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7eA3e4—te818—Ii70 APPLICATION FOft PERMIT
HEATING - VENTILATING - AIR CO IONIN
'
COUNTY OF LOS ANGELES BUILDING
DLFPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINKER
COLaMAN W. JaNiCINB, SUMMINTIENDtNT GF BUILpINe NEAREST
CROSS ST.
FO APPLICANT TO FILL IN . oy,�N t
(PRINT OR TYPE ONLYa
MAI L
N0. TYPEOFAPPLIANCE-OR EQUIPMENT FEE ADDRESS
CITY EL NO.
ABSORPTION SYSTEM, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC,
LICENSE NO. 0.
VENTILATION SYSTEM a RICE NO. CLASS z Na eaf[
EVAPORATIVE COOLER /
FURNACE: FAU_GRAVITY INDPICTION RKCOR4
FLOOR BTU
HEATER: SUSPENDED-UNIT
WALL
O
Ot
NEW—ADDITION— PERMIT: S 9 00
ALTER—REPAIR_ TOTAL FEE S
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
LWDA SY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANDE THAT THE ABOVE If CORRECT AND AGREE TO COMPLY
L ORDINAR CiS AND LAWS REGULATING HATING, V-ENTI- APPROVALS DAT[ tKSP[ 'S SIGXA RK
IR CONDITIONING. ��H
REBY CERTIFY THAT I AM NOT ACTING1 TIONERfl, DVIlIONa I f AND 110XAL FINAL
TH[ STAT[ OF FORURE JACK R. AL.LQd,SUPERVISING MECHANICAL ENG'R,
MITT
EFZMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATI
-9 0 3--6 Z-- » -4 1 o 6.0 0 �
aQ SACK OF APPLICAT"FOM CDM FLET[mE aCHmULE .
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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
i
FOR APPLICANT TO FILL IN Bu L NG ���� S�R �--
(PRINT OR TYPE ONLY) ADDRESS n
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
NEAREST
CROSS ST. Cf
ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER,BTU CrrY TEL NO.
COMPRESSOR,BTU CONTRACTOR
l
VENTILATION SYSTEM ADDRESS , ,Jb
EVAPORATIVE COOLER CITY TEL NO.
FURNACE: FAU GRAVITY STATE LICENSE NO. LIC.
FLOOR BTU CLASS
HEATER: SUSPENDED UNIT- DISTRICTNO. G1toDP zoNE De
wA 0 Q' (h,4_ �_
INSPECTION RECORD
Plan check fee 25% of above.
PERMIT ISSUING FEE$
TOTAL FEE
PLAN CHECK APPLICANT -
NAME
ADDRESS
C nY � �� ;A1 ��xA, TEL NO. ,�(,�(�" 3p
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, VENTILATING, AIR
CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE. I GTDR'S eK:NATU RE
CHAPTER 9, DIVISION 3, OF THE BUSIN AND PROFESSIONAL CODS
OF THE STATE 0 ORNU. ROUGH
SIGNATURE FINAL
OF PERNIMM
PLAN CHECK VALIDATION cr< W-0. CAM
PERMIT VALIDATION cx tea. CASH
485rdal. 638 B 27.00e39