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761664-CE818-1/70 , APPLICATION FOR PERMIT �fll /�11^1111
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' HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES ADDRESS P Z L% •G�it�� <
DEPARTMENT OF COUNTY ENGINEER T
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING NEAREST
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CROSS ST JfT
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
NO TYPE OFAPPLIANCE OR EQUIPMENT FEE
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CITY GF C` EL NO
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CONTRACTOR
AIR HANDLING'UNIT, CFM �
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BOILER, HORSEPOWER
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COMPRESSOR, HORSEPOWER STATE rr�� LIC
LICENSE NO J CLASS
VENTILATION SYSTEM DISTRICT NO
CLASS -G RRO-U-P' ZONE PROCESSED BY
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NEW_ADDITION PERMIT $ 3 00 N
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ALTER_REPAIR_ TOTAL FEE $
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 DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING ,
" ROUGH
I HEREBY CERTIFY TH I AM NOT ACTI N VIOLATION
OF CHAPTER 9, DIVISION O THE BUSINESS ND ROFESSIONAL FINAL
CODE OF THE STATE OF OR NIA
SIGNATURE /�/ JACK R ALLEN,SUPERVI G /E ANICAL ENG'R
OF PERMITTEE
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION
2 NOV 2 4 1 D 8.0 0"
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE I
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1405280011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID FEES PAID BUILDING ADDRESS
ITR 13329 LT 41 UN 002 1 I 5021 CLOVERLY AV 1
I 1FEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917803813 1
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET LA ROSA
18590-022-025 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY CAI
1 102 COMPRSR < 100 KBTU 1 00 COM 27 00 1
ITENANT 108 FURNACE/HEATER <100 1 00 UNI 27 00 ITSSUED ON PROCESSED BY PLAN BY 1
130 AIR INLETS/OUTLETS 20 00 UNI 88 00 105/28/14 SR
132 APPL VENT (OTHER) 1 00 UNI 12 90 1
(OWNER TEL NO 141 VENTILATION FAN 3 00 FAN 47 40 1FINAL DATE FI Y CODE I
1CHEN, HENRY J (818) 286-3236- 1 TOTAL FEES 230 10 1 Y 1
15021 CLOVERLY AV I
ITEMP 917803813 1 IDD S�TION OF WORK 1
1 IINSTALL A/C AND HEATING SYSTEM, 20 AIR INLETS, 1 APPLIANCE 1
1 IVENT AND 3 VENTILATION FANS
(APPLICANT TEL NO 1 I 1
ICHEN HENRY J (626) 864-7919- 1
15021 CLOVERLY AVE I ISPECIAL CONDITIONS 1
1TEMPLE CITY CA 91780 1
1CONTRACTOR TEL NO 1
APPROVALS DATE INSPECTOR SIGNATURE
IEVERGREEN CONSTRUCTION AND REMODELI (213) S05-3293- 1
13 SAGE CANYON ROAD LIC NO 1 1FAU/WALL FURNACE I
IPOMONA CA 91766 946278 1 11
1 1COMBUSTION AIR OPENINGS 1
(ARCHITECT OR ENGINEER TEL NO 1 1DUC1 WORK I
LIC NO I JAC/COMPRESSOR 1
ITHERMOSTAT 1
IFIRE DAMPERS 1
ISMOKE DETECTION DEVICES I I 1
1 1COMMERCIAL HOOD I I
1 1 I I i I
1 1 I I I I
I I I I I I
1 I I I I I
I I I I I I
I I I I I I
1 I I I I I
I I I I I I
IREPORT ID DPR264 ROUTE TO BS0508 1 1
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