HomeMy Public PortalAbout5433 PERSIMMON AVE_Mechanical__ SA354_CE9.ta_a_aa APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR ZONOIT NING
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- COUNTY OF-LOS ANGELES '
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAbDRESS
_�
JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGFOR APPLICANT TO FILL IN / / RiTiJ"G'E
(Print or type only)
OWNER
No.. TYPEJOF APPLIANCE OR EQUIPMENT FEE MAIL �1_
ADDRESS 11�{
ABSORPTION SYSTEM, BTU CITY �� TEL. NO.
..r/
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEPOWER ADDRESSy j
COMPRESSOR, HORSEPOWER CITY 7— C.- TEL. NO.�;. p�C
STATE r r.i LIC.
VENTILATION SYSTEM LICENSE=NO. f Yl/ CLASS
DISTRICT NO. I GROUP -ZONE. PROCESSED BY.,
EVAPORATIVE COOLER �. Q /O
FURNACE: FAU sr GRAVITY 1�
FLOOR—BTUI INCT.ION R ORD
HEATER:.S.USPENDED ,UNIT
WALL
CD
C.')
CD
C13
V
' W
• CL.
• y
' Z
NEW_eADDITION PERMIT. $ 3 00
ALTER—REPAIR— - TOTAL FEE $ .lty
Plan check applicant
Name
Address
City Tel. No.
I HEREBY ACKNOWLEDGE THAT 1 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' IN PECTOR'S IGNATURE- _
LATING,•AIR CONDITIONING. -
ROUGH yv
-
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION FINAL
OF CHAPTER 9, DIVISIONS F THE BUSINESS AND PROFESSIONAL
2-71tcf KJ"
CODE OF THE STATE OF OR NIA.
JACK R. ALLEN,SUPER IS ECHANICAL ENG'RSIGNATURE .
OF PERMITTEE r --�—j -PERMIT VALIDATIO CK. M.O. CASH
PLAN CHECK VALIDATION
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
764A364-- EpE 818- 9-71 y .1
APPLICATION FOR PERMIT
_ e HEATING - VENTILATING - AIR CONOITIONI• G
COUNTY OF.LOS ANGELESBUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO: FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO: TYPE OFAPPLIANCE OR EQUIPMENT FEE;, ADDRESS
CITY IV EL. NO.
ABSORPTION.UNIT, BTU 4T 5 V -
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 BY
EVAPORATIVE COOLER
0 ( o}
FURNACE: FAU_GRAVITY111
• INSPECTION RECORD. •• �
FLOOR BTU U
HEATER: SUSPENDED UNIT_
WALL W
Lu
N
Plan check fee.25%of above. See.reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE
PLAN CHECK APPLICANT
.NAME P
ADDRESS
CITY TEL.NO.
IHEREBY ACKNOWLEDGE T T 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 IN j;ECTOR'S SIGNATURE
LATING,AIR CONDITIONING. �/
ROUGH Y'�/
I HEREBY •CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PERMIT VALIDATION ' CK. M.O. CASH
OF PERMITTEE r -
PLAN CHECK VALIDATION CK. M.O. • .CASH
LrtC�o 5 2.3 6—"' . 3 4 1 D .1 0.50 N
CCC PAPP OF APPI If_ATInN FOR rnm P1 FTF CFC Cf NFOIII F _ '