Loading...
HomeMy WebLinkAbout3781A76A364C CE-818(REV. 6/781, ©= APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS / (PRINT OR TYPE ONLYI LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE r 12- NEAREST CROSS ST. ABSORPTION UNIT, BTU OWNER AIR HANDLING UNIT, CFM MAIL ADDRESS BOILER, BTU CITY TEL. NO. COMPRESSOR, BTU CONTRACTOR, / VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER CITY TEL. NO. FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU LICENSE NO. CLASS HEATER: SUSPENDED UNIT ALL _ APPROVALS / D,ATE �, INSPECTS 'S SIGNATURE 190016 /.�,�ru �0 00 ROUGH FINAL 2 ( ®f.��,> 4 [� ?S L INSPEC ION RiECORD Plan check fee 25% of above. PERMIT ISSUING FEE $ TOTAL FEE' PLAN CHECK APPLICANT PLAN CHECK VALIDATION t[ ME 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, VENTILATING, AIR CONDITIONING, PERMIT VALIDATION I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE OF THE STATE OF CALIFORNIA. " SIGNATURE OF PERMITTEE - DISTRICT NO. PROCESSED BY f 5 ,��� I ZJ rd 7E WORKER'S COMPEFNMAt9 ON CER It=lCAiION I cet'tuv that 1 will be rmimnsan'o for file mril to I)n. under this permit and that, in the Iparfamnar,u of the wrd( €or which this permit is issue¢. I shall not emploq anr parson in r u so as to beeeme subject to file 1No bar's Compensation laws of cclifornia. I further comity that if Bring fhe c,,,, et rorr,I*tic?ion under this permit I should he^c �,;r.c._ o 4Varkei t-c �,-y�o; :ion rsmuiramnnts, I will file Use requi '! eerdlicate. of r^olfeo that iaHura to do so will neeas i'.,,ir au;pcn.-,ien of ti•.e pr.rtni!. I P.aJa roelhwd an explanation of the. iisaits and conditions of this certificate still have road and fully and rstand 11 um Signature :,:e��-•(�/ L� �.- ✓�-?,,�' „e,�,.,.,,�, Title 4; L�1 RI®tn —S