HomeMy Public PortalAbout9471 OLEMA ST_Mechanical__ 76 A364- CE 818-1/75
APPLICATION FOR PERMIT
r HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY.
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAI L
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
u•� CITY TEL. NO.
FORCE AIR FURNACE, BTU Ably r
CONTRACTOR
COMPRESSOR, BTU /
ADDRESS
VENTILATION FAN f
CITY / TEL. ,�" 7
LIST ALL OTHERS BELOW STATELICE SE NO!/�5<?/ CLASS
DISTR_ICT NO. GROUP ZONE PRO SED BY
INSPECTION RECORD
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Plan check fee. See reverse. z
PER111T ISSUING FI:L: S QJ
11 I'OTAI. Fl,'-I-:
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY. TE -4'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCESAND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE -�
LATING. AIR CONDITIONING.
ROUGH
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, 0 THE BUS I!!5 S AND PRO ESSIONAL FINAL
CODE OF THE STATE OF CA NIA.
SIGNATURE / PERMIT VALIDATION C . M.O. CA
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
'7 3 t).NA.gpY 6 4 11
1 2.v 0 ��
76 A364- CE BIB- 543 `
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING �4/-7/ O G
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. 014A4
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAI L
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM `
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ADDRESS .4�aff G+ 7W
BOILER, BTU CITY r �! TEL. N0,_7
COMPRESSOR, BTU STATE LIC.
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PRO SSED BY
EVAPORATIVE COOLER
FURNACE: FAU_GRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDE UNI
WALL �.
CL.
C7
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O
F-
V
t, W
9'+ N
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE $ 3 00
TOTAL FEE Q
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO. Yl
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 t
I HEREBY CERTIFY THAT I AM NOT A TING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE USIN AND P FESSIONAL FINAL
CODE OF THE STATE OF A IF
SIGNATURE PERMIT VALIDATION cK. ' M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
el-
`4 5 .9rAPR 10 41 U 8.0 A98
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE