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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUIL/DING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
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(PRINT OR TYPE ONLY)
LOCALITY T
NO. TYPE OF APPLIANCE OR EOUIPMEN7 FEE
NEAREST
CROSS ST. ,
ABSORPTION UNIT,BTU
OWNER ��
AIR HANDLING UNIT,CFM Q
ADRESS / �!T Z-
D '
BOILER,BTU JJ]� CITY �' /` TEL NOdW-3 al
COMPRESSOR,BTU O '� CONTRACTOR 'L
VENTILATION SYSTEMADDRESS
EVAPORATIVE COOLER CfIY TEL NO. ��
FURNACE: FAU GRAV �/) STATE LIC. 7
FLOOR BTU U LICENSE NO. �d �`""' CLASS aU
HEATER: SUSPENDED-UNrT-
WAI I
APPROVALS DATE iNSPCCTg1'SSICNATUpe
ROUGH
FINAL O
INSEE ION RECORD
Plan check fee 25% of above.
PEWMIT ISSUING FEE$
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME W'-- •
ADDRESS o�O 3 0 d
5
CITY TEL NO.
I HEREBY ACKNOWLEDGE TRAT 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
CONDITIONING. PERMIT VALIDATION ;2 4 2 7a 7 A
.I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER fl, D N 3, OF THE BUS S AND PAOFESSI NAL CODE #'0 0 0 0 4 1
OF THE STA F FORMA
00 PERHR �� 2 0 0 3 !i O O
D LSfRICT NO. P CDB 0 0 0 3 7 O 0.5
�f 050'8-79
COUNTY OF LOS ANQEZS9 TEMPLE CITY 0508 MECHANICAL PERMIT
DEPARTMENT OF PIIBL.IC WOR1r9 9701 LAS TUNAS ME 0508 1204180008
BUILDING AND SAFE'L'Y / LAND DSVELOPMEM TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
BIC: 9 PG: 95 PC: 1 8865 GARIBALDI AV
FEE DESCRIPTION: QUANLTTY: DOM: AMOUNT: TEMP CL 917801516
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STR.SfiT:
5384-002-033 01 PERMIT ISSUANCE ilm 27.80 THOMAS PAGE: 596 GRID: H2 LACALPI'Y: TEMPLE CITY, C
02 COMPRSR < 100 XBTU 1.00 CON 27.00.
TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY:
30 AIA DqL•T?TS/OUTLa-M 9.00 UPI 39.60 04/18/12 SR
TOTAL FEES 121.40
OWCER: TEL. NO: DATE FIJULL BY: CODE:
PAM ROGER S;BROIII'AR VICKI L (626) 286-3641- _
8865 GARIBALDI AV
TFd[P 917801516 DEhCIRIPTION OF WORK
REPL?.CE HEAT (CLOSET) REPLACE A/C (YARD) AND REPLACE DUCTS
(ASBES70.9)
APPLICANT: TSL. NO:
RAMIREZ, CO@iNTE (626) 815-1632-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APMWALS DATE INS R SIGNATURE
COMFORT CLIMATE CONTROL, INC. (626) 815-1632-
1017 W FOOTHILL BLVD LIC. NO _ FAU/WALL FURNACE
AZUSA CA 91702 641060 C20
COMBUSTION AM OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT MORE
LIC. NO: AC/COFBRE SOR
THRRMQST&T
FIRS DAMPERS
SMOKE DETECTION DEVICE9
COMBRCIAL HOOD
REPORT ID: DPR.264 ROUTE TO: 1390508