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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES BUIILI
DEPARTMENT OF COUNTY ENGINEER ADDF
BUILDING AND SAFETY DIVISION LOCALITY i
NEAREST
CROSS ST. 'R
FAR
R APPLICANT TO FILL IN OWNER -
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F APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
PTION UNIT, BTU
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ADDRESS
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BTU INSPECTION RECORD
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PEHVIl'r ISSUIIAG FEE .S 3 00 -
'1'OTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS "
CITY TEL.NO.
I. HEREBY ACKNOWLEDGE THAT 1 HAVE HEAD 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
LATING, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT 1 AM NOT ACTINGtlVIOLATION' //J�,w�CHAPTER9, pIV15 N 3, OF THE BUSINESSANO ESSIONAL FINAL p eOI�N!_ �� �/1
CODE OF THE STATE A IFOfl A. L IIJJ �.CCJJ /�_�f/8./TY
SIGNATURE �'/n/I PERMIT VALIDATION CK. M.O. DASH
OF PERMITTEE F.
PLAN CHECK VALIDATION CK. M.D. C SH
1:2 5;r- ..721 2 1-'D 8 0 C A"
SEE BACK 01 APPLICATION FOR COMPLETE FEE SCHEDULE
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COUNTY OF LOS ANGELES TEMPLE CITY #-1508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 9912220004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13531 LT: 3 10217 LA ROSA DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803307
ASSESSOR INVURMArION NUMBER: NEAREST CROSS STREET: ARDEN
8585-006-003 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
30 AIR INLETS/OUTLETS 10.00 UNI 43.50 12/22/99 UT 06/19/00
TOTAL FEES 125.25
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
MORTON WEBSTER G;EDITH R (626) 443-2528- 1Q
10217 LA ROSA DR IZ'.$6'�P9
TEMP 917803307 DESCRIPTION OF WORK
INSTALL NEW COOLING AND HEATING SYSTEM IN RESIDENCE
APPLICANT: TEL. NO:
BRYANT HEATING AND AIR CONDITIONING (626) 286-1141-
1350 E. LAS TUNAS SPECIAL CONDITIONS:
SAN GABRIEL, CA
PNGELES CO
CONTRACTOR: TEL. NO: QS �/�/�, APPROVALS DATE INSPECTOR SIGNATURE
BRYANT HEATING AND AIR CONDITIONING (626) 286-1141-
1350 E LAS TUNAS DRIVE LIC. NO FAU/WALL FURNACE
SAN GABRIEL CA 91776 221751 C20
COMBUSTION AIR 50 GS
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ARCHITECT OR ENGINEER: TEL. N0: k DUCT WORK
LIC. NO:I/ 111111 AC/COMPRESSOR
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REPORT ID: OPR264 ROUTE TO: BS0508