HomeMy Public PortalAbout6047 GOLDEN WEST AVE_Mechanical__ 76 A364 -,CE 8I8-1/76 -
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING .
:�o�7
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS - �d
BUILDING AND SAFETY DIVISION. LOCALITY Arcadia CA
NEAREST
CROSS ST Longden ,
FOR APPLICANT TO FILL IN OWNER
(PMAIL(PRINT OR TYPE ONLY) ,. Ray Johnston
i
NO TYPE&SIZE OF,EQUIPMENT FEE ADDRESS �2g—ZaSLe� � _ T�mpl e C I t
SEE BACK OF APPLICATION,
CIT_ Y, TEL. NO. 1.1, _ 82
FORCE AIR FURNACE, BTU _88-0A0 44
J CONTRACTOR E. pAyNECoMpANy _
COMPRESSOR, BTU :
ADDRESS
166 W';'. u ve- Oak Ave:
VENTILATION FAN CITY TEL. NO ,
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO. j gn 7A CLASS. -
DISTRICT NO 'GROUP ZONE SS ED BY
Ds '�_
INSPECTION RECORD
- - O
U.
• O
-" - - - - - W
0-
Plan check fee. See reverse.
10 I'•11. I-L• I': $12 00
PLAN CHECK'APPLICANT
NAME
ADDRESS
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, 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 -3,7
CODE OF THE STATE OF CALIFORNIA '
SIGNATURE - "" PERMIT VALIDATION CK ' M O CASH
OF PERMITTEE
PLAN CHEC ALIDATION CK M O CASH A
9,6 5'r`_'I0FC' :30*a 1""0 _,1 2.0 0 �'.