108-04 - 129 PALM AVE WAPPLICANT / CONTACT PERSON:
TERENCE KWOK
ADDRESS:
109 E FLORAL DRIVE
MONTEREY PARK, CA 91755
TEL' (323) 697-2120
PROPERTY OWNER:
WANG HSING-SHENG
ADDRESS:
720 INDIANA CT # 1
EL SEGUNDO, CA 90245-3401
• E
TEL:
GRADING PERMIT
BUILDING SAFETY DIVISION
COMMUNITY, ECONOMIC DEVELOPMENT
SERVICES DEPARTMENT
350 Main Street
El Segundo, CA 90245
24 HR Inspection Request Line. (310) 524 - 2379
ARCHITECT:
ADDRESS:
TEL:
Permit Number: 108-04
BUILDING ADDRESS:
129 W PALM AVE
en
/�;60003-04
Tract. Book. 4132 Page: 009 LOT/Parcel)
DisiT2/3/2004
Appl Rec By: TUDYC
PC NO.: 0402-016
C Edition: CBC 01
ENGINEER:
ADDRESS:
TEL:
No. of Plans.:
Plot Plans Only:
No
CONTRACTOR:
ADDRESS:
TEL:
CITY BUSINESS LICENSE:
UCENSED CONTRACTORS DECLRATION
I hereby sttkm under pantry of perjury that I do licensed under potions of Chapter 9 lanmenaeg cal Section 70001 of
Ott 3 n and Outs and ROIWIos Cede and my license is In It font' end rasa
Lit pass Lit Number
Date Signature of Contractor
Et Date
Cubic Yards.: / 075
PLAN CHECK FEE5f 206.00
GRADING PER
FEE
$ 206.00
PLAN RETE ION FEE $ 0.00
TOTAL $ 412.00
I certify that : read this application and state that the above Information Is correct I agree to comply
with all . , d county ordinances and state laws relating to building construction, and hereby authorize
represe fuss of this city to enter upon the above -mentioned property for Inspection purposes
Data Signature of Applicant or Agent
- WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
I hero end will maintain a cent of consent to venture for watt cot
3700of the Labor Coif, for the Normand of Ow wax for when the plena I
I have and va maintain workers' compensation, as ratted by
for the performance of the work for which this permit is issued My wo
carver and policy number are.
Carrier
Policy Number
Mt section need not be completed d me
1 ably con In the performance of the eat for eft OM
so as to Scot Waal b the waken' compensation laws of
ions compensation motor or Sac 3700 of ton Labor
Date Signature of Appiccan
WARNING. FAILURE TO SECURE WORKERS C
AN EMPLOYER TO CROI ML PENALTIES AND CIVIL
($TOCAas) Ri AOOKnsn TO THE COST OF COMPCIMATI
TXP . Bann Male 1117F0
Saran
Labor Code,
Insurance
42xit
Una i- 31(Mt
any person In any manner
become subject la the
apse promMs
UNLAWFUL AND SMALL SUBJECT
HUMORED THOUSAND DOLLARS
VAS PROVIDED FOR IN SECTON 370e OF
Own
OWNER -BUILDER DE' TION
misty affirm under penalty of Amen sal I am exempt San Ind Con
7031 s, Went end PrnYtab Cale My city or County vkkt red
repair any structure. It to Its Issuance, also Means, the applicant
b aauad pursuant to provisions of Ow Octagon License
the Wdtea and Professions COOS) or Tat he or she b tempt
• Omitn of Sec 7031 s try any absent for a petit Subtle the
met realm
_I. as owner a Ts pretty, a my employes whet tips
p
Is not Wooded or Offered ra sale (Sc 7044, Went and
to al owner of Potty to bads or mprdas Taaw, aW
anpbees. anted poll bnpeverlana
mpr ennt b state one Mt Of aunato the
build or improve for the purpose Of ale )
I as catty of the popst aft avavtely
Balm and Professions Cede The corn ralae
Improves mereon, end who contracts for at prof
rety Bond $: 0.00 NO.:
Surety CO.:
Date Filed:
Rec'd By:
Cash Deposti $: 0.00
Date Filed:
Rec'd By:
Proposed Used Of Graded Site:
Dimensions of Site:
Area Of Site:
Supervised Grading: YES NO XXX
Supvg. Gradg Engineer:
State Lic. NO.: Phone:
License terror the following reason (Sec
I to construct, alter, Improve, demolish, or
permit to fie a signed statement Olaf he or she
erg (commencing Man Sec 7000) of St 3 of
end Ma basis for the alleged tenpaen My
m to a ter penalty of not more Ten Ova hundred
db compensated will d the welt an the saute
s Code The Contractors Ludt Law does t POW
dons WM work armed a homed or trough hie a Mr
Wired for I, howaw, MO budding a
Mh have the burden of proving that M or she did not
treed contractors to construct the protect (Sec 7044
Law dim not apply n en ewer O property who lulls Or
Cmvetter(n license pursuant to the Contractor* Leann Law I
I am exempt under Section , ' C for this reason
Date Signature of Owner
CONSTRUCTION LENDING AGENCY
I hereby Berm under pertly of penury Tw mere is a construction lending mercy for the performance of me wok for when
t panel a Wand ISc 3a% CN C
Lenders Name
Lenders Address
Cubic Yards Handled: 0
Remarks:
Public Works:
THIS IS A UNITED PERMIT. ALL WORK AUTHORIZED MUST BE
COMPLETED BY:
TIME LIMIT:
READ CONDITIONS BELOW
The work authorised horse by Issuance of Ts pamb H subpp to all the odes and regulations sat faith T the omit the
and anedmwite of Ow City al m Segundo. and gm awe at the eats of Gaubert T regard to such work, and all
amendments gland
TM. podia becomes moll and void If we* Is nal commenced within one hundred eighty ram days from date of
Issuance Or If work is auepanded or sty time during contagion for the sale peed el pass. or If any wok is
done In violation el the Cy Ordinance or Slab laws oovemino sem