1082-03 - 610 DOUGLAS ST SOYRIEPBUROER OECLARr rt3N
I aaebr adorn ubw 1%/W1y Oi Pc/duty that I am eywyl ITM Ile CaII•300,
Lcenso It. tot the tdtowtn° roam (Sec 70315. &elnoss and Professions Code:
Payeeyor of wtadmam
ma a wend to construe; alter. Amtosa demolish,a
r arena. pna to its Issuance, alto mmares Ida ape ns tor such
:o tie a :Aped ualemem mat he a son Is Scentedperms
Contractors lkvOe Law (Claptoe 9 (ylwnenpursuant to the of O W l o a e
Busmen ern Professions Coda) a that ha A. she �» m Sac root) of D:.. S h ow
fa the aouRdenmplon MYMalona Sc. Mt.e9 by y anyt c ro n leend thebasis
. me a.Ttfant te a ar: pauCy a no: man man amased Saws
a Parch
J 1 w caner a the property. or my emaa.q ie15v bunted o (tura :
WnM4a e a the wort and to sWtloe Is not t.tbdod or �eced toe solo
ec.
704. Bunion sod AVteams Coda: The C[Nracatt Lamas Law deos rot aptly to an owns Stproperty who ha or improves thereon. and inn pop soot Mown Name or herselfor owomi1 Ns or her owl ernabysm pro -ado, Mat huts
improvements ere not Internee X armed Me Fain. I. hammy. ON aµattg or ins. V summon h LAM math, ale)ea a Cpmptaoe the dmbtmMdee W have Ma
[amen of peok1° that lie« she as not Aetd or .tame tot me owes. a ADO
O I. as cob of the pm o . am OA nYrdr contracting well hawses con -
imams to 2n¢•ud Ind Pe)ea (Sect 704.. Badness rd Pofessions Code: Th.
Common Lktme LOW dads nalapayloanowner aapeerhwins Lott ores -
oats' amok and who contract. to Rich potcb .era a tr OXs) tkalw
d... to Ow Ctactps License [}y )
O I am exempt under Section BAC C. toiNs tea son
T Oow Mre aO.mer
LUCEM..cD DDNlfACTORS DECLARATION
•Here yA( �site a INN alk7 1 mats an lMly order pecaBMoof
PradamM Code. a'dmy Ito i, In rSetco ue Iota and noNSIon es me (L.Vyayq
a Conhaoa
WORKERS* COMPENSATION OEC-ARATION
I hereby learnt under tonal, of penury erne a me INownd aedarsa ma:
oasnensaevManVN vt for by Swami O a PO Lebo. Code. II.,Ow
f as a
f:ann a the was to Msq MU Remit Is Issued.
Me and we nwwan oAM mmbm+rtm ameanm. sa naiM by
IA of No tabor Cote. M the perfomw.ee of a.aso* fee M.M too -tam
a u. My sotto.' conpw.Wu. wvraoe Ci.M end poesy ins' . .
Dery
Pow.. ou
��11 auuesaraemrare tor.. edw was dam✓
i•o�oatern I cantsn peon an inm of Inc wall tor aeMhthis pemlf weaurd.
pka.my peso in an^ewMs so as tosbecalma Sitieaard w'atrr coteret cn Iwyof CYAmW, and spree that t I shed e.mne'abject Ioen
worse,' cam: anonamons to of Sec. nW et the Labor CcEss shad femMm comply elm r,ete Ppwamt
Rmewure
N.IRMMO: $AazRE 10 MECVRE NCalERYC041PENsaf7:111
CO.nteen A ANF)A AND y6VL SUBJECT ANEMPLOYER TO
cA9V✓_ MUMS APO CIVD. FINESup TOOK[ nrmoatD
rtl:CMhS• JNLRS groom. INAcorn:m/0 1NE COSTA
CONFNSATON D.AM*CES AS PR0WOE0 FOR so sECTON )Tat Dr
TNT LABOR ... INTEREST AND AnamNErs $E65,
CONSTRUCTION LENDING ACENCT
I hereby atfe n under per a yof pm)W Nab thee as a cons i,C.An twang agency
Ta the .Tfarr. c. ofC work Ca Mtiy. this pans Is issued Moe 3.997. CI+.^:.
Lamers Name
.Stoats Adreta
I meatotemIr.ew rama nNwyae aai eye Nine YtlrNeetC.. Wnnerdt
epee o dowdy awn at eras 'moon adbe%Ona and slab tow for
mono to b. ao emus -whoa. awn:wa y 'woman Npeseryypya ohms oty
to anbt ton Ne etown.am.pNO moped! hi Vnceabd pinose.
( EMCN.IEC.
1 I1
BUILDING PERMIT
BOWING SAFETY (ANSION
COMMURDTY. CONDMIC & DEVELOPMENT
SERVICES DEPARTMENT
El Segundo. CA 90245
Indgrtlrn Recant I Int. (,10) 52E-PTT9
610 S DocAtis AVE
-dr-
Et—TG7dEER
ADDRESS
Cm I oTA
AOPP!
i.Mn.stiq S &Rain° )Mtely:;OUYTC-R 17'dl3C ''SlowaroworaistaGRDINtc PERWT ECM REVISEDS
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las: CS -el
ZIP
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PLAN CHECK/PERMIT NUMBER: 7 b
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STATISTICAL CUSS
VALVQWN
PI AN CHECK FEE S
ENERCYPUNCNEC% S
A AN Cne< POE
ENERC . PLAN CHECK S
lnT:ALS lame
PERMIT F ES
RETEN'KN FEE
SAVO FEE
ACCELER:TLD FEE e
TOTAL I CROWS PERU T FEE i
r� 1 SCHCOL FEE; REDO CD HEALTH DEPTP APPROVAL Recto1 1 SANITATION I ITT. Accra C.j FM K OEPT. APPROVAL
C� r.wORNs ref a REDO CM N•s^cn) APPROVA.
= Op m Pain moans D INDUS TIBAL WASTE APPROVAL
;N. MILS I OATS
DATA
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