HomeMy Public PortalAbout10243 RANDWICK DR_Mechanical__ 78 A3647��y^nE 818 — 9-71 APPLICATION FOR PERMIT
�01 HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELESBUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS ��7Z`J� plviGK x_
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. 41-/(;14 A1.4A)
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) "v� n rzl v A-L
MAIL {�
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS 11024 ,P AIRO-ICAC !/2'
CITY Qf� ej� TEL. NO. 411/* L6�Y
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 BY
EVAPORATIVE COOLER O ,?: c}..
FURNACE: FAU_GAAVITY
FLOOR BTU INSPECTION RECORD v
ed
HEATER: SUSPENDED UNIT_ '� �
WALL p7 w
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE 8 a oo
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
W
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION �,V
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE .t iINSPECT $,SIGNATURE
LATING,AIR CONDITIONING. ]
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS ID PROF SSIOI L FINAL -
CODE OF THE STATE OF I RNIA. I
SIGNATURE PE '1_T VALIDATION M.O. ASH•
OF PERMITTEE
PLAN CHECK VALIDATION CK. .O. CASH '
.1 9 8 1 JUL 2 4 1 D 8.Q Q N
REF RACK OF APPLICATION FOR COMPLETE FEE RCNFOIILF