HomeMy Public PortalAbout10105 LA ROSA DR_Mechanical__ 76 A364 - CE 618-1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONINGCOUNTY OF LOS
UILDING
DEPARTMENT OF COUNTY'ENG NEER ELES FB
ESS L�
BUILDING AND SAFETY DIVISION LITY
S ST.
FOR APPLICANT TO FILL IN R Gy.�
(PRINT OR TYPE ONLY) F Flp,MAIL
NOTYPE&SIZE OF EQUIPMENT FEEESS /I� SP��}Al
SEE BACK OF APPLICATION
zO CITY DSC TEL. NO.
FORCE AIR FURNACE, BTU _-
/ J CONTRACTOR TV
COMPRESSOR, BTU �
ADDRESS
S q/
023„23 -/e er t
VENTILATION FAN �-/
CITY eLe 7 w1yf ATFL. N0. 333,-��/•DA9•r
LIST ALL OTHERS BELOW STA E LIC.
LICENSE NO. 'Z S—/LZJ� CLASS 0-2-0
DISTRICT NO. GROUP ZONE I PROCESS D By
2/
INSPECTION RECORD
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Plan check fee` See reverse. z
PERMIT ISSI'ISC FEI.: S O
PLAN CHECK AP`,
PLICANT -
NAME �IGy S�eeT�y 12;?Z_!/f
ADDRESS a3a3 ^)7' l... /� � •]jam
CITY >E/�C�ea A .�. C TEL.NO.333-7.29
IHEREBY 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, VENiI- APPROVALS DATE INSeECTOR'S SIGNATURE
LATING, AIR CONDIT I ON I N6.
j
HEREBY CERTIFY THAT AM NOT ACTING IN VIOLATION ROUGH
OF CNPPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CA IFOR NI A.
SIGNATURE n PERMIT VALIDATIO aK. M o. CASH
OF PERMITTEE_A,
�S—
PLAN CHECK VALIDATION CK. M.O. CASH
870-�acT3141D 23.25A�-d
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APPLICATION FO PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND FETY
FOR APPLICANT TO FILL IN - BUILDING
C
(PRINT OR TYPE ONLY( ADDRESS
LOC77.
ALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSSST.
ABSORPTION UNIT.BTU /
OWNER
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER.BTU CIT TEL.NO� p
i
COMPRESSOR.BTU CONTRAC OR
VENTILATION SYSTEM
ADDRESS Q
EVAPORATIVE COOLER CITY TEL.NO -,
FURNACE: FAU_GRAVITY STATE 7 LIC.
FLOOR BTU LICENSE NO. .S CLASS
HEATER: SUSPENDED_UNIT APPROVALS BATE INSPECTOR'5 SIGNATURE
WALL
ROUGH
FINAL Q-�7 79 �, O
INSPECTION RECORD V
Oi
0
Plan check fee 25% of above. y
PERMIT ISSUING FEE$ Z
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK �VALIDATION ,
NAME
ADDRESS
V
CITY TEL.NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL :2 5 1 Q 0 A
ORDINANCES AND LAWS REGULATING HEATING. VENTILATING. AIR
CONDITIONING. PERMIT VALIDATION # • •!• • 4 1 .
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9, DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE p
OF THE STATE OF CAL A. C - 27.00
SIGNATURE
OF PERMITTEE - 27005
°'STRI`T NO. `R By
0625-79
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