HomeMy Public PortalAbout5322-5326-5328-5330 VILLAGE CIRCLE DR_Mechanical__ 76 A364.� CE 818- 5-73
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDR SS 1 S3 �3zb 53Zg3-33
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALQ�
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN- OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS ZQQ
CITY
ABSORPTION UNIT, BTU
CONTRACTO r
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU _ CITY
TEL. NO. o7.
COMPRESSOR, BTU - '. OD STATE r q LIC.
LICENSE NO. / e1 / Z CLASS a0
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROC SSJ ED BY•
EVAPORATIVE C.O ER jr 0 6 apt) Yea—
FURNACE: FAU_GR r/ TY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL
0
v
CD
Luv
0-
' CL
_ N
Plan check fee 25%of above. See reverse.
PERMIT ISSUING FEES O
TOTAL-FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CI TY 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 INSPECTOR'S SIGNATURE
LATING,AIR CONDITIONING. )G
ROUGH• rf/G'7E-
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION J l 76'
OF•CHAPTER 9, DIVISION 3, OF THE BUST SS AND PROFESSIONAL FINAL -"
CODE OF THE STATE ALIFOR NI
SIGNATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMITTEE ,
.PLAN CHECK VALIDATION CK. M.O. CASH
1 5 .6.'a rF
11 41 D 6 4.5 0 a�Z