HomeMy Public PortalAbout5139 GOLDEN WEST AVE_Mechanical__ 76A364C ♦ ,
CE-e,e(REV 676) APPLICATION FOR PERMIT '
HEATING - VENTILATING.'- AIR CONDITIONING
COUNTY OF LOS ANGELES ' BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
• DDRES
(PRINT OR TYPE ONLY) A
_ - LOCALITY �
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
a NEARESTA
` CROSS`ST .�
ABSORPTION UNIT,BTU -
AIR HANDLING UNIT,CFM OWNER
MAIL
ADDRESS „
BOILER,BTU "'
CITY TEL NO _
COMPRESSOR,BTU o_- ID CONTRACTOR ,
VENTILATION SYSTEM
ADDRESS
EVAPORATIVE COOLER . , CITY' TEL NO FURNA '
LIl
FLOORCE FAU BTU'GRAVITY - �1 LICSTATEENS O_-2 ( •,CLASS �26
HEATER SUSPENDED- UNIT= APPROVALS DATE INSPECTOR SSIGNATURE
WALL
ROUGH o _
FINAL6 d IC'V V L.�f ,/+,,%'L� A
INSPECTION RECORD V
®C
Plan check fee.25% of above 9
PERMIT ISSUING FEE$ 7 Z'`
TOTAL FEE Li
PLAN CHECK APPLICANT : PLAN CHECKYALIDATION ,
NAME NJ
ADDRESS s ' . ' ,
CITY '' 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, VENTILATING, AIR
CONDITIONING PERMIT•VALIDATION
I HEREBY CERTIFY THAT I AM NOT' ACTING IN- VIOLATION OF ,• -' 5 3 a 7'-A
CHAPTER 9 DIVISION 3 F THE BUSINESS AND PROFESSIONAL CODE '
OF THE STATE OF CALIF;7A •�
SIGNATURE # O.O O o'4 1
OF PERMITTEE '• , 1 - 7,O O ,
O O.'
DISTRICT NO PROCE BY
;o.o o 27.00
0 7.''1 V-79