATION FOR PERMIT
HEATING- VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING / -
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY L r
_NE A R EST
CROSS ST,
FOR APPLICANT TO FILL IN OWNER
- (PRINT OR TYPE ONLY) 151
d�• A
MAIL /'
No. TYPEOFAPPLIANCEOR EQUIPMENT FEE- ADDRESS 7 /
CITY y- ,11/'G A/ TEL. NO. //�.-7y(1 e)
ABSORPTION UNIT, BTU IAV// L 7
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU A
CITY• F - TEL. NO. J�( '3,79Q U
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO, GROUP Z P E Eo Br
EVAPORATIVE COOL ER, _.�
FURNACE: FAU GR'II ITY
FLOOR INSPECTION RECORD
-BTU '
HEATER: SUSPENDED—UNIT_
WALL '
CD
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U
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Plan check fee 25y of above. See reverse. _
PERMIT ISSUING FEE S 3 00
TOTAL FEE
PLAN CHECK APPLICANT
.NAM Er.•fs/A+PLS - PG/Y�J • .
ADDRESS -/3F _ .,Ie /�'
CITY� C7/ TEL NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS - DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITI ON I HE
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION _-7 194 1AI
[�
OF CHAPTER 9, DIVI510 OF. THE BUSINESS AND PROFESSIONAL FINAL 7� 7 '�
CODE'OT THE STATE OF A IF4RNI
OF PE URE PERMIT VALIDATION cK. M.D. cnsn
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. :CASK
9 .83°9�sEr T:8.4 U 8.0 (),A-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE