HomeMy Public PortalAbout5314 PERSIMMON AVE_Mechanical__ 7+ A3.W-,brAE yL8 - 9-71 e l
APP ATION FOR RMIT
• HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FAD7DRESSMIA,.-
DEPARTMENT OF COUNTY ENGINEER F._
BUILDING AND SAFETY DIVISION IL
FOR APPLICANT TO FILL IN OWNER JC>Ht4 R. C,qpp-f��
(PRINT OR TYPE ONLY)
pS
MAIL
' NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS A- I-4- PER-St
CITYV TEL. NO. Z I
ABSORPTION UNIT, BTU
CONTRACTOR --
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED 13Y
EVAPORATIVE COOLER
FURNACE: FAU' GRAVITY
FLOOR BTU DO U INSPECTION RECORD v
HEATER: SUSPENDED UNIT_ CD
WALL w
a.
Z
Plan check fee 25"c of above. See reverse.
PERIIIT ISSUI\G FEE S 3 00
TOTAL FEE d
PLAN CHECK APPLICANT
NAME t—_AA_21q MAL
ADDRESS
CITY TEL.NO.
k. 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
i'. LATING,AIR CONDITIONING.
ROUGH '�P ✓~r
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
CHry
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL L�--Z7 71S
CODE OF THE STATE OF CA IFOR NI A. --
OF PERMITSIGNATURE:TEE ' PERMIT VALIDATION CK. \ M.O. CASH
PLAN CHECK V LIDATION CK. M.O. CASH
�la,
CQ
.a?3, VA 14 4 1 D 8.0 0
iEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
6A364 - CE@IB 3-69 �� 4�-��
APPLICATION OR PE MIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING � - � O
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY CSC
,;OLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY) OWNER
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
{
ABSORPTION SYSTEM, BTU CITY TEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEPOWER r ADDRESS y
45 CITY �¢��!i(/GL r TEL. NO.pf7 •/
COMPRESSOR, HORSEPOWER STATEJ
LICENSE N0./ �D�s� CLASS
VENTILATION SYSTEM DISTRICT NO. GROUPZONE PROCESSED BY
EVAPORATIVE COOLER /J/ Fee=--
1
FURNACE: FAU GRAVITY L/ /�
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL
i
c
F
t
L
c
c
NEW—ADDITION— PERMIT $ 3 00 s
ALTER--REPAIR_ TOTAL FEE $ O `/
PLAN CHECK APPLICANT y
NAME C�e-foe
ADDRESS
r
CITY C TEL. N v
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 HEATING,VENTI- APPROVALS DATE I ECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINALof
CODE OF TH STATE OF RNIA.
SIGNATUREJACK R. ALLEN, SUPERVI MEC ANICAL ENG'R.
OF PERMITTE � �`�
_ PERMIT VALIDATION cK. M.O. CASH
"PLAN CHECK VAL TION
LPEO 2 2 6 .3-6-4 SEP 7 4 1 D 1 0.5 0~ c4
rEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE