HomeMy Public PortalAbout5626 PERSIMMON AVE_Mechanical__ 76-A364 =CE 818' s-7i APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS 5C,2C, PL�CSI�n/►'aa^i Avg
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY �9�„� C/? 0AL-;F.
NEAREST
CROSS ST. pE)@5)mA-1VdV Qt I.l yA6 OAK
FOR APPLICANT TO FILL IN OWNER n h ,,/
(PRINT OR TYPE ONLY) MAIL u ONA4-b v VAi
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS &Z G A%,'E
CITY '. NM.p 1 •g C� TEL. NO.44�.0313
ABSORPTION UNIT, BTU / ,II b
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO.
GROUP ZONE CESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY v
FLOOR BTU �Q INSPECTION RECORD
HEATER: SUSPENDED UNIT_ CD
WALL Lu
00
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE $ a 00
TOTAL FEE Q
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 INSPECTOR'S SIGNATURE
EATING, AIR CONDITIONING. - C t
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE ST ALIFORNIA.
SIGNATURE '► PERMIT VALIDATION .CK. M.O. CASH
OF PERMITTE
PLAN CHECK VALIDATION CK. M.O. CASH
IN ,
.00NSL; C0 () 7 1 * JAN 2 4 4 1 D 8.00—
SEE
EE BACK OF APPLICATION FOR COM PLFFTE FEE SCHEDULE
'15 A•964' CE 818- 5-73
APPLICA ION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING >{
DEPARTMENT OF COUNTY ENGINEER ADDRESS G '-b f ✓ ' ��I�• s'4� /"7 W
BUILDING AND SAFETY,DIVISION LOCALITY ��/�` �� (� �
NEAREST
CROSS ST. �,J V6- O �<
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) d12,yy A
MAIL
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS ��� O �✓�, jos y'
CITY i`ypy� G fir/TEL. NO.
ABSORPTION UNIT, BTU
il
CONTRACTOR �� Vic• � yo �
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU O Ov STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROLES ED BY
EVAPORATIVE COOLER9i� b
FURNACE: FAU_GRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL
a
0
v
0
U
W
CL
h
Plan check fee 25% of above. See reverse. z
PERMIT ISSUING FEE 3 3 00
TOTAL FEE �d
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
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
LATING,AIR CONDITIONING. ,
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL �'/�i '� '' Y ,F�/ ✓
CODE OF THE STATE OF CALIFORNIA. v
SIGNATURE PERMIT VALIDATION CK. M.O."', CASH
OF PERMITTEE e
PLAN CHECK VALIDATION CK._ M.O. CASH
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