HomeMy Public PortalAbout5215 CAMELLIA AVE_Mechanical__ 7E A3e4 — CE SIS - 9-71 APPLICATION FOR PER T
�- �- HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �s
DEPARTMENT OF COUNTY ENGINEER ADDRESS �jme
BUILDING AND SAFETY DIVISION LOCALITY e C C
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL Awe C'
NO. TYPEOFAPPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY IV TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GnouP M FRO EBBED BY
EVAPORATIVE COOLER
FURNACE: FAU R VITY INSPECTION RECORD 8
FLOOR BTU
HEATER: SUSPENDED UNIT_ o
WALL t3
o..
Plan check fqe 25% of above. See reverse.
PERMIT ISSUING FEE S s 00
TOTAL FEE
LDA
CHECK APPLICANT
ESS
TEL.NO Z
RESY ACKNOWLEDGE AT I HAVE READ THIS APPLICATION
ATE THAT THE AGO IS CORRECT AND AGREE TO COMPLY
LL ORDINANCE/ AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE Df1PECTOR'G IHINATURE
, AIR CONDITIONING.
RO UG H
ERESY CERTIFY THAT I AM NOT ACTING IN VIOLATION
PTER 0, DIVISION S, OF E SUSINEIS AND FR IIONAL NALF THE STATE OF C41 IA.
TURE ERMIT VA I ATION CK. M.O. CASH
ERMITTEE
PLAN CHECK VALID ION CK. M.O. CASH
1. 8 8 673 JUN 7 4 1 A
2EI SACK OF APDL ICATION FOR COM R.ETI FIE GCHEDU LI
7°'"°"Z(CIL- °A' 'r"
tPLI�ATIOM FOR PERWIT
HEATING - VENTILATING - AIR CONDITIONING
r
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDINGu ,
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY '
O. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST.
ABSORPTION UNIT,BTU 'rL — .
OWNER �
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER,BTU CfTYTEL NO.
COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITYTEL NO.Z
�
FURNACE: FAU GRAVITY STATE LIC.
FLOOR SITU LICENSE NO. UZ CLASS
HEATER: SUSPENDED UNIT— DtSTRICT NO. alrouP 1011EPYROC ED WAI I
INSPECTION RECOR
Plan check fee 25% of above.
PERMIT ISSUING FEE '7 Q
TOTAL FEE
PLAN CHECK PLI
NAME
ADDRESS UA-Y%:5
CITY
IHEREBY ACKNOWLEDGE THATTI
I HAVE READ THIS APPUCAON AND
STATE THAT THE ABOVE LS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING. HEATING, VENTILATING, NR
CONDITIONING.
I HEREBY CER THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE IILSPECTOR'S SFGNATURL
CHAPTER 9, DMS OF THE ESS AND PROFESSIONAL CODE ROUGH
OF THE STATE OF ORNU.
6lONATURE FINAL
O P PE RIA rr_
PLAN CHE VALIDATION CK. M-0. CAsr� PERMIT VALIDATION Y.O. CASH
C O M ;�WSA U R p
5 8 W-1"V[4 13.0 4.4, C1 .0 0
-�. ,[-<<,V H01-DER. - . .