HomeMy Public PortalAbout5520 TEMPLE CITY BLVD_Mechanical__ ,6A 4E ICE slam 11/96 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER `• ,
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
NO TYPE OF APPLIANCE OR EOUIPM ENT FEE LOCALITY
NEAREST
�f CROSS ST
ABSORPTION UNIT BTU '^ � -
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS e. 1
BOILER BTU CITY'reVK /o• TEL NO
lil t
COMPRESSOR BTU CONTRACTOR E oat
VENTILATION SYSTEM ADDRESS V
EVAPORATIVE COOLER CITY TEL NO %LE
FURNACE FAU_GRAVITY LSTATE G O� LIC
FLOOR BTU LICENSE NO CLASS
HEATER SUSPENDED—UNIT— DISTRICT NO GROUP TOME PflOC EO BY
WALL OU
INSPECTION RECORD 0
v
IN
F01-
Plan check fee 25% of above y
PERMIT ISSUING FEE;
TOTAL FEE —
PLAN CHECK APPLICANT
NAME �Ql
ADDRESS (a�fiI36 VN
CITY (••E TEL NO f
1 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 VENTILATING AIR
CONDITIONING
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF • APPAOVAES DATE INSPECTOR 5 SIGNA E
CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CAWEORNIA ROUGH
SIGNATURE FINAL
OF PERMITTE
AIH
,PLAN CHECK-VALIDATION CA MO GASH PERMIT VALIDATION cK mol I
WORKERS COtAPENSAT1ON
V y �L`Vlll,
e 5.:
POLICYHOLDER ,
POLICY NUMBER: [� ®'