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76A364 - CESIB - 3-69
1.
- APPLICATION FOR PERMIT���?�� " � y/
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES 7ADDRESSw,!g'4/j
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY TEL. NO.
CONTRACTOR
AIR HANDLING UNIT, CFM
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BOILER, HORSEPOWER A D D R E S S
CITY TEL. NO L
COMPRESSOR, HORSEPOWER
STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE "SPR CESSED BY
EVAPORATIVE COOLER
FURNACE: FAU G ITY o J o CCC��/dfC
FLOOR BTU Md. INSPECTION RECORD
_ HEATER: SUSPENDED UNIT
WALL
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NEW—ADDITION— PERMIT $ 3 00
ALTEREPAIR_ TOTAL FEE $ (j(,
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI-
LATING,AIR CONDITIONING. APPROVALS DATE INSPECTOR'S SIGNATURE
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF ROUGH f"1-1-70
CHAPTER 9, DIVISION 3, F THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF IFORNIA, y YQ
lirOF
SIGNATURE JACK R. ALLEN, SUPERVISjbIjG MECHANICAL ENG'R.
OF PERMIT l
PERMIT VALIDATION CK.) M.o. CASH
PLAN HECK VALIDATION
I pr„5 119.9 MAY27 4 1 D 7.0 0^. q
`EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE `� �/,V