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' 76 A364= CE BIB 1/75
APPLIC ION FOR PE_RMI
HEATING - VENTILATING = AIR CON01,11ONING
a.
COUNTY OF LOS ANGELES - BUILDING.
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY•
NEAREST �.
' CROSS'ST' Q J
F R APPLICANT TO FILL IN OWN ER+
(PRINT OR TYPE'ONLY)
MAIL,_ 1 f
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION ,-r
CITY NO. r
FORCE AIR FURNACE, BTU' `
CONTRACTOR
COMPRESSOR,"BTU
_ ADDRESS >`�
VENTILATION F;AN CITY J ,TEL No_351 C
f LIST AL'L OTHERS BELOW STATE F 'o] LIC
LICENSE`NO. L ' / • •CLASSC�
DISTRICT NO GROUP ZONE PROCESSED BY
,INSPECTION RECORD '
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Plan check fee See reverse { z
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PLAN CHECK APPLICANT v
i
NAME x
ADDRESS
CITY, TEL NO _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION r `
AND STATE`THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY. ,
WITH ALL ORDINANCES AND LAWE T
S REGULATING HEATING, VENTI- APPROVALS - DATE' INSPOR'S SIGNATURE ,
LATING AIR CONDITIONING
I HEREBY CE FY TH T 1 AM NO7 I CTING ROUGH-
IN VIOLATION '
OF CHAPTER 9, D VI ON 3 OF TH BUSINE S AND IN
FINAL
CODE OF THE STA E F IFORNI
SIGNATUREMO • -CASH
OF PERMITTEE '^"� , ✓� - PERMIT VALIDATION .' �
PLAN CHECK ALIDATION CK M 0 CASH v "
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76A364E'(CEµ91EAl-9/" APPLICATION FOR PERMIT
HEATING - VENTILATING - A'IR CONDITIONING
CO�LOGELEESCJ t .,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL' IN BUILDINGIV
-- (PRINT OR TYPE ONLYI ADDRESS Gv
' LOCALITY ^ -•
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST'
N CROSS ST , ,
ABSORPTION UNIT"BT ��
OWNER r'
AIR HANDLING UNIT CFM MAIL -7n
ADDRESS• �((ff
BOILER,BTU CITY TEL NO �
COMPRESSOR,BTU CONTRACTO G ,
VENTILATION SYSTEM ADDRESS.
EVAPORATIVE COOLER _ CITY6 TEL NO �
FURNACE FAU_GRAVITY STATE l �/ `� ,..,� LIC
-FLOOR BTU LICENSE NO /,q C)G+ CLASS
HEATER SUSPENDED UNIT- DISTRICT NO OUP ZONE ESSED BY
WALL 00 ,
INSPECTION RECORD l 0
V
as ` -
Plan check fee 25% of above -
�+.
PERMIT ISSUING.FEE$ Z
TOTAL FEE
PLAN CHECK APPLICANT '
NAME
ADDRESS
CITY' TEL NO j-
IHEREBY 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 - r
CONDITIONING +
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF �. APPROVALS DATE INSPECTOR S SIGNATURE' 1
CHAPTER 9, DIVISION • OF THEyBU NESS AND PROFESSIONAL CODE - c ,
OF THE STATE OFC RNIA ROUGH `
SIGNATURE FINAL �/`
OF PERMITTE JG"U
PL.AMCH VALIDATION CK M 00 SH
_
PERMIT VALIDATION CK MO CASH
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POLICY HOLDEP..�'� 9 419�:��r�'€� 8'4 1 0` 1"_5..'�
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