HomeMy Public PortalAbout4965 PERSIMMON AVE_Mechanical__ 'BAS°°-CEO'°-'/'° APPLICATION FOR PERMIT
HEATING - VENTILATIN'G - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDINGf '
DEPARTMENT OF COUNTY ENGINEER ADDRESS' !7
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT.TO FILL IN- OWNER ®pp� I vpdy-
(PRINT OR TYPE ONLY)
MAIL C
No. TYPE OFAPPLIANCE,OR EQUIPMENT FEE ADDRESS _
-
ABSORPTION SYSTEM, BTU CITY TEL. NO.
CONTRACTOR ® / f
AIR HANDLING UNIT, CFM
ADDRESS• �.mvo
BOILER, HORSEPOWER CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE
CENSE NO. ��/ CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS .GROUP, ZONE PROCESSED BY
EVAPORATIVE CO?LER oO.
��• ��
JFURNACE: FAU_GR VI
FLOOR ' BTU � INSPECTION RECORD
HEATER: .SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL
C
� C
C
NEW—ADDITION PERMIT $ 3 00 G
a
TOTAL FEE $ /i) a O
ALTER_REPAIR_ d"
PLAN CHECK APPLICANT
NAME G
ADDRESS
CITY" TEL.NO. I,t�
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ALATHAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
RDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS - •X ATE INSPECTOR'S SIGNATURE
CONDITIONING.
ROUGH
BY CERTIFY THAT I AM- NOT ACTING IN VIOLATION
' 9, DIVISION 3, F THE BUSINESS AND PROFESSIONAL FINAL
E STATE OF C OR NIA. .
E JACK R. ALLEN,SUPERVISING CHANIC/yL ENG'R.
TTEE
PERMIT VALIDAT`IO.N CK. CASH
PLA HECK .VALID.ATIONYl�
L.&.2 7 0 1 W 5 4 .1':D 1 2';5 0, � .
SEE BACK OF APPLICATION FOR COM PLETE FEE SCHEDULE - '
Temple City
r�A36a=�Ee+e-+1�o APPLICATION FOR PERMIT
` HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
" DEPARTMENT OF COUNTY ENGINEER ADDRESS 4965 Persimmon
BUILDING AND SAFETY DIVISION LOCALITY Temple City
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT QF BUILDING CROSS ST. Trower Azusa_ '
FOR APPLICANT TO FILL IN OWNER Tom �'guda
(PRINT OR TYPE ONLY)
MAIL same
NO. TYPE OFAPPLIANCE,OR EQUIPMENT FEE ADDRESS
CITY TEL. NO. 287-4193
ABSORPTION SYSTEM, BTU
AIR HANDLING UNIT., CFM
CONTRACTOR Authorized Air
ADDRESS 1908 E. Covina Blvd. '
BOILER, HORSEPOWER CITY Covina . TEL. No, 331-2518
1 COMPRESSOR, HORSEPOWER 4 00 STATE LIC.LICENSE NO. 232117 CSS C-20 .
VENTILATION SYSTEM DISTRICT No. CLASS GROUP ZONE PROCESSED BY
-EVAPORATIVE COOLER
FURNACE: FA _GRAVITY IN PECT ON RECORD
]. FLOOR BTU 0
HEATER: .SUSPENDED UNIT_ Q �(
WALL '
C
a
C
P $ 3 00 L
ERMIT
NEW_ADDITION—
'e
ALTER—REPAIR— TOTAL FEE $ 15 50'
PLAN CHECK APPLICANT
NAME
ADDRESS
CI TY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE.15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCESAND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S S GNATURE
LATING,AIR CONDIT[ONINO. f
: f.9
I HEREBY CERTIFY ROUGH
THAT I AM NOT ACTINO IN VIOLATION ,
OF CHAPTER 9, DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL-
CODE OF THE STATE OF FORNIA.
SIGNATURE JACK R. ALLEN,SUPERVISIN CHANICAL ENG'R.
OF PERMIT '7i� '
PERMIT VALIDATION cK. !O. CASH
PLC HECK VALIDATION ,
CQ
4. 1 0 1 5,5 0~
w -
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE '� J ' -' .•