HomeMy Public PortalAbout10800 DAINES DR_Mechanical__ 76 A364- CE 818'- 5�73
APPLICATION FOR PERMIT
r HEATING - VENTILATING - AIR CONDITIONING
f.
COUNTY OF LOS ANGELES BUILDING O[0C> 'n
DEPARTMENT OF COUNTY ENGINEER ADDRESS d8��--'' cs De.
BUILDING AND SAFETY DIVISION LOCALITYmOl.r C1'
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER ` MOR
(PRINT OR TYPE ONLY) n n G • ORAS 05
MAlL `
No. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS Jcc-Ono A LIE
CITY aF TEL. NO. 4ily6 ./1
Lel
ABSORPTION UNIT, BTU
CONTRACTOR LSn
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU
- CITY _ - TEL. NO.3351-30-35
COMPRESSOR, BTU STATE LIC. U_ I
LICENSE NO. CLASS u
VENTILATION SYSTEM DISTRICT NO. GROUP - ZONE PROCESSED BY
EVAPORATIVE COOLER �..8
FURNAC : FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED—UNIT_
WALL
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0.
O
U
O
I W
0.
N
PIUn bheck fee 25> of above. See reverse.
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PERMIT ISSUING FEE S 3 00
.1'0TA L, FEE
PLAN CHECK APPLICANT
NAME Von PA In ILk
ADDRESS'S ai-) CC0 c - -
CITY 41&�='iA TEL.NO,
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALLORDINANCES AND LAWS REGULATING HEATING, VENTIy APPROVALS, DATE INSPECTOR'S SIGNATURE
LATING,.AIR CONDITIONING,
ROUGH p/i
HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION "
OF CHAPTER 9, DIVISION 3, OF TME USINESS AND PROFESSIONAL FINAL ^7 N
CODE OF THE STATE ALIFORNI
OF PE u IT D�l_ � PERMIT VALIDATION CASH
OF PERMITTEE n
PLAN CHECK VALIDATION CK. M.O. CASH
97 9nN'UY 29 '4..1 D 8.0 0 A98
SEE BACK OF APPLICATION FOR COM PLETE FEE SCHEDULE `/��