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76 A364- CE 818 -1/75 ��,,�,`.�.� � "�"• {
APPLICATION FOR PI�AMIT °
HEATING - VENTILATING - AIF CONOITIONAG
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER s-, -
BUILDING AND SAFETY DIVISION LOCALITY r`
NEAREST
CROSS ST. f
FOR. APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FSE ADDRESS ?
SEE BACK OF APPLICATION
CITY i TEL. NO.
FORCE AIR FURNACE, BTU
CONTRALTO
COMPRESSOR, BTU --7—'
C 7f Ar-
ADDRESS
VENTILATION FAN CITY ^T� . O.
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LIST ALL OTHERS BELOW STAT L1 C.
LICENSE NO, a CLASS
DISTRICT NO. GROUP Z NE PROCESSED BY
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INSP C ION RECOR O
U
— W
ILL
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Pian check fee. See reverse.
P1111011T ISSI-W; IJJB 00
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Joy
PLAN CHECK APPLICANT
NAME l
i
r
ADDRESS t,d
C1 TY,1 TEL.NO....
I I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION
i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES-AND LAWS REGULATING HEATING, VENT--I APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONLNG.
ROUGH
I HEREBY CERTIFY �~HAT I; AM NOT ACTING IN VIOLATION -
OF CHAPTER 9, DIVIS N 3, OF THE BUSINESS AND PROFESSIONAL FINAL
i- CODE OF THE STAjF F CALIFORNIA.
SIGNATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMIT
di—
PLAN CHECK VALIDATI N cK. V,0. CASH
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76 A364 - CE 818 - 9-71 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS i
BUILDING AND SAFETY DIVISION LOCALITY V- _
NEAREST
CROSS ST. ?i
FOR APPLICANT TO FILL IN OWNER :� ��-
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS I,
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR e—
AIR HANDLING UNIT, CFM Ic -
ADDRESS A✓ r""
BOILER, BTU CITY ti yEL. NO. ,"
COMPRESSOR, BTU ? STATE LIC.
LICENSE NO. ! CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY y
a
O
EVAPORATIVE COOLER J v
FURNACE: FAUGRAVITY
FLOOR BTU INSPECTION RECORD J
HEATER: SUSPENDED UNIT
WALL f,
Lu
W
1--
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE 8 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 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
LATING, AIR CONDITIONING.
ROUGH
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 CALIFORNIA.
SIGNATURE P 1 PERMIT VALIDATION CK. M.0. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE