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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �f
BUILDING AND SAFETY DIVISION LOCALITY �� _ / ��
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. Z-p1J / ---Al
FOR APPLICANT TO FILL IN OWNER �.
(PRINT OR TYPE ONLY) C-
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NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS JyJ
CITY TEL. NO.
ABSORPTION SYSTEM, BTU
CONTRACTOR '��-��� 74Z—:
AIR HANDLING UNIT, CFM
ADDRESS/3/ 7 3, t"
BOILER, HORSEPOWER
CITY� '�', ( T L. NO.
COMPRESSOR, HORSEPOWER STATE73 �r' CLASS' L d
LICENSE NO.C. c� ��
VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL
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NEW_ADDITION— PERMIT $ 3 00 N
ALTERZREPAIR_ TOTAL FEE $ `7 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I 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 INS TOR'S SIGNATURE
LATING, AIR CONDITIONING
ROUGH
I HEREBY CERTIFY THAT 1 M HOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE CALIF NIA
SIGNATURE �L.rr JACK R. ALLEN,SUPERVISING E HANICAL ENG'R.
OF PERMITTEE
ffPERMIT VALI®ATION C'. M o. CASH
PLAN CHECK VALIDATION
LAW �. , - r,� 12 a o 7.0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76A354E !GE•SIBA)-11/76 APpkICATION FOR PERMIT
HEATING - VENTnATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT.OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TfPE ONLY) ADDRESS 6 3 2 0 I4. Roseniond
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NO f TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Temple Cit
NEAREST
CROSS ST LotY-(jCn
ABSORPTION UNIT BTU
OWNER LVA Qwmercial Prgpertits
AIP HANDLING UNIT CFM MAIL
ADDRESs203 Arizona Avenue Suite Z
BOILER BTU
CITY
. TEL NO �r
l—�71"
if "u- Jstita Nonice CA -.12 COMPRESSOR BTU 4S"
CONTRACTOR Id k!cAfee L-nQinuprim,
VENTILATION SYSTEM Exhaust jlADDRESS :2 r1r.. roililif _ tG( yrtOo i
Toilet—
E jAPORATIVE COOLER CITY CerscI CA
1
9074" 'EL NO
=URNACE FAU GRAVITY STATE LIC
=LOOK 9TU LICENSE NO 297Fj;; CLASS
--EATER SUSPENDED UNIT_ D,STRICTNO ZO.E PROCESSED B�
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(i;F,�,ctiF�11 C
INSPECTION RECORD
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deck fee 25% of above
PERMIT ISSUING FEE$ 7 g
ITOTALFEE 35 Cr
PL- CrECKA'PL.'CANT
C TEL NO
4=.EBY ACKNOWLEDGE THAT I HAVE READ THIS APFLICATION AND
--_ --�T THE ABOVE IS CORRECT AND AGREE TO CON1FL) WITH ALL-
-:,CES AND LAWS REGULATING HEATING VENTILATING AIR
=C'D17'ON,NG -
_ -EREBY CERTIFY THAT I Ah1 NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR S SIGNATURE
TER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODE
c_--E STATE CALIFORNIA ROUGH
S•G 'ATURE - t
C== - Il'TEF` �-1 • 2�� FINAL
LAN CHECK VALIDATION CK Mo Cash PERMIT VALIDATION CK Mo cases
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