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76 A364 - CE 818 - 9-71 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES ADDRESS 9 33 HALLW000 IA.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST _
CROSS ST.
FOR APPLICANT TO FILL IN OWNER J. VICKSON
(PRINT OR TYPE ONLY)
MAIL SAME
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO. 2,16-aV77
ABSORPTION UNIT, BTU
CONTRACTOR L.M. HAMM, INC
AIR HANDLING UNIT, CFM.
ADDRESS 425 W, MAI N
BOILER, BTU CITY ALHAMRPA TEL. NO.Xya-a 114;,l
COMPRESSOR, BTU STATE LIC.
LICENSE NO. /74-5 7 L CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP) PROC SSED BY
EVAPORATIVE COOLER 6� �8 a
FURNACE: FAUGRAVITY o
FLOOR BTU INSPV
ECTION RECORD
HEATER: SUSPEN D UNI C:)
H
WALL -7-50v
- W
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N
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Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS IW
CITY TEL.NO ,? 1Z1
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, V.ENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATINO, AIR CONDITIONING.
ROUGH141-01-7,71
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 CAL OR NI
SIGNATURE PERMIT VALIDATION CK. M.0. CASH
OF PERMITTEE -
PLAN CHECK VALIDATION CK• M.O. CASH
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SEE BACK OF APPLICATION FOR COM PLETE FEE SCHEDULE