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76 A364 - CE B18 -175
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
lits of T*Mle City Licwf2962
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS IY414 Goldm W :,ot :'_0_
BUILDING AND SAFETY DIVISION LOCALITY Tfn*le att
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) e- W
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N0. TVPE&SIZE OF EQUIPMENT FSE (MAIL ADDRESS 14�.5 maimi 7Rne
SEE BACK OF APPLICATION
q I CITY Armlift TEL. NO.
.4 FORCE AIR FURNACE, BTU DD
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COMPRESSOR, BTU .C]OD 10,00 ADDRESS 712 j,bzth Loren
VENTILATION FAN dk-1
CITY �,u" TEL. NO. 317-6732
LIST ALL OTHERS BELOW STATE 237LIC.
LICENSE NO. l 3 Q 2-l�
CLASS
[1ISTRICT NO. GROUP ZONE ,PROCESSED B1
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INSPECTION RECORD O
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Plan check fee. See reverse.
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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, VENT(- APPROVALS DATE- INSPECTOR'S SIGNATURE
LAT ING. AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I. AM NOT ACTING IN VIOLATION -
OF CHAPTER 9. DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL -
CODE OF THE STATE OF CALIFORNIA. / L
SIGNATURE y I 'F.' "7L'_" PERMIT VALfDAT N cK. M.o. cnsH
OF PERMITTEE -
PLAN CHECK VALIDATION cK. M.o. 1:11H
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