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HEATING- VENTILAIT N-GON ® AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER,-,
ADDRESS 5508 N. R71M .AVE.
BUILDING AND SAFETY DIVISION LOCALITY
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CROSS ST.
FOR APPLICANT TO FILL IN OWNER ����++��77���� �pper�++
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NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS SAM
SEE BACK OF APPLICATION
CITY TEL. NO.
1 FORCE AIR FURNACE, BTU
CONTRACTOR' 'jMNE HCC
COMPRESSOR, BTU
ADDRESS
2034-N, PECK RD-
VENTILATION FAN CITY ' TEL. NO.
LIST ALL OTHERS BELOW STATE' 01'd.-
LICE SE NO. 265094 CLASS C-20
DISTRICT NO. GROUP ZONE ESSED BY
INSPECTION RECORD
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Plan check fee.•See reverse. _ z
PE1011 ' ISSI;ING FEE S 4 5Q
T&AI, FEL:
PLAN CHECK APPLICANT
NAME
ADDRESS
'r CITY TEL.NO.
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH A,LL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
' LATING,AIR CONDITIONING.
.''ROUGH
' I HEREBY CERTIFY THAT IaA� A TING .IN VIOLATIO 'OF CHAPTER 9, DIVISION H T E AND AN VI SIO FINACODE OF THESTATE O •-
SIGNATURE 0.IT VALIDATION CK. M.O. CASH ,
OF PERMITTEE - ,
PLAN CHECK VALIDATION CK. M.O. CASH
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