No preview available
1115-02 - 201 ARENA ST1 L VERSION 12.2000 OWNERfUILOER DECLARATION I neatly iron utter peeay of penury Mall Ain exempt from the COntl*Cpa L.eMSeta tame lalpnnn reason IS fO3t.a. ewlw end Prneawn fee: WO chi Or malty M,Cs nacres a person IO MYNCI, err. improve. OMMlish, a t5mr any fumy % poor t3 m la,LaM9. also maa're00m cooaa11: fur goal onto 10 Mee fiord statement that he G she bhce Va pWvlarlt to eta:emisions at the taWaWas License lye (Chalet 9 (commeidng each See 701A)Ot Div. 3el CV Wane= sae Hvtnli ns ONOI Or Oat no M she is eltanet Bi r000m ea me Dais for me exemplun. Any Notion of Sec 7031.5 by any errant for. pewee a s me apa.Onitea We penalty of not more than eve banana dollas ($3001). L at owner of the pmoefy. Or my empresses with wages as their Selo corn. Iion, win Ao as week and Sc YNd ye a not Intended or offered f(t tub (Get 7044. Buren and Professions Coda: The Contractors License Law doesm N;ly ban on or popery who bads aimprovesmacm and ale ems such rah hanself or herself or throat, Ns or her or employe+. pmtla Intl such improvements are r0l lnlueen or offered for WO. IS however. ese bra lg aMn a,Y'MMII R ado 'wean ere WarWlnaean. Pe owler{WCer two NM me pore rya ne a ere a non Ordid a engrave fa me puryse F Sa10.). I, b Owner of Lb empathy. am esduswely mmoadog with licensed MN 1• - to meoud me area (See 7044, Surest sec Pmbsattm Coda The Jeters beer Law pea net arty b an owowoe arrest woe OAPs or rry -Pea thereto. Da who mnoacs:or sad nomads arm a omradal:l fame warrant to mmm Creators Use Law, ), exert urea Std.Ne BSP.C. Ice thin mason A(3-03 %<e ,A Data Serra A UCEMSED CONTRACTORS DELLA7N11ON 1 rasoy Alum undo peals el pansy that l am beamed rater mentor Of Char D (commendng MN Sypdw r000)et Orton 3 of the Ba,ma and mbssta Code. sac my act- . • 4 Mimosa ar plea. license Can, ber Date \ Sgnalum of Contractor D WORKERS COMPENSATION DECLARATION here3y si raper pen thy.! parry one etne blbmng derratons: Q I have and wf maallw., a refire of corm to seasons for Rykor campeossban, a pa'Med for by Seam 3700 of the LUAor Code, fe Ma per. foram OP Sc truce which this pemut a lames. p I nave alto wnm ainta n wo e,t gmonsalm insurance. as reread by Sec 47aa be Lacer Coon. tome mdamence CO Esecaa Ia watch but Dome a ousel My noteseasa0arV0n frowsy* char ant Peaty number an: Gra Peace Na. �/ n Cho 5w,_I mla as,ewwe 4 Pare , eMw„eeeasen..wlw�5(n I =Of; in the WdcaOf me welt for etc, tea parr herd.I notemploy as penal In say Rana w a e brae subject to the emtat mmpense,on laws of CNfane. aria area rat I and bootee subject :0 Me valLi mmpMyucin sons of Soc. 3700 of LAbceCods.1 Il fauiTe+n cam* am lam prow s. 4 IZi _le Stratum al'COWBIl WAANMi: FALURE TO &ICORE DRNER*TAN ENSARON COLASR 5A LAVIA4WUL APO Sella SIP 70AN EMPLOYER TO CRcNAL PO/ALTa(S700, a AMES UP make EOoDRED IA0041100( FORITO n•eCOa7OP CCVPFMS0FKR 0C DGSS AS PROYIDOD INEEC710Y S:M OF ME LABOR COW INTEREST AND ATP:KNOTS FEES CONSTRUCTION LENDING AGENCY I area arm row oeaJty of paw Mat Ira b e Gra nter trauP Sotnoy fa no aabmnnce of the work for ran alb pert:T !sac (BSc 3097. Cat C.). Leash Name Laths Arras C� N met I law /Ya lM amcato, and shale dun use aeons Clean) eas maac Iagree to comply with all clv— County a:anon and cab ' Nara ISD.IN TO baanfi IWMr apupae mapbnnOlives of thus erly IC tote toga one a WAN aj0 pjpa4A(a •eat er Alen SITE ADORESS BUILDING PERMIT BUILDINO SAFETY DIVISION COMMUNITY. ECONOMICS DEVELOPMENT SERVICES DEPARTMENT SSD Main Street El Segundo. CA Et245 Insoectlon Rung I Ina' (3101 A7.4a170 Not a svrr'zear SUITE / IDENTIFYING NVM.BtR ASSESSOR PARCEL NUN PACE PLIGN, I CONTA„T PEkSOr4 F Asv 40-*AtJ DATE 01 t..waa ADDRESS 2c6 4y elCAno k CRY STATE Ch PHONE NO. 32ZootZ ZIP C,C)245 PNOPbRTY OWNER E'er 4-14e3 ADDRESS GOt AR.Zr PHONE NO. 360 83t • 'Net. -Ott' Stz ...woo ARGNl GCT STATE CA t He'stc Crizfora ADDRESS ZIP 2c6 4ICAno Aran- . C STATE ,>0 CA J atet5 ENGINEER PHOVE G ADDRESS CI STATE ZIP CAIOdPNT�I�'tA��C��T0��0.'S NAME ;JOi+_ . 7 CU /4 . �Vt���FhLE•AI3i�, /I'h4.I�t 'V /r,r. .SOss T40Nt NO. 7 0 &02— & of ,tecrZar �'O05'lj 130059-ea. CAI/ -,c6c PLAN CHECKIPERMIT NUMBER: ` �/ 'i LMY USE S•-0G. AREA D JEW N mDENLAL Pu �d.w. USE LOS. AREA AL ERA lhO o3 a DESCRIPTIONO WORK: ifsa=h t ARKAOQ.. of I.rLL$t 30UACE FOOTAGE 'iA R- go STATISTICALLASS CIFICASIO No f7(Y oeo.CO VALUATION D C. SRPUPIS) IYPe SI OF CON B51 % 3 NO. OS ORI'e' UNIT(S) ear IIRc ,PRINNLERG PUN CHECK FEE G ENERGY PLAN CHECK $ IN • IALS REVISED VAO.Iif, T1N // PLAN CHECK FEE ENERGY PLAN CHECK PERMIT FEE RETENTION FEE SNIP PEE ACCELERATED FEE TOTAL BUILDING PERMIT FEE DATE 3 3 SCHOOL FEES PAID r'i HEALTH DEPT. A APROVAL r—i SANITATION DIGT. PAID FIRE DEPT. APPI OVAL r—I PUBLIC WORKS TEES PD r—I SCAOMD APPRC JAL IC OSHA PERMIT OBTAINED r—( INDUSTRIAL WA FIE APPROVAL INA4tJ0Y - L r a 2 ci V In IRYECT1ON OATS INSPECTOR REQUIRED BUILDING INSPECTIONS AND APPROVALS Bl Loubn sin aeaads IQ SOD EmoaHMAppnal _ _ 03eaSailliGaGIOCUOns 51.62-4 7._ r C3 Bin Sbumral concede Fat al grade 85 Rases Boor Smug 96 Under Sore N>YYoon ^� ET CD knot Som.Fuaiaag _ Ba SOCab awe Co .Olathe .-• eO TledkaH Sox Sheaths* 'l 610 Pmiswduq ICOICaJ tlOh ._ .. - •. v Gran St ink Gann ... ■ OM Groutla v en Grout e12I Stara Waring 613 Fn Dept tans a.paTM au BoaSt2 m Dtpr berepee at J r rel f� _.. 615 Fee *mew harps . Sit asbSrnUeablor n8 BIT rawer tort mdCr dryasa % D:i 2 /l 018 Caesar Ian SW RatadtcoP:NPg assentHin B20 Rated war ay emeoa 021 Rakdcpenmg pmOloCvn 822 Raw call ecnMucian E"3 TLar .edge 824 La dIWOB 825 Penney DaV Nyco.11 826 CD Dspt ADDIre'al• 8n Pumb worts Oqt Apaays .• 028 Poe` &Ming vpealon approval . DESCRIBE COMPLETELY THE INTENDED USE OF ALL *PACE APPLICABLE TO THIS BUILDING PERMR: The following statement must be signed by the Building owner. tram ,Wwovad by en Bunt Orrkq( en ovn✓a awl may aro forDRmss *Mn than the maw or NM, bolding Ptrnle AY E4ybymo tuba* but.5apscoms.g lun4001MGgaa r. •%lovI or mbdure containing • hazardous material sees la a Dinar than mr amamr agbllba os Pa NLrdous minas internat. n GaoT Yes or NO .Rer II V o *miser loco qunhon Sea TM.Nn lad proposed Drafty orIllOdrod Daly b8 erns 10001M1 at ow outer bmrmary Ma school? Yes or Na caner I have mad the repeat material klamrlul 'MO and the SCAOMD wiener: LOedam I wden Gnd myNpfOment under The Maio of Cs aorta Harm and Sandy Cop Gerson 26505. 20533 end 25634 M00nn*s hazardous matey* repartee YO, a No .sou NAME SIGNATURE INSPECTION NOTES: • :. Y- c,q- -»-r-11,— "•V%O ©,3_;.$7 nzs `4