HomeMy Public PortalAbout5004 PAL MAL AVE_Mechanical__ 76A364C
CE 818(REV.11/78)
®: APPLICATM FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS �t
(PRINT OR TYPE ONLY)
LOCALITY CS
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE,
NEAREST 0
CROSS ST. __ Cyr
ABSORPTION UNIT,BTU -
OWNER
AIR HANDLING UNIT,CFM MAIL OR LJ i
ADDRESS
BOILER,BTU CITY TEL.NO
COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS C� iSPF/
EVAPORATIVE COOLER CITY" TEL.NO.FURNALL
/�pp /
FLOORCE: FAU BTU GRAVITY LICENSE NO (p d CLASS
HEATER: SUSPENDED UNIT APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
U ROUGH
2 J FINAL
INSPECTION RECORD
a
Plan check fee 25%of above. IL
tA
% PERMIT ISSUING FEE$ �
TOTAL FEE
PLAN CHECK APPLICANT .PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING VENTILATING, AIR
CONDITIONING. PERMIT VALIDATION --r679. 1
n
I HEREBY CERTIFY TH T I G IN VIGL�TION OF
CHAPTER 9, DIVI ES "Pi$OFESSIOM4L CODE # 0 0 0 0 �I
OF THE ST F I
O PERM EE 2 - 27.00
DISTRICT NO. PR SED BY p D D ( f (•
CC/ 2.0-79
r. ,. C G/
' 76'A364o- 091871/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS ®�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY I
NEAREST
CROSS.ST. Sf
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS Q�y -Al,
BACK OF APPLICATION
CITY 5 / TEL. NO. SC C2/�
FORCE AIR FURNACE, BTU L
�� CONTRACTORie&yx lm
COMPRESSOR, BTU 76-0
ADDRESS
VENTILATION FAN CITY ��� TEL. NO.t? _� �
LIST ALL OTHERS BELOW STATE17 ol // LIC. ,g
LICENSE NO. (O CLASS Iff— � .
DISTRICT NO. GROUP ZONE PROC
tJ`� •
SED BY
{ a 8 �r /CZO- /
.' INSPECTION RECOR
E.
O
U
O
F—
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Plan check fee. See reverse:
PEWNTIT ISSVING FETE S O
TOTAI,
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 A LAWS REGULATING,HEATING, VENTI- APPROVALS DATE INS TOR'S SIGNATURE
LATING,AIR COND ITIONIN '
ROUGH
I HEREBY CERTIFY AT 1 A NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISI OF TH BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE CALIF RNI
SIGNATURE PERMIT VALID.ATjQfiCK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATI N CK. M.O. CASH
8 2 7 r,'fJG! 27 4.1 D. 1 9.50 ®'