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76A364 j_CED.C1-li7o APPLICATION FOR PERMI
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HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES rADDRESS_ & o/Q
�D pNDEPARTMENT OF COUNTY ENGINEER ABUILDING AND SAFETY DIVISION Y JOHN A LAMBIE COUNTY ENGINEER
COLEMANW JENKINS SUPERINTENDENTOFBUILDING
FOR APPLICANT TO FILL IN OWNER [Z S MR(9 7-
(PRINT OR TYPE ONLY) MAI L
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NO TYPE OFAPPLIANCE OR EQUIPMENT FEE
ADDRESS LOO1 Ho A NES (l�V e
ABSORPTION SYSTEM BTU CITY ret.,,PL2, r1 Y TEL NOa62- 7 J J-4
CONTRACTOR,3 R-IS ON P)1 2 Ga+�0
AIR HANDLING UNIT CFM
ADDRESS 6'30 93 r E p N o P L
BOILER HORSEPOWER
CITY 60-q I N A TEL NO-37347,6-31a
COMPRESSOR HORSEPOWER ✓� STATE LIC
LICENSE NO 6110 -' 'q Gd CLASS :)I0
VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER �♦ I/ if/
FURNACE FAUGRAVITY INSPECTION RECORD
FLOOR BTU/0QQ0 G
HEATER SUSPENDED UNIT_
WALL
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NEW—ADDITION— PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE S OV s
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 DAT INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
ROUGH
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CA IFORNIA
SIGNATURE , ' 1, JACK R ALLEN, RrcK)
CHANICAL ENG R
OF PERMITTEE v✓-w
PERMIT VALID mo CASH
PLAN CHECK VA DATION
0SEELAUo 4 ^ 'APR 14 4. 1 D 1 3 00--
SEE
BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE a r
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1308140033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
ILEGAL ID I FEES PAID BUILDING ADDRESS 1
ITR 6561 LT 50 UN 002 I 1 6018 AGNES AV 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917801707 1
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
I
15385 028 016 101 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY CAI
102 CON-RSR < 100 KBTU 1 00 COM 27 00 1 1
ITENANT 108 FURNACE/HEATER <100 1 00 UNI 27 00 (ISSUED ON PROCESSED BY PLAN BY 1
130 AIR INLETS/OUTLETS 8 00 UNI 35 20 108/14/13 SR 1
141 VENTILATION FAN 1 00 FAN 15 80 1
1OWNER TEL NO I TOTAL FEES 132 80 IFINAL DATE FIN�L CODE 1
KHAN SAM (626) 665 3557
1
16018 AGNES AV
ITEMP 917801707 IDPESCRIPTION OF WORK \
(INSTALL A/C AND HEATING SYSTEM 8 AIR INLETS AND 1 VENTILAT11
ION FAN I
(APPLICANT TEL NO
IMIU HONG (626) 675 6692
11809 S MONTEREY ST 1 ISPECIAL CONDITIONS 1 -
1ALHAMBRA CTS 91801 1
ICONTRACTOR TEL NO 1APPROVALS DATE INSPECTOR SIGNATURE
IMIU CONSTRUCTION INC (626) 675 6692 1
11809 S MONTEREY ST LIC NO 1 IFAU/WALL FURNACE I 1
1ALHAMBRA CA 91801 938325 1 1 �I�1
1 1 1COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER TEL NO IDUCP WORK I
IWU HAROLD P (626) 288 0708 1 !
11168 SAN GABRIEL BLVD LIC NO 1 IAC/COMPRESSOR
ISUITE N 938325 I I
IROSEMEAD CA 91770 ITHERMOSTAT
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IFIR. DAMPERS
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ISMOKE DETECTION DEVICES I
COMIdERCIAL HOOD
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1 * ADDITIONAL DATA ON FILE
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IREPORT ID DPR264 ROUTE TO BS0508 1
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