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76 A636411- CE 818-1/75'
APPLICATION FOR PERMIT
' HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 6427 Livia Avenue
BUILDING AND SAFETY DIVISION LOCALITY Temple Cit
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER Lydia E. & Adelaide Heath
(PRINT OR TYPE ONLY) MAILy
NO TYPE&SIZE OF•EQUIPMENT FEE ADDRESS 6427 Livia Avenue
SEE BACK OF APPLICATION
FORCE AIR FURNACE, BTU CITY Temple City TEL. No. 287-2929
CONTRACTORAAA CONDITIONED AIR LJC.
COMPRESSOR, BTU iz. 75-0
ADDRESS 10160 E. Valley,Blvd.
VENTILATION FAN CITY El Monte TEL. NO
579-1800
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO. 293529 CLASS C-20
' - DISTRICT NO GROUP ZONE
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INSPECTION RECOR
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• Plan check fee. See reverse. Z'
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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 AT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, 3, OF THE BUSINESS AND PROFESSIONAL FINALCODE OF THE S:DIVISI
ATE F CAL FORNIA
SIGNATURE PERMIT VALIDATI cKM 0 CASH
OF PERMITTE
PLAN CHECK VALIDATION CK MO - CASH l
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