HomeMy Public PortalAbout9417 LA ROSA DR_Mechanical__ `. 70
76 A354 - Cr A18 -1/75 -
' APPLICATIO FOR PER
HEATING - VENTILATING. - AIR CONDITIONING
COUNTY OF LOS ANGELES AUUIL7NG.
DEPARTMENT OFCOUNTY ENGINEERBUILDING AND SAFETY DIVISION LOCA ' lN EARCROSr-lz
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) f
NO. TYPE&SIZE OF EQUIPMENT FEE MAIL -
SEE BACK OF APPLICATION ADDRESS ��„� QSC�
/ FORCE AIR FURNACE, BTU / Olaf a CITY le__ el;l TEL. NO.
CONTRACTOR l~ n °Lr+
COMPRESSOR, BTU
ADDRESS ----
VENTILATION FAN CITY TEL. NO.
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
DISTRICT NO. GROUP � NE ESSED BY
INSPECTIO RECORD
d
O
CL
Plan.check fee. See reverse. O MPII aI 2,-
IIERMIT 1,S,51I NG FEE 8 ky 'S-
I'0'1 /US —oocw6venL
PLAN CHECK APPLICANT
NAME O
ADDRESS 11
CITY' t TEL.NO, v�
I HEREBY ACKNOWLEDGE T AT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L
RDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS - DATE ECTORSIGNATURE
CONDITIONING.
ROUGH
Y CERTIFY THAT I AM NOT ACTING IN VIOLATION 9, DIVISION 3, OF THE BUSINESS AND PROF SIONAL FINAL.E STAT E aw
PERMIT VALIDATIONTTEE
PLAN CHECK VALIDATION CK. M.O. CASH
6 3 5:v'--ARR .13 4. 0 1.2.0 0