HomeMy Public PortalAbout10601 LOWER AZUSA RD_Mechanical__ 76 A364- c•E ala - APPLICATJON FOR PERMIT.
HEATING
HEATING VENTILATING..=,AIR CONDITIONING
COUNTY OF LOS ANGELES" BUILDING /® a2
DEPARTMENT OF COUNTY ENGINEER' ADDRESS- (�
BUILDING AND SAFETY DIVISION LOCALITY ,
NEA
R EST
CROSS ST.
FOR APPLICANT-TO,FILL' IN : OWNER —
'� t.
`(PRIN•T�OR TYPE ONLY.). - � �
MAIL ..
�N'o. TYPE OF'APPLIANCE-OR EQUIPMENT FEE ADDRESS jy CITTEL. NO. 110eABSORPTI.ON UNIT, B"TLl
CONTRACTORAIR HANDLING UNIT, CFM ADDRESS41BOILER, BTU ,�/CITY TEL. NO.:, !CQMPRESSOR, BT.0 STATE• � LICLICENSE NO. p)-9 7).T CLASS "'
ENTILATION'SYSTEM 6 DISTRICT NO: GROUP ZONE P OCESS B
EVAPORATIVE COOLERCD
FURNACE': FAU_GRAVITY
- INSPECTION RECORD
FLOOR- BT'U ..
HEATER:',•SUSPE'NDED UNIT_ o
WALL'
w
N
z
`Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE $
TOTAL FEE
PLAN CHECK APPLICANT.
NAME
ADDRESS 4 vflu� ri-L . ,
C1-TY J' N TEL.NO'.`
I.HEREBY ACKNOWLEDGE.'THAT IHAVE READ THIS APPLICATION -
-AND STATE. THAT.THE.ABOVE,IS CORRECT AND AGREE TO COMPLY-
r.WITH ALL ORDINANCES AND YAWS.REGULATING HEATING',MENTI- APPROVALS DATE i PECTOR'S. GNATURE
LA,TING, AIR'.CONDITIONING. w - .
ROUGH
+b HEREBY CERTIFY. THAT I AM.. NOT ACTING IN VIOLATION
-.OF CHAPTER 9, OIVLSI 3, OF-THE BUSINESS-AND PROFESSIONAL .FINAL
-CODE OF T HE STATE O ALIF IA
SIGNATURE .,. PERMIT (DATION CK. M.0. casH
OF'PERMITTEE -
PLAN' CHECK VALIDA 1 N CK: -M.O. CASH
ISEE BACK OF APPLICATION FOR_COMPLETE_FEE SCHEDULE - :
76 A364 -'CE 81,8 - 9-71
APPLICATION FOR PERMIT
HEATING - VENTILATING.- AIR CONDITIONING
COUNTY OF LOS.ANGELES' BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING'AND..SAFETY DIVISION LOCALITY .�
NEAREST
CROSS S :
T 4
FOR APPLICANT TO FILL-7N - p
... :: (PRINT OR.TYPE ONLY), OWNER' ZG-!_ Z .'6LC-/�Gf�J•� -
MAIL
N O'. TYPE OFAPPL.IANCEOR EQUIPMENT FEE ADDRESS ''�Of/d/�lY�/. 441
CITY TEL. NO.
�. .c( /f�! T .F,0�d Lir y
ABSO; I IT, BT ,� `
CONTRACTOR
AIR HANDLING UNIT, C M
ADDRESS -O U -woa/
BOILER, BTU
CITY-1
ITY GiN/t/IJ /G' TEL. NK.
n�
COMPRESSOR, BTU STATELIC: o
LICENSE NO.47�J1� CLAS
VNT, S
EI LA SYSTEM DISTRICT NO. . GROUP ZONE' PRO ESS ED BY
EVAPORATIVE COOLER
FURNACE:. FAU GRAVITYCD
FLOOR BTU 170, q," ?_ -,� INSPECTION RECORD' c�
HEATER:;SUSPENDED, UNIT_ O
WALL W
rL
N
- Z
Plan check'fee.25% 'of above. See reverse.
PERMIT ISSUING FEE'S 3 00
TOTAL FEE t`
PLAN CHECK,APPLI'CANT
NAME
ADDRESS
CITY TEL.NO.
I,HEREBY AC KNOW L'EDGE•THAT'.I.HAVE READ THIS.APPLICATION
AND STATE THAT THE A BOV E IS CORRECT AND AGREE TO COMPLY -
WIT ALL:-ORDINANCES AND,LAWS REGULATING HEATING, VENTI- 'APPROVALS - - DATE - i TOR'S SIGNATURE
LA,TING, AIR CONDITIONINGLYH,,A
- - -
ROUGH
i I HEREBY- CERT Y1AM _ ACTNGIN VIOLATION
OF°CHAPTER' 9,-,DIVIOFTHE B -NESS AND PROFESSIONAL FINAL{ODE OF THE STATEFOR.NIA.SIGNATURE PERMIT-VALIDATION -- crc: M.0; CASHOF .PERMITTEEO - -
PLAN, CHECK VALIDATIO CK. M.O. CASH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE