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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 5007 A-
BUILDING AND:SAFETY DIVISION LOCALITY IT
NEAREST
CROSS ST. pn
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) l,.oberte rim-r—iott
MAI L
NO. TYPE OFAPPLIANCE'OR EQUIPMENT FEE ADDRESS q027 X A'Td en
CITYTEL: NO.
ABSORPTION UNIT. BTU
�*$ 1rFiA
CONTRACTOR 1 m-i Andell Co.
AIR HANDLING UNIT, CFM
ADDRESS AaT
BOILER, BTU CITY San Ga Gabriel TEL:NO-f& 5203
COMPRESSOR, BTU STATE LIC
LICENSE NO. �iJjw CLASSCi
VENTILATION SYSTEM
- DISTRICT N0. -GROUP ZONE PROCESSED
EVAPORATIVE COOLER �� .. / f
FURNACE: FAUGRAVITY
FLOOR BTU INSPECTION RECORD
•-' HEATER: SUSPENDED UNIT_ o-
1 WALL CDC->
- w
heaterIrl
. � J
u-
360, 00 y. • Q
'LC
O
d
Plan check fee 255 of above. See reverse. w
F—
PER\4IT ISSUING FEE 8 3 00
TOTAL FEE Q
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 ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING. ,
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVIS ON 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE F.CAL FOR NIA. - "`±•
SI
GNAT URE
PERMIT VALIDATION CK. M.0. cnsH
PLAN CHECK VALIDATION CK. M.0. CASH
1
4 1
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE