- 610 DOUGLAS ST SAPPLICANT ( /�
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ADDRESS
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NAME
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ADEGE$S 2.4 ,na-ro_r2.Gl.VE In * - Gan"
CITY L., 4.1 pad •s_ci, STATE/ZIP
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I ADD ESS PHONE.
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CITY LIC NO of
2
I MI.>y LRAM order pray or perry mai I am kanf d Moan pm.tiens a Cnpw 9
icon' he'byi w t .bon NW) GI Drown 301 M throat. and Pta.ysona Coda. and
my Lance H N Natty* NKt
u(«hw MSS In No Syftfiltri
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oat. _J/zla/Ora Conti Sronatre AU./ 7 4
WORKER'S COMPENSATION DECLAPA ON \.� )
:way n.y Nam under under ptt4 el ptMYono a oera L0.or. tit d.claratdnt
I nays me;r. mainly" a tNNK.!e NLMseflW N[.MV, for Won' aeaa\\
froen3. as purpled let by Secn 3703 of St taw Code. forme ps1o'Mc��
O ( If• eM 01 im ohtc1C peinl if dad e
L` ]y�f—•• Ilan V4 art mambo's aMM.contW.a:O.nw.• we. as Nicoski by Semen
a7000l re Labx Code, to is a -cc -note o1 mh eaa for xn.cl. 9n Orn..l 4 dia./
`t tly op ks.‘conitonshissis rnty{M. Coles sad po!I Mm X. L� �a
W Carrot ,Tait ros"LI Racy Renoir rFJ� 0'{ l C) / /
t(TM ae3M mei al On eonpYYd 6 Si alms rS Me
Z I a.1h Sat nine pnrtamance d 04 we* 1a MrM
V MOUSY soy pm on n any lit net N es bacon,* I
y teas OfCydory..no ape PMdi 050M Norma
p.rr.nrnrLJ s °I Src37el the tsaaIshii
iOros
CaleI'44. Bgnstxh
ao Oasdras colitis (3100) N lass
atmn.l:isuad I that AM
KI o Oa calm comaiitAi
c la Om aeries'
... tabooW
r lint
lb MrtC..
La'0
alkyl*
WARNING: Feiwit aeolsxaaerrscr4 todIr rota On umlui.O.o Nu
sotto an emyWYer by>n^_'FOttcnos c Cord to a0 m..t Nadia Inbound
Pests W.7..: -,.01. n aW cCo to trio coot dame^: too, °amigos n winded lot n
Semen 3704of Oa trhOr Cozy. r.'eresl and aroma, a rues
' I Met/ Nomuniet pinery el a%Vy twat its cc. p Lan the Con4K10'a License an
leo 1M lob«erg reason (Sec 7031 S (Mons and Prvyscnf Coon Any ety or coney
' ranch .ioayn atmt to aaltva. shyb mpfoaa. dnrpsh or mar err suture. plot
1 WN.PuaaCt trio rpNYa S' gp.eanllcs won pNmr to ON a fiMd slat.MnhP.IM
I nd ate n tuMid p✓aWa b M proWaxq ol trot Catenaa Lens n(Chap9
I (amTPnon9 di Sector TWO) W t/. a-cn3 of Pel:nMat an 'eteOUS rand
I Sa1 N0 ire Y trump'. IM,Atpn ar4 M pus for m. opal .Itn) iy ..aeoem
01 boon74Ji S tp any coolant lb a petrvl subpart Nt appF✓. a MMa inner. 01
MImGa PM rye /wrihed dotsonlSSX111 I J
W- i I Las corer or Oa FCOa1N a to W00Ukas with p xl : oewe yton Wa n mmpin
oro roman' Vaan' Na a Malone re not offers' sac. ;Sec ZOO Boyne.* and
V - PIW.asMts Coda) TM CMFKHO bowie La f M tidy, to moans, M a pca:h
ra mho Vntls or mums. s 54*44 e4 eta such aM rumour a N modu;l y:.t or hat own
((((5.mporer. gaud that Oath ocpoi. Ca ars era nitaded at enema lot Sr. It
W turner. ter: or-tnp of iewo-rain t son w::Nn ota yam of canpatd., errs cash.
M+Ualera bya the bad.nti omgmtIM4- sMid rot OmWc Alpo. a lalM
3 : P40914c7 art
O ()1. as tow or Me Nilo Ern wittingly mambo; wan Icemen anaelparo
cenmaun. go- (Sects 7014 Bowes. and rta.spms Code Tot Conuauwt
lcac* Ls. %MI. rOi b an ova olpOp'M arm O.ehit V. mpots meet. and
*hot COnH{CIS ip such p:c ci.wit.aot,iclNlal Wantt wrist to ma COIOtrb't
' 11044 La«)
111 l am uampt one* S.c"- .1 PCWT4 pawn
Cate Ontnt_�,r _ —___
CONSTRUCTIONUfNG AGENCY
w IN'ryy than ui t penally ofpej.r/Fal'aen aN n a tonau0On Mnp agency lot
c SA a- 'c-mance d the w011y41.th Me arml tf wluad (Set 3091 Co C)
y. 1111106.4 Ilan
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ur901et.11
UMIty W WHILE !OWl YELLOW (*Want)
drys FOPM B, 102 Ira. '9S
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BUILDING PERMIT
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
PLAN CHECK NO. f1�_
ULD� i CDDHESS
SP E V
✓ yPaI.`
1Y E FCONST
USE ZONE
i T / I DRAWING NO.
BLOCWPAGE LOTIPARCEL
3
GROUP
RUM YARDS
I
NO STORIES SIZE CCONSS.
USE OF BUILDING IUDO ED.
SPRINKLERED '�TE�J NO
WET STANDPIPES YES ears)
SORPTION OR REMARKS: NEW [ADDITION ALTERATION
t ..Cl4rb cAft I � �
iZeno✓aal.'a aF IAEfi -tne./T ringioV&.
--tea Eta T'-r'v 4.4 r®
.r�� I :ice?
(\'/1r• rii/, it.-//d_r,h<
. IaM1ny moat i MT. taut Out worULM sottin Wl % atom vi9rmLH14 caned
Agfa, to coop/ .:ill 1p city Ina comp M. nitcaf and ant. hat rW:ty lobsni&lg
GNSLKOOry 1,1.'.lY aumMll lapreaanlsv aagpn ott W enter llpOn tY Oaoa
• •
▪ I non: � W n p rs`•�?� 2
/y/0 $
Sgntmrs of AppNam a Apron Da s
FOR DEPT. USE ONLY
APPL REC BY <' IDATE ._4.;4..
_Cxz. .. / 1 E
[-BLDG. SAFETY DTI —RE DEPT.
PLANNING I YAHKSIREC
I PUBLIC WORKS
1
CI
CLIP USE
I CMP USE
CMP USE
RI.JG. AREA
BLOC. AREA ----
�Dl DG. AREA _ _.
VALUATION OF JOB/\ $ 3 5 tie G
S-M I. FEE CAT• y114S ' fl 65
I
IENERGY FLAN CHECK `s ":__ _
PLAN CHECK FEE-'-
BUILDING PERMIT FEE
IPI Am!;eTEN-10N FEE
TOT
i 64, � j
Is -.g .it�.Q
s - ICE. _
AL s jl 1 LJ,- 9
PERMIT ISSUE DATE I I7 (", JOra
READ CONDITIONS BELOW
The waa .Tn'Vaa by ifs nMa of teas p tmil:f avoid I: sate ties t4 M1ya'at000 Ial IpNn
da adm.'rs set inuetdmsnia W mh Cray o1 El SpuUO. aM is lass siM Slag 01 C.ldaya m
rpm" so such peak Ind aam.rdmmtsmavb-
Tres perms Worries nub and .o4 d wok .s rot commsnada:Mrn one NMGed>ON lleo) drys
Item dale of:ssanct or d cork is tutanced at any Irma Arrp consitatpn la Oct t.mn v'Wd Si
en:. of any cork tt dona mrcttto Pea Coy Ordnarca si Slate Ices pwaMng urn.
VALIDATION
}
INSPECTION RECORD
Plan Check No.
PPROVALS
AEXCAVA
DATE
INSPECTOR
APPROV
I�ECTL'
ION
DRYWALL
21
'--it
JJI
FLOOR JOISTS
5 • 1 D . EnWALL
STEEL
FRAMING
ROOF
DOND SEAM
INSULATION
PANELS
LATH, EXTERIOR
RETAINING WALL
INTERIORLATH
MASONRY
ACOUSTICALFENCE
ENERGY
FINAL
REMARKS
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General ContractoLrans 2ua,. besign
Job Addrsss (,to S- Uoost.* r
CITY OF EL SEGUNDO
Sub Contactor7. Lis' 7
? 'Lb DO3°Cc // �ia,GK Date
Telephone 3LO-3ol. 44.17 Plan Check No.
City 4G >* • :,•
,tab Desc; ,,, :e.::
Corilpany Name 'e'
St, Lit. No.1Contr.`Acti; egS - : =:
Ci4Y; .; r * - r,�,
�'i 10[t9u k«
Pbtltot,NO.` E
1204 t ': s .
.
6°1 "..vL,
Elec.
2"nrnes f• 5; e,
594Qiy
/(cor, /0,- co Gr.
trf.e.co
3b 3Yzczsro9
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Ki)0
PALm.6.n9
TT ;�yy
X✓1.f
Gr/1%r.fyn�
ves-sec. iv.-.p..
L.,.,.32324/
Slfere
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f15f49/I /'au/' l
SW S A9 h .5
66/5V95-
.,$$75 ✓en jka
CA/Aboso5
1t1S-,7/-o66iS
6 J
ge Peered &,e,
7z Z 7 3 f
(06S18 Rrsedr. Will/
gig 705
i(4,u4ic -
i-y).;.O
i�j1
CY4/c%
sue et USA
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Blv
C� ve. C.'{ y
t4� B1v7 777�
n.Lf E
Centtacti,y.
/L7oLmnyne4:a/1ZE
12.ve/sus
909 .272 Lino
II
El Segundo regulations require any person conducting business in the city to first procure a ci y business license (5.04.010 ESMC).
Before a FINAL INSPECTION is given or a Certificat ' of Occupancy is issued, this form MUST be completed. This form must be returned to the Business License
Division and all city licenses verified prior to a call for a Final Inspection.
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motk'e iwaCini
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OWNER -BUILDER DECLARATION
1 homey rem unsf;haM Of penury Net l onexempt from Cu "erne, to 'Ire
Law Sr Nof' Iry cn(yt 70315. Bermes, and Pretensions Cede' Any ay Or
county wbtlr morAn a penal to construct alto:. rngeow. demolish or Nat Cary
YNaro p+T:a Rs issuance, also rewires NO hem'- nnt foe such porn to Lin a veined
enemy t'he Of she a ''ceased pursuant to the prow:NMI aNO Canu dpa License
-anon tem s . 3 e': ,+air hcod Pewees
W Cci or that he et t Wm rump! Curetron aro O. tons tor NO aiie td exemption Any
do->Arn n of 57Gr S by any apacart Kw a poni4 saiyxs he npitcant w aG.:
naay a not more than Inc NnCroct dos. s le-n$
L O4Nynex of No p.9.rOy, Or ray wnor,_ n+m wages ma tees sole
mmoen,as,,n. teat Gavin work. nd lee MN aro- n'erdw- or rmemY for sale (Sec
7A14. Ex: -r.'. and Rxe,rw... Coon' Tno Contraden. I,r rce I m Can tro, ayw/N
an Mr C lv.n.Y
oohohalals to yryyOand
oves afron. aw.0 a+, au:. work Iumw:or
ernelr or Moot) hoer her own employ... pmwra that ,vet .rr:yownerts are not
mended P C It -red roe sole if. however. to,, bur.Orng of mmrovammnt t sold wrN,n one
Mar el Comp Non. the Owry.yyder tea have Inc burden IA plow V, that hew she did
not toed or m row for the purpose of sale
,_ I, as wm ,e. of the property, aetdusbely aNtracbq wN Icahn, contractors to
mmuud'he propq (Sec 704:, Buseern an, Plata. MS Coda. The Contractors
Loan, Law Ides not apply to an Omar M properly wNa Quads or unpwes thereon. and
who contract, for ='+Or projects with a eontracttNt) tense tenant to ter Con radon
Lmense Law $
I am exempt under S.c' _ B.PC b the reason
Date Sgnrwm of Owner
BUILDING PERMIT
BUILDING SAFETY DIVISION
COMMUNITY ECONOMIC DEVELOPMEN,
"'"RVICES DEPARTMENT
350 Main Slrcet
Elsegundo. C. 9024S
24 HR Inspection Request Line: (310) 524 - 2379
PLAN CHECK/PERMIT NUMBER: 20-04
DATE: 1/7/2004
30C19-04
NEW
RESIDENTIA
CM? USE:
BLDG AREA:
ADDITION
COMMERCIA
CMP USE:
BLDG AREA:
ALTERATION
CM? USE:
BLDG AREA:
SITE ADDRESS:
610 S DOUGLAS ST
LICENSED CONTRACTORS DECLRATION
t hereby asmn under penally of pef y that 1 :on Lrnrced under provisions of Chapter 9
(cone ,nrg attm Secaon 7000) of Diction 3of Ire Bevnesa and Protr$ssona Coro.
AM my krone is in for force and ettN
Lac Gat, C16 we Numbr 7s13Cr Exp Oar 10(31/2005
—
Date,
pf Convxta L
WORKERS' COMPENSATION DECLARATION
hereby atom under penalty Ol penury And of the talMMmp a .daeaoma:
I have and wet maintain a comfcato a Consent to setrelm 10 **ten'
cenpensabat.as wooded for bySron 3700 of the Inbar Codo. Ier the performance
of the won foe which con Vent a rsmono.
1 nave and war eminent w thenrcorrN eaapn. as mewed by Sector. 3700 of
.a'.aad'Code. force perwnanya of the went for witch this Derma is n.sued. My
worms' uanpaasalcn rsurar x<-amm ad pricy mambo; am
Carrier ST FUND
Policy Number 0024484
and cow$ r.ed Mt b. comma eh. o.na a ne e e wa$e.d &au« n cool
honer
er thee
wry veer me set Omens: en perms is wham:Sh in .Wwy sty
Men a Lan "mane b Pe vise' Mmernwnr Mr tl Caatemu. w4 open
were ffrmr..ekwreermw.wte..m.+o+ers.< »loam.'
rova oedIrsemcor.ueont use s /� _
/i/ sgawmMAwlio2L stint 'A Tc:
WARNING: FAILURE TO SECURE WORKERS COMPENSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT M EMPLOYER TO
CRIMINAL PENALTIES MID CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS ($100,000), IN ADDMON TO THE COST OF
COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF
THE LABOR CODE, INTEREST„ ID ATTORNEYS FEES.
SUITE / IDENTIFYING NUMBER:
DESCRIPTION OF WORK
F/S RELOC 7 ADD 13 Out of Scope Fire Sp inkier
REF
OCC. GROUP(S)
TYPE(S) 0: CONST
ASSESSOR PARCEL NUMBER
Book. 4138 Page: 010 Parcel: 301
SOUARE FOOTAGE
0
NO. OF STORIES
FIRE SHRI 1KLERS
YES: 150:
APPLICANT / CONTACT PERSON:
TAPIA CANDIDO
ADDRESS:
27071 CABOT RD #103
LAGUNA HILLS, CA 92653
TEL: (949) 348-9118
STAT CLASS
ors Fire Sprinkler
UNIT(S)
CODE IN E°FECT
CFC 01
PLAN CHECK r" $ 47.84
$5.000.00 STORM WA1 to $ 0.00
VALUATION ENERGY PLAN CHECK $ 0.00
PROPERTY OWNER:
610 PARTNERSHIP
ADDRESS:
26 OAKMONT OR
LOS ANGELES, CA 90049-1902
TEL:
RECEIPT NUMBER CLERK I DATE
EG 11/72004
ARCHITECT:
ADDRESS:
TEL:
50.00 PLAN CI PECK FEE S 0.00
REVISED VALUATION
ENERGY PLAN CHECK $ 0.00
RECEIPT NUMBER
CLERK
EG
DATE
CONSTRUCTOR LENDING AGENCY
I tamy atrium under penalty of penury ;hat Pon w 0 mutru0en knew agency the
pertormanoe of Neyat tor nmidt Otis (Anna is =nen(Sac 3097. C.a C.).
Lenders Name
Lenders Address
ENGINEER:
ADDRESS:
TEL:
RETENTION FEE $
SMIP FEE $
PERMIT FEE $ 36.00
1.00
1.05
ACCELERATED FEE $ 0.00
TOTAL. FEES COLLECTED $ 245,89
I coneyNat I Nye read ems avocation and date that the above elf remotion acorrect. I
are to maplywit al: oty aroteanty ordwan rsa d sore laws rotating ID building
mmebudon. aro homey auC oe rapfeambNesofNaCalf Manta. uponthe ahem'
_ awd arty lac inspection Outface e z
1/
6�Sym namdApplicant MAgent «et (We
/1/1✓
CONTRACTOR:
NEPTUNE FIRE PROTECTION
ADDRESS:
27071 CABOT RD, #103
LAGUNA HILLS, CA 92653-
UITY BUSINESS LICENSE: 21962
C/TY COPY
'TEL:
12/31.2:1
SCHOOL FEES PAID
SANITATION DIST, PAID
TT: PUBLIC WORKS FEES PD.
OSHA PERMIT OBTAINED
RECEIPT NUMBER
HEALTH DEPT. 4PPROV
FIRE DEPT. APPROVAL
SCAOMD APPR DVAL
INDUSTRIAL WASTE APP
NAG o