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1 HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES JBUIL70INGDEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION '
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY /// EL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR _ NG
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY Lfi TEL. NO. _
COMPRESSOR, BTU Q STATE
LICENSE NO(_: "76 — �� CLASS
VENTILATION SYSTEM DIsrRlcr No GROUP ZONE6: CESSEI) BY
EVAPORATIVE COOLER d O �I
FURNACE FAUGRA TY D
FLOOR BTU O INSPECTION RECORD
-HEATER: SUSPENDED UNIT_
WALL
a.
O
U
O
F_
U
W
CL
Plan check fee 25% of above. See reverse.
PERMIT ISSUING F'EE S 3 00
TOTAL EEE Od
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 D /IN$PECTO SI T E
LATING, AIR CONDITIONING
ROUGH ,
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISIO OF 7HE BUSIN AND PROFESSIO AL FINAL
CODE OF THE STATE CAL F RNIA • A
SIGNATURE PERMIT VALIDATION CK./ M o cnsH
OF PERMITTEE
PLAN CHECK ALIDATION CK O CASH
7 9 4 MAY 2 4 1 U 1 '3.0 0 A ss
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE