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APPLICATION FOR PERMIT - -
HEATING.- VENTILATING - AIR CONDITIONING
City of Temple, City-7671
COUNTY OF LOS ANGELES ADDRESS lO6 Ke est
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER Teaple. City
NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) J OYIh
n Sell
MAIL
•NO. TY PEOFAPPLIANC EDR EQUIPMENT FEE ADDRESS 2023 Bella Vista Drive
CITY Arcadia TEL. NO- 445--2772
ABSORPTION SYSTEM, BTU
CONTRACTOR J' & J Ht g & A/C S rv.
AIR HANDLING UNIT, CFM
ADDRESS 2379 First St'•
BOILER, HORSEPOWER CITY La-Verne TEL. N0.339-6011
COMPRESSOR, HORSEPOWER STATE' LIC.
-LICENSE NO. 261695 CLASS C20
.VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONEr PR CESSED BY
EVAPORATIVE COOLER
1 FURNACE: FAUJL
_GR Y` INSPECTION RECORD
FLOOR BTU 5 00.
HEATER: .SUSPENDED UNIT_ c•
WALL
' U
' H
U
. d
•NEW-ADDITION-
PERMIT $ 3 00 ?
ALTERREPAIR— TOTAL FEE $ '8. 00
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, VENTI-, APPROVALS DATE INSPECTOR'S SIGNATURE.
LATINS, AIR CONDITIONING. . - ` w
' ROUGH
1 HEREBY CERTIFY THAT I M NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF T SINESS AND PROFESSIONAL FINAL -
CODE OF THE STATE OF CALIFOR
SIGNATURE !f r •JACK R. ALLEN,SUPERVISING MECHANICAL ENG'R.
OF PERMI
T T E
PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALI ATION
L ,o.�'. 4 .7 3, OCT 2 6-. 4 1 D..:. 8.0 0 a
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE