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76A364 - CESIB - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER ,
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU
CITY NO./ C�
CONTRACTOR J s
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER r
CITY p TEL. NO. -6 44f
COMPRESSOR, HORSEPOWER G
LICENSE NO. f(.� CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL
O
O
u
W
o_.
NEW—ADDITION— PERMIT $ 3 00 L
ALTER_REPAIR_ TOTAL FEE $
L�
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
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,VENTI- APPROVALS TE IN CTOR'S SI ATURE
LATING, AIR CONDITIONING.
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISION 3, OF THE BUSINESS Ap PROFESSIONAL FINAL Pi
CODE OF THE 5TATE OF CA IFORNIA.
SIGNATURELJ� (I JACK R. ALLEN, SUPERVISING MECHANICAL ENG'
OF PERMITTEE f-l& •c+y
PERMIT VALIDATION CK. M.O. CAS
PLAN CHECK VAL. ATION
3 4 0 9c-- Jitri2 0 4 1 Q 7.0 0 .
IIF _
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE O /