HomeMy Public PortalAbout6012 KAUFFMAN AVE_Mechanical__ 76.A 364,E CE 818-1/76 ••
APPLICATION FOR PERMIT'
1
HEATING*- VENTILATING '- AIR CONDITIONING
COUNTY OF-LOS ANGELES ADDRESS/ ,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY, G1
NEAREST
CROSS ST. '
FOR APPLICANT TO FILL IN.
" (PRINT OR TYPE ONLY) - OWNER
MAIL w -
NO
TYPE'&SIZE OF EQUIPMENT FEE ADDRESS ,
_ SEE BACK OF APPLICATION
CITY TEL. NO,/f
FORCE AIR.FURNACE, BTU v��
CONTRACTOR
COMPRESSOR, BTU
.ADDRESS
VENTILATION FAN CITY TEL. NO.
'LIST ALL`OTH RS BELOW STATE LIC.
LICENSE NO. CLASS
DISTRICT NO. GROUP,' ZONE PROCESSED BY ,
O.
INSPECTION RECORD
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Lu
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Plan check fee. See reverse. - `z
f'I IiVI'f I,tiSt;IN FEI': c
I'O.TA 1, F E El 00
PLAN CHECK APPLICANT
NAME
A DDRESS
CITY T,EL.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 R E GULATING •HEATING, VENTI- APPROVALS DATE INSPECTOR'SSIGNATURE
LATING, AIR CONDITIONING. '
ROUGH aQ-7 --- .
I •HEREBY CERTIFY THAT I AM- NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISIO 3, OF THE BU NESS AND PROFESSIONAL : FINAL ��' '�! / "
CODE OF THE STATE OF C LIF NIA - • •
SIGNATURE PERMIT VALIDATION fK, M•0 ,•CASH -:.OF PERMITTEE—
,PLAN CHECK VALIDATION CK. M.O. . CASH ;
50 6 I0V GJ 4,1 ;: � 1'71
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