HomeMy Public PortalAbout5452 GOLDEN WEST AVE_Mechanical__r A 76, A.U4- CE 818-1/75 � II
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING L
'4ty of remiplF City IAO.02982
COUNTY OF LOS ANGELES FST.
NG
DEPARTMENT OF COUNTY ENGINEER SS
city
BUILDING AND SAFETY DIVISION ITY `� 7
yn
ST _
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL upowx5riV
TYPE&SIZE OF EQUIPMENT ADDRESS
NO. SEE BACK OF APPLICATION FEE
CITY TEL. NO.
FORCE AIR FURNACE, BTU
CONTRACTOR
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY EL. N .
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. '> CLASS !r
DISTRICT NO. GROUP ZONE PROCESSED BY
}
d
INSPECTION RECORD O
U
W
_ J
LL
}
O
CL
W
Plan check fee. See reverse. H
hl.li�irr l�sruc Hr:l:
�1, FFI:
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PZZ
ERMIT VALIDA I N CK. .o. cash
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CtvS+rlt A`
''.�] • Ci
-43
1'J