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1280A (6)
�6A364� �r��l�r'�.i i0iti �_(�� r��i�i��im�� �tipItRLKti'CU\IPFNSATIO\UI-.CL.-1R.-aTl[)N ��." I heroh� ;iffirin [hxt I h:i�c a cartifica[e oYconsent lu.�elf CE-81S!2901 � insure.ur a c��rtifi�at.nt KorAen'Cnmpensutir�n Inxurance,��r HEf,Tii�1G-V'chTILHTIfVG-Hi�7 C ��e�cir��a�<»,�nz�z�,e,s«,3eoo,i.�e.c.> OtVDITIONIFiG i���r�> ���.�.—r�,�„���,,...,.... __ --- ❑ t�rtifiod�„py�:��zr�t,y r��nu�i:��. COUf�TY OP LOS ANGELES BUILDING ANDSlaFETY a -- — C��rl�ti � [i5�y fiie�l»��[I�tli� i nt)l�uil-,i'i- ��spz�ti��n p 3UILDINC / �j� l -_ - -:,_��.e �eP.�rf n � FOR APPLICANT TO FI LL li� aoor+ ss�p73 �Q (y�� 1).ite .4gF!�.;int_� __ . IPRINT Oil TYPE OR{YI ._ '__ . .... -_ _' __ . . _' '_-. .. _. - . __. {� C'k�L2lll lt -iI.')i E:ik:?il'll("i\Fi.U..�',tOHhi.lLS' NO. I TYPE OF APPLIANCF OR FC UIP'�}EI�iT I FEc � LO(,A IT `A�.,__ J _ _ .„JLJ3eYMt0'Y�l.� L019YE15'vTli)V[\SI�RAVCf. --- -----� --" � ��--;'Je�.�e5? (This xectiun n�_1 nei i�e compl:.:d iP ihe �rork involro�eu 'ABSOR?TIO�.u`iT e7u � `�Ross Sr.-����e�,��� � � � d by the petmit is For cr:e Imrurrd etr,liurs (S10U) or less.) � ��- `m;;s,c;r,;;. ;�.cc,_sse,av 1 ��rtifi th � i h��y r- t ,. i f i;e«�irl. 1_ iel:tl,i< # ' ' �dc=i NI � � I U i. .. -- -- QQ � perm�t n u-u I sholl n�i m�,� r p�r * . .-___- . .. -_ . .. .—._� � 5 .0 wn i i ar mannr� , �,�ti�I>e�m �ub)•.��i i t� 1'i�r n'ComF .at-n L:�.�� � �601LER.6-U - _ ___ ' s . . U t ��/_ b � —_ " - - ' -1- _ A"Pfii:�.15 �UHTL � ,�a2r,:,.���'i.U>�,;RC V HT PDh �nt _ — � 1 cO+nPF�FS50P,L�Tu a� . ' QOx ;-.�„y.- - - __I 9. 'v(111iF -I() 41Y1 � \i l.r .-A �_t :: <� t ��t ,F � � �VENTILFTir.�,5vc-�� , � � -- p-- -- - ' k. mpt uu 1 .1� I �- �, ti ! t � ti. 1i k r. /a FI'v.�L __,.���a-� � Z (,umU��s,;.r;,. 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E 'FURNACE: Fq�'__'"___GRAVITY� ' LiCE'Y4i.'iil0':71?�+f'T012SUi�CLA12qT1O!� _ �FL��+�:-- _ dT� � 1 i 7 tser_�r_�fu:�.. �ii. . �;i(�;:ai'I.r �i-IE:.TEi�"t: .1E.❑ _,••i1l' . �i �.� nrt ,.�. ..,`:(..,U,�nio•� 7 -Y t-- R-. s v�aa�4 , . res,en1 i. ,e ..,;l 1_ r.��u. !., i n . ..f .>r.. ,,.._ _ _.__-__ _ ._ _. _ _' .,__.______t � . ,: . . p u c-T__ , !O� . ��fz�t ' � EKrE,�o � �Op` 4.icenxe�uml,e:��__ I,�;;.Ci�s,�� _ -___ _ _ . _ ! � i n Cnn[ractor_"'.._.____.._- I�a!e—_— �I. .;._...___-__ ` zF� 2�.Q n '_ '_ z ' , � 1 am � 4.t hnr [h�I,.e-� y uunenn�,t a � � I ._ .._. __._ . i #.��� ��8. in�n,. c ,- r 3 nre� t .�� S Plan che�k{e�:"e�°5 of�beve, ! � p �'es -cei ` �<<r�,;. ��, ,,� F�<�'- ,._. ,� �, .;,�� ,�, ,u��. �, :-- R ► ••3Q50 �- - - ����,,: - _ , , m�..,undl�ut.>.�h.:a>C,i:i��. s PERiViITISa.,,.:GFtE`.�', /D�i�; • � • _ �------- O. O V i.,�.<�::<�,.u�,.-- ----------�a�r ----. � j TOT:;'t;EE i 3p i.�L�` ��� � ---' 0127=84 �to�t�-.o'.rvpit-B���t.!�F'�tDG.ci.au�l�<iti �a�aNcriecKaNFuc::r:i N� ° I huch• uf(ir!n tb�� 1 ;.m _4 �tcnr tl��� C�,ntr cr�� . „-- , � Lic^_rsa L��r (•�r ;h.• t��Ik:wiuE:c'z�,��n , ..u�,r 7031.�. Hu,i 9 ry•�•._ p _ _- . .p _ .._ . __ ne�s�n:l f'r��tr., �;i.('n,;:.�1: ' no�RE552U � �i. � � . ' i a, �. i � ' a -� - S .� ], • .,�:. .. � �tr i��u i. i ih .. f( �{ f ir sale IGeet �� CITY �_— �TC��.�C�� s F � � —� l! -�+-� + ❑ 704C.�.�..,��...,....�.,.,...�... �r;�'� °GY R .���y�1� 5 f L ax m�n,.r::f[hr pruGc��i. :i:n :tcb_�itiely contraei;ng c_]d8d�� �� u�ith lieensad wu[rnctun , cnnstruit thc pr�i7«t NiAIL ` (5ul'I�tJn 7f14+,fius.ResS�::.1 iiufes��J:ts C�udE'). j. J�RES'S____ _�/ � { � �O�ST!21'C��fU\I.!til�l�(;.il;l>;i('y ;CITY // TEL.NO, r� $ [ Lereh> a;firm [h�� therv is d cunsVuctinn Itnding a�auc� -- ---. - ...._._.� for th� pariurinen.e nf thn -�c��ri�. For ��hich :his V�rmit is CONTRA^TOH � _ � � '>.ueJ 15�-.30v2 Ci�.C.I. �___ _-' _a Lcnd�r's\.�n�,•.__- -_._ � . .__._.._.— .. . iAODR.�cc �� ._ ___._--_ � Lnxlerb Aduresa__.-_- ! --- CITY (/ TLL.Nv. (�' [ccr[ify that i i��l.��r��u chi� a.'Vli�:iii��n,i�id st:�te th�( ih�� STATe �p�^7'_____...LIC.--- - .ib��ua infurmo�iu�t i:eorzrrt.1 a '�t•,e ni�ply��+ith all Cuu�n> IJC�i�d;E i:n � _(` y., /� CLASS; ,�.. urJin�ncrs arJ S:aie I.n�,v caccl�,::i�ii}{eaiiu,;.Vrutil;�ting�nd Air Cundi�ianin��.unti hcre67 z�.nlinri;� rcP�e,rne;�[ives uf ihi.� St:l-:NI(Vl�.k51�.DUIi Ifhf•L.\�.1[Ultt 1.4n;�;GA(;F" (� t� t�r entzr upun tl�. ,il;;��:mrnti��r.rd pr�ptrt) I:ir ii,p� t�o�i(�urp�iy ,. � ,,S �_zb_ ii .:i..e ui k�ern:ittce �—. Da�._..__ � '{ -! � . �4 , �; �� � . . ; � �`4 `; E ,_ . .. .. . . �1 ( � � . • ` .. ' • `� �; � . � � i - ' . .. `. . . _ . . . �t . ' . ` . ' � , , � .. � ' , , . _ " � , : " . ` � ! y'` ` . ., . '.- ' l '' � �� 5 ; �y, �i �, ��_ � . ': � � . . � � '! 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