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APPLICATION P
HEA G - VENTILATI AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS 4940 Temple Cit Blvd .
(PRINT OR TYPE ONLY)
LOCALITYrem C1
NO TYPE OF APPLIANCE OR EQUIPMENT FEE l•
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NEAREST
CROSS ST
ABSORPTION UNIT BTU
La Rosa
OWNE enar Ambrust .�
AIR HANDLING UNIT CFM MAIL
ADDRESS 4940 Temple City B vd:-- 4
BOILER BTU CIT1F QRS
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COMPRESSOR BTU 48^ OOO• CONTRACTO
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VENTILATION SYSTEM ADDRESS 167 W . Oran
EVAPORATIVE COOLER
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1 FLOOR996
FURNACE FAU BTU GR"' AuyV ZO• O LICENSE N a 343771 CSTATE LASS
HEATER SUSPENDED (_UNIT_ APPROVALS DATE
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ROUGH y
FINAL 0 l
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INSPECTION RECOR pE
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Plan check fee 25% of above �A
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PERMIT ISSUING FEE; 9 8 z�Azt I �0 ce ?
TOTAL FEE 37 00
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL NOIHERE
STATE THATBTHE ABOVE
IS CORRECT ANDE THAT I EAGF ETHIS TO COMPLYATION ANWITH ALL n-996,5 6 Fl
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR e e e • (j 1
CONDITIONING PERMIT VALIDATION
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF Z • • T O O
CHAPTER 9 DIVISION 3 OFT BUSINESS AND PROFESSIONAL CODE .J 7 Z
OF THE STATE OGt II O 7,D a r U
SIGNATURE 3—oZS$d • • • o c
OF PERMITTEE
IDISTRICTNO PROLES ED BY o a o 1 -80
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