1228-00 - 350 DOUGLAS ST NBUILDING PERMIT APPL.!CATION
OWNER -OUR -DER DECLARATION
I homy Own now DrOaty of Penury Mot i am C,eTOI trod. . Conncees
Comae W par tin aucwn, Mason ISoc. 7031,5, Beans ate Otearoom. Cone:
Any or cwCrony. 7-ltafl1MPurw u poring to Conroe& Keg, Myg q. demean. or
'ep any iwadure. RRs vita croon,. also etmNea Te erommettre Seat p0100
to lea a mown inner,. :• u,rwd :MO n Mawr roman to Ma ap1YMs Of Pw
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anepeE exemption Any vbtal.on C Sec loaf S By any ao$ 'af for s pearl
me 00000ant to a CM Senn to not noon tni ten w✓Wpl 11
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IO an Calory el property Woo DAM Down Uryyetr a wla tl er Coy
R'nsNl V tweet or rtoytl his ll1k Own renew-rm. ,Tn040 tar foal
are nrwnrntended or-+Jt�i�-�-�r II. however. Ile bal2:a= en.
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Lane law '.rgl.apOryW anal: a property cane Was or ten
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LICENSED CONTRACTORS LiECLARATtON
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WORKERS' COMPENSATION DECLARATION 1 (
N Terry Me Of PMMINoWyfI deowa:gs {i
Rune and. 1
as veo madIN a MN'no' 7'O Content tuac CooWe la w per.
as wdtler(oIOy Shoo T700ti.D. Leta Cole. tit The pee
aPw way linen lit re'wt...
tie Ynhoo TVnN wpkerS COMPetnital wMCO.tr et't r Dv
WM s Labor . ftoflm pe%OrmMUn the YR,of Malice Ireemu,
My woheyS Care tsa:ro ins NM Car Mr Ma pdN to near are
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not awry any penal In any manner so as to become urger IOW wptns'
lava 01 CalAom'a. and agree NY rl I (Onald become pineal lit e
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COVERAGEdRISMARUNUWR14NDOSNAftCS TONEHURDlEDiO
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oeby aTnace under M st.t4Wsee1tiiCweed((Sc. 30 T.CmC.).
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toner. I ogee to Comply en pry erq cowry a on.ao,n and elatels.' re-
Lw.D to Warta mnv on. hereby puck ramvsMmmes OIL any
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BUILD:NG SAFETY DIVISION
COMMUNITY, ECONOMIC, & DEVELOPMENT
SERVICES DEPARTMENT
35e k.:Bn Street
El Seoundo. CA BALM.
Inspection Request Line: (31S) 524-2379
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PLAN CHECKIPERMIT NUMBER: /d!o -Z
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ICI SCHOOL FEES PAIO 1-7 HEALTH )EPT APPROVAL
r-1 SANITATION GIST. PAID !1 FIRE DES T. APPROVAL
r—I PUBLIC WORKS FEES PO r i SCAOMD APPROPAL
T—I INOUSTE AL WASTE APP TOV..
j—� OSHA PE OMITOBTAINF.0
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ACING PERMIT FEE
RETENTION FrEE(
Sall, FEE (i
TOTAL BUILDING PERMIT FEE
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3 9. X5
$
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DATE
INSPECTOR
REQUIRED BUILDING INSPECTIONS AND APPROVALS
81
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Pubac Wats Debt Approval
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OECCIINII COMPLETELY THE INTENDED WM OF ALL SPACE APPL CASLE TOTHLSWEDNIG PERMIT:
The following statement must be signed by the Building owner.
'. (Mrwr aapranoby as INNanp OffIno $• 0 4' .n(s.ey sr bA^^Ng other fun Me MIWI or Yrep eulplq•Fermjt
Wtge appwant or ken atdng omrpent sancta n N:w o.a malpula 807s3OantaRrng a OaaardoupmaRost must :0 ofpretstDan Demean W.Iafial an thehakvdart matnab nlanvWn Du.GLT Yes of Na psi
n the anslw: S. me auosmn was Ws. sib meM emool bth1 lg w enabled WOaey 80 worse 1000 fool M To
Yes or -Wo - POT*, •
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rlww mad eiennaroa:n mabM!iHamMan Ou*M and the £CADpr; arn.:.b.-gmckkt IfMnslandrm- enurement ueos,» ate of f2Homa Hon and SafelyCodo Saari 2550S, 18580. end 25E84 nayrmnO hatrdaO matn7a it:Ann. Yes or No loos.
SC -NATURE
INSPECTION NOTES:
/3/O/ UAooL�eCnorot ell 4-z c-cr ✓�
2 -/-
a.. 17311p