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76A364 - CI.818 - 3-69 APPLICATION; FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION _ 1
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY lif' io C i��11/^
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST CROSS t� OL //r /v 4-
FOR APPLICANT TO FILL IN OWNER D,DlF/1 `7
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(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY , TEL. NO.
CO•NTRACTORe� lo_-:g</ 'G`Y2s
AIR HANDLING UNIT, CFM /
ADDRESS/< /��Rj�Pl✓ /� �/
BOILER, HORSEPOWER
CITY��'��.i,�(�i9-Ct� TEL. N0.
COMPRESSOR, HORSEPOWER STATE
LICENSE NO? CLASS
3 r� CLASS
VENTILATION SYSTEM DISTRICT NO. GROUPZONE CESSED BY
EVAPORATIVE COOLER ` ' `
FURNACE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL
O
u
oc
O
V
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NEW—ADDITION— PERMIT $ 3 00 z
ALTER_REPAIR_ TOTAL FEE $ (�
PLAN CHECK•APPLICANT
NAME `
ADDRESS
CITY TEL. NO.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI,CATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS DA IN TOR'S SIGNA E
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIO L FINAL
CODE OF T C� OF CALIFORNIA.
SIGNATU �rC// JACK R. A EN, SUPERV MECHANICAL ENG'R.
OF PER
MITTEE
PERMIT JAL.
TION cK. M.O. CASH
PLAN CHECK VALIDATION
r'- 1 14 173 LW-1 1 D 8.00-
'--E
-E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76 A364 --CE 818 — 9-71 • . APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FNE
ESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LITY
EST S ST. !(' �/�
FOR APPLICANT TO FILL IN OWNER L
(PRINT OR TYPE ONLY) v er l ,, v
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR.,�A4
AIR HANDLING UNIT, CFM �y
BOILER, BTU
CITY/ TEL. NO.
COMPRESSOR, BTU STATE �� �- LIC. la
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE ocEssED
EVAPORATIVE COOLER U i 0
FURNACE: FAU VITY U
FLOOR BTU 40-t) �Pj INSPECTION RECORD
HEATER: SUSPENDED UNIT_ O1--
WALL v
w
a
• Z
Plan check fee 25% of above. See reverse.
PERMi,r ISSUING FETE S 3 00
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 INSP R'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLA N
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESS L FINAL
CODE OF THE ST ALIFO A.
SFPERM TEE'S PERMIT VA 'JDATION K. M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH ! 1
u' •
3 09 99r3. SEP `7 1 D 8.0 0
�EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76A364-`CE818-'/70 APPLICATION FOR PERMIT
HEATING -VENTILATING - AIR CONDITIONIN
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER"
'COLEMAN UV. JENKINS, SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT'OR TYPE ONLY)
MAIL
NO. TYPE'OFAPPLIANCE,OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION SYSTEM, BTU
CONTRA
AIR HANDLING UNIT, CFM '
ADDRESEo�a
BOILER, HORSEPOWER CITY TEL.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO CLASS
VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE C OL J r V Jj /P
2�9
FURNACE: FAUG ITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT-
WALL-
C)
NIT_WALLO
U
O
U
W
d
N
NEW_ADDITION_ PERMIT $ 3 00 Z
ALTER_REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAME
`-A DDRESS
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 TE PECTOR' S NATURE
LATING, AIR CONDITION,
NG.
ROUGH
I HE CERTIFY THAT 1 AM, NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF ORNI
SIGNATURE JACK R. ALLEN,•SUPERVISING MECHANICAL ENG'R.
OF PERMITTE '
PERMIT VALIDATION CCK M.O. CASH
PLAN CHECK VALIDATION '
gF,> 8,. FEB25' 4 1 D TO O a
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE