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76 A364 - CE 818 -1/75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
':.qty of e City 140.#29,92
COUNTY OF LOS ANGELES FBNG.G
GC? Ix1 $k3taE1 ; �
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION le City
FOR APPLICANT TO FILL IN(PRINT OR TYPE ONLY)NO TYPE&SIZE OF EQUIPMENT FSESEE BACK OF APPLICATION
,�QL TEL. NO.
FORCE AIR FURNACE, BTU,� - 2�).
CONTRACTOR !aa- & /C
COMPRESSOR, BTU
ADDRESS 2
VENTILATION FAN CITY Azul- TEL. NO. 31I6/7-
LIST ALL OTHERS BELOW STATEmow} LIC.
LICENSE NO. Jf M CLASS
DISTRICT NO. GROUP 'ZONE PROCESSED BY
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Plan check fee. See reverse.
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T-101 31, 1'I:b: 1 3 10C l
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -WITH ALL ORDINANCES AND LAWS REG-ULATING HEATING, VENII- APPROVALS DATE INSPECTOR'S SIGNATURE
LATINS. AIR CONDITIONING.
ROUGH
J HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9. DIVISION 3', OFTHE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE PERMIT VALIDATION CK. M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH w