HomeMy Public PortalAbout10114 RANDWICK DR_Mechanical__ 7GA364E ICE-81 BA)-9/77 APPLICATION FOR PERMIT
HEATING - NTILATING - A R,C N®ITIONING
COU OF LOS ANGE
DEPARTM T OF COUNTY GINEER
BUILDING AND SAFETY VISION
FOR APPLICANT TO FILL INBUILDING' 1014 Q� DR.OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE .
NEAREST
CROSS ST. '
ABSORPTION UNIT,BTU
OWNER lel Lvr.`Ir�DT SIMNM
AIR HANDLING UNIT,CFM MAIL
ADDRESS SANE
BOILER,BTU CITYTEEM clu�1+p�1�T�+ TEL.NO.
1 COMPRESSOR,BTU3 BP CONTRACTOR �.1�[•M HCC'
VENTILATION SYSTEM ADDRESS 2034 N. PECK M.
EVAPORATIVE COOLER CITY NpNmTEL.NO.
FURNACE: FAU_GRAVITY STATE LIC.
FLOOR BTU LICENSE NO. CLASS
HEATER: SUSPENDED UNIT- DISTRICT NO. GROUP I ZONE 'SED BY
WALL
INSPECTION RECORD
V
Plan check 9
fee 25%of above. W
PERMIT ISSUING FEE$ 7 00 a
TOTAL FEE00
—
.PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
IHEREBY 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, VENTILATING, AIR
CONDITIONING.
I HEREBY CERTIFY THAT I AM N T ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION OF TH BU E AN PROFESSIONAL CODE ; ROUGH
OF THE STATE OF CAL R IA
SIGNATURE FINAL �� J
OF PERMITTE r`
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH
WORKERS COMPENSATION
01 4 tiAPR 1.9 41 D' 1' .0 0 A
76 A364- CE 616-1/7S
APPLI ION FOR PER T
HEATING - VENTILATING - AIR ONOITIONING
COUNTY OF LOS ANGELES BUILDINGDEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION ;LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER plop.
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
FORCE AIR FURNACE, BTU
0 .Q CITY TEL. NO.
CONTRACT
COMPRESSOR, BTU
ADDRESS
VENTILATION FAN CITY OQ-? TEL. NO. 2/
LIST ALL OTHERS BELOW STATE LIC.
LICENSE N 'pt CLA
DISTRICT NO. GROUPONE PRO SSED BY
09
-r i
INSPECTION RECORD
IL
O
U
O
F-
U
W
0_
N
Plan check fee. See reverse.
Z
PF.1i111'I' ItiSI 1\(: F'L:I: S 3 00
TOTAI, FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CI TY TEL.NO,
1 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
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3 F THE BUSINE§AANDAROFESS NAL FINAL
CODE OF THE STAT IFORNI
L�01FCNAT URE PERMIT VALIDATION CK, M.O. CASH
PERMITTE
PLAN CHECK VALIDATION CK. M.O. CASH
5 4 9t"-'JUL 214 1 D 8.0 0—