1060-02 - 325 MAPLE AVE E (3)VERSION 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
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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