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1060-02 - 325 MAPLE AVE EVERSION 12-2000 OWNER -BUILDER DECLARATNIN I hereby elfin Under penalty of penury that I ea amyl from the Contractors License Law to the tdbwna reason (Sec Mil 5, BUaness and Professions Code Any thy a county Midi requires a pennd to construct. alter, reprove, demolish, or repair any structure, prior to Its issuance, also requires Me applicant to such pemmt to De a signed statement Oral he a she Is licensed pursuant to the provision of the Camera License Law (Chapter 9 (cona.,ccky with Sec 7000) ot Dw 3 of the - Busmess arc Professions Loren or that la a stir Is exempt acehan and the basis for the afeged exemption My yldabm of Sec. 7031 5 by any applicant for a permit sW�e� the aperture to a cal penalty of not more than Me hundred dollars (MO) ) u I, as mule of the properly. a myemp(oyees with wages as their ores coon 770444, Busn°atessand Profes w Cede The°Cmtractoorss LicU nseoRLaaww fdooes noot(5ec. to apply an owner of property who builds a Improves thereon, and who does such work himself herself trough a a his a her can employees, prowled that such improvements are not Intended or offered for sale If, however, the building or Im- provement Is sold Won one year of completion, the oweeranlder wit have the burden a proving mar ne or ya did not orb a Improve to the purpose of sale I I. as owner of the pro arty, am exclusively contrectug with (tensed coo tractors to oorstud the project (Sec 7044, Business and Professions Code The Contractors License Law OJM nor apply to an owner or properly who paps or im- thereon proves and when contracts for such projects th a contractor( s) license pursuant to the Connectors license Law ) IN I am eaernpt under Sendai B AP C for his reason Date Symature of Owner LICENSED CONTRACTORS DECLARATION I hereby affirm under penaltyof pequry that I an, (tensed wider pr°nsrons of Chapter 9 (commenting with Section 7000) of Division 3 of the Business and Professions Lode and my license is in lull lace and erred License pass License NwMer Emratan Dale Date Signature of Contractor WORKERS' COMPENSATION DECLARATI • I hereby affirm under penalty of pequry as of the following . :.. . . I have and wBmanan a certificate of consent to.:. :fa compensation, as provided for by Sedtm 3700 of the :... . -, for „ '... tormented the work Or which this permit Is Issued I have ad Ma maintain woofers compensation in Sec 700 a rue Labor Code, for the pertamance of the to di t is .. . is issued My workers' tompmaaton msaence canes - - ber :. . Cemer y Poky No me men aW as b tense d Ta parrs straw breed Mars aMat w ass1 12 I catty that in the performance of the work for Midi Ws permit is not employ any person M any manner so as to become suged to .: -. •'ai compensation laws of California, and agree that ill should berme - .. . „ the waters' compensabbm provisions of Sec 3700 of the Labor Coda, I '- fmnlrMth aarwy win those provisions Date Signature of vnt _ WARNPW FAILURE TO SECURE WORKERSNSA nON COVERAGE IS UNLAWFUL, AND SHALL S : AN EMPLOYER TO CRIMINAL PENALTIES AND Cup. RNE O ONE HUNDRED THOU.SAN0DOLLARS (TWOApO),. - .. ro THE COST OF COMPENSATION DAMAGES AS • FOR IN SECTION 3701OF THE LABOR CODE, OVTEREST, AND ATTORNEYS FEES, CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of penury that there Is a consbucbon lands* many for the performance of the work for which tea Dana is Issued (Sec 3097, Cr, C ) Lender's Name Lender's Address I certify that I have read this application and state that the above Information Is correct I agree to comply with all sty and county ordinances and date taws ra- tably to imam Caatudjon, and hereby authorize repreffintatives a Mrs oty to enter upon the abovemention ed properly for nepectan purposes Date ScnaMa AoolOant or Aoent SITE ADDRESS BUILDING PERMIT BUILDING SAFETY DIVISION COMMUNITY. ECONOMIC S DEVELOPMENT �- SERVICES DEPARTMENT 350 Main Street El Segundo. CA 90245 I Insoectlon Request Line 11101524 2379 32.5 East- I4APL•E A'e OL SUITE / IDENTIFYING NUMBER ASSESSOR PARCEL NUMBER soot PAGE APPLICANT / CONTACT PER Fi2ANK ADDRESS 200 kL CITY sE6 OPE OWNER -t " K .;" t4 ADORE 3 CITY EC,uN-oPo CT PAROM. DATE a oz Py" NO vi t0 22 oo 22. ZIP _90245 PHONE NO 7 to 3Z2oo22 MOLE AX.»t STATE AA cJ . {r1ZAP K Gi L�(n1PJ ADDRESS 20s {J. AT1(14O Ave., ZIP ,02°t5 PHONE NO 7 to 32Z Dolt 2. CRY STATE CA- ZIP 7� fir `s S ENGINEER PHONE NO ADDRESS CITY STATE ZIP CONTRACTORS NAME 0 WP1IA CITYUC NO ADDRESS PHONE NO CITY STATE ZIP PLAN CHECK/PERMIT NUMBER: ' CA42 O —0 2 CMP USE SLDG AREA NEW RESIOLNDAL CM? USE DG AREA ADDITION MERCIAL LMP USE LOG AHLA ALrEHA •. UES,yC-RilpytoN O WORK Up 4o" µl crew, WA'U. go' LONG..,.. ,a r 'I F 0 OCC GROUP(S) IYPNSI OF CONSTRUCTION SQUARE FOOTAGE NO OF STORIES FIRE SPRINKLERS YES NO STATISTICAL CLASSIFICATION tic UNIT(S) CODE IN EFFECT S 2 LJ� PLAN CHECK FEE S ENERGY PLAN CHECK S VA UATION 'ECEIPTNUMUEk INI fIALS DATE S PLAN CHECK FEE $ ENERGY PLAN CHECK S REVISED VALUATION RECEIPT NUMBER I INITIALS DA rE PERMIT FEE S RETENTION FEE S SNIP FEE S ACCEL RATED FEE S TOTAL BUILDING PERMIT FEE S FEES PAID DIST PAID WORKS FEES PD I--] PERMIT OBTAINED APPROVAL APPROVAL APPROVAL WASTE APPROVAL _ SCHOOL _ HEALTH DEPT I—] SANITATION fl"] FIRE DEPT f-1 PUBLIC SCAOMD I—] OSHA r -i I INDUSTRIAL RECEIPT NUMBER i INITIALS DATE ZINALLU Uy DATE 0 C r 0 z c). -U, m z r 0 Z NO INSPECTION DATE INSPECTOR REQUIRED BUILDING INSPECTIONS AND APPROVALS Ell Location and setbacks B2 Sods Engineers Approval B3 FanesbNTrerrh forms Bs Stmctral concrete slab rot grade B5 Raped Doer framing 08 Under Roth nsubbon 87 Fink level door sheaWng B8 Second level floor Sheathing . 89 Thrd level Door sheeting BID Rod sheathing B11 Canasta bloat Ink Grout eh 2nd Gaut MI 3rd Grout M 4th Gmul eft B12 Steellndrnbp 813 Fre Dept frame inseams.? B14 Eusdrp Dept frame nspMAon B15 Fre spanker hangers • B16 Insulation/weather SBDpbg Bi? Inlorer bh and/or drywall BIB Ealmv bh Big Rated floontalin9 assembles 820 Rated was assembles 421 Rated olemng polecton B22 Rated shall canwcbon B23 T-barcengs B24 to damage B25 Pbmatg Dept Approval B26 Fee Dept Approval 827 PuNi Woes Dept Approval B28 Final Budding nspecbon approval DESCRIBE COMPLETELY THE INTENDED USE OF ALL SPACE APPLICABLE TO THIS BUILDING PERMIT The following statement must be signed by the Building owner. (When approvedby the Building Official, the owners agent may sign for permits other than the Initial or shell building permit WI the appwanl or future Iu13Mg occypapt hands a hazardous metered or mMwa contesting a hazardous material equal to or greater man the amount seethed on the hazardous mateNLs ntennabon gueei Yes or No 1e1 8 the anther to he question vas yes we the proposed budding or madled briny be pawn 1000 feel of the outer boundary of a sdeol? Yes or No them I have read in material bdamabon guide are the SCAOMD permmalg the dhst I understand my regurement under the Slate of Catfoma Heath and ly Code 25505 25533, and 25834 concemblg hazardous materials rearming Yes or No laat SIGNATURE INSPECTFQN NOTES:. t. r, C1 M DUSTING CURB CIS 3fIN3A`d 31dVW WE PUN 325 EAST MALE AVENUE- DRIVEWAY RERACEI@JT - GARDEN WALL Is e 45-T EXISTING SF R us. BADHR of eV are OWNER _. _.,�..3Rolje PERM ,A tv122 REMOVE AND REFUGE NEW DRIVEWAY• ' TMCK 2 OODP5I CONCRETE WI 5XB WI 4X1 4 a LOAD) I Y OF EL SEGUNDO aTLIE BUILDING & SAFEIti ARCHITECTURAL/STFI!" ENERGYSTANDARD _ ELECTRICAL VIECH & PLUMBING IRE PREVEN ; IOI\ NNING Sir WORKS ROUTING DATE 0 SIGNAJUr4 TEMPORARY - PLAlNCHECKNO�_0Z f��ar p 8Z