HomeMy Public PortalAbout5827-5827 1/2-5729TEMPLE CITY BLVD_Mechanical (2) 76 A364- CE 818- 5-73
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FADDRESS ( S
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ITYSTST.
FOR APPLICANT TO FILL IN OWNER r-
(PRINT OR TYPE ONLY)
MAI L
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS r
CITY +.,�+;' .. r"✓ f.r TEL. NO.
ABSORPTION UNIT, BTU /
CONTRACTOR ' S
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY T_�.� TEL. NO
COMPRESSOR, BTU `$ ! STATE LIC.
f LICENSE NO. tv? } CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER r
FURNACE: FAU GRAV.JjY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT_ o
WALL c�
r
CD
Plan check fee 25% of above. See reverse. w
PERMIT ISSI'ING FEE 8 3 00
TOTAL FEE 0
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 ALLORDINANCES 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, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PERMIT VALIDATION CK. M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. .'M.0. CASH
,o. ✓ 4
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEnIILF