HomeMy Public PortalAbout5341 GOLDEN WEST AVE_Mechanical__ 76 A364 -- CE 818 - 9 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY '
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER i.
(PRINT OR TYPE ONLY)
MAIL
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NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ,ty/ 7�
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACT R
AIR HANDLING UNIT, CFM
ADDRESS �r j
BOILER, BTU CITY r TEL. NO.
COMPRESSOR, BTU STAT LC
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE ,,, SSED BY y
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EVAPORATIVE COOLER ,.4'- r `t, ., I a......,,.�,- " w
FURNACE: FAU GRAVITY w
FLO�'JR BTU /y INSPECTION RECORD U—
HE4TER: SUSPENDED UNIT _
WALL
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Plan check fee 25% of above. See reverse,
PERMIT ISSI 1*\G FEE 3 00
1'01 \I. 1'F,F
PLAN CHECK APPLICANT
NAME
ADDRESS ; ? 7
CITY AA✓r TEL.N0.
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.
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.
41SIGNATURE i�
,/ PERMIT VALIDATION CK, M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
4
1 :2
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE