HomeMy Public PortalAbout5731 LOMA AVE_Mechanical__ C
743 A364 CE 818 - 9-71 p�Opg10N FOR PER
BEATING - VENTILATING.- AIR CONDITIONING
.41
COUNTY OF LOS ANGELES BUILDING -
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALIT
NEAREST
�:. CROSS ST.
s
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) _
MAI L
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS. Jpe - s
CIT TEL. NO.
ABSORPTION UNIT, BTU
CONTRACT R
AIR HANDLING UNIT,'CFM
ADDRESS
BOILER, BTU CIT TEL. NO .11, 71/601
COMPRESSOR, BTU-3,e '-- �j� STATE
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE ( CESSED BY
EVAPORATIVE COOLER �45
FURNACE: FAU_GRAVITYINSPECTION RECORD �
FLOOR--BTU —
HEATER: SUSPENDED UNIT_ C:)
WALL w
d
Z
Plan check fee 25% of above. See reverse.
PER\91T ISSUING FEF. S 3 00
TOTAL FEE 3
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 ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPE TOR'S SIGNATURE
LATI NG, AIR CONDITIONING.
ROUGH / r
b HEREBY CERTIFY THAT I AM NOT ACTING_'N VIOLATION r
OF CHAPTER 9, DIVISION 3 OF THE BUSINESS AN OF SINA L FINAL - - •ro �-' .r ,, ="
CODE OF THE STATE OF FOR I +
SIGNATURE PERMIT VALIDATI N CK. M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH -
5.5:,3U6'.: 5 4:1. 8. 1 3.0,0 � 3
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE