1175-01 - 1310 IMPERIAL AVE E (3)sfregseia-
l
VERSION 12-2000
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of penury that I am exempt from the Contractors
License Law to the telowing reason (Sec FU31 S. Business Professions
and Lode
My aty or county wtadt raptures a permit to construct alter, ImAeve. demotsh, or
repair any structure. prior toes issuance also mares the applicant la such permit
to fire a spgled that he
statement or the d licensed pursuant to the provisions of the
Contractors license Law (Chapter 9 (commencing well Sec 7000) of Div 3 d the
business and Professions l.Wel or that he a she q exempt m¢/etmm yid Me bags
for the alleged exempam Any violation of Sec 7031 5 by any appfrant for a pennll
eds the applicant to a awl penalty of not more than five hundred dollars (150o) )
I, as owner of the property. or my employees with wages as their site ani-
ben. will do the wok, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code The Contractors license Law does riot
apply to an owner of properly WPO builds or Improves thereon, and who does such
work himself or herself or trough his or her own employees provided that such
improvements are not intended or offered for sale If, however. the btaldng or im-
provement is sold within one year of completion, the pyre -builder will nave me
burden of proving that he or she did not but a or enoove tor me purpose Of sale )
1. I as owner of the property am esdusivety contracting with Icensed con-
tractors to construct the peed (Sec 7044, Business and Professions Code The
Contractors License Law does not apply to an owner of properly who OneIds or Inn -
proves thereon. and Wto contracts for such protects wish a coneado(s) license
prsuant to the Contractors License Law )
1. I am exempt under Section 8 8P C for this reason
Ila/iwoI V eta
6�
Dale Signature of Owner
LICENSED CONTRACTORS DECLARATION
I hereby aeon undespenalty ofpepenuryMal I a licensed Under provisions of
9 Tanon Sectionand
g with 7 O Sion 3 of the Bu
ProfessionsCoWoeed end my license Is In tun t a effect
License Class Li N oer Expiration Date
Date Signature bacta
.----ele WORKERS' COMPENSATION DECLARATION
I hereby affirm order penalty of penury one of the fdbeng declarations
Q I have and will maintain a certificate of consent to sell -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code for the per-
formance of the work for wfurli this permit is Issued
Q I have and vas maintain workers compensation insurance as reduced by
Sec Tam re me labor Lode tar the performance d the work for which ass puma
is Issued My workers' compensation insurance earner and poky number are
Cams
Pella, No
Mrs cam roe] M be mipeled r re PAPA a Wore mxgtl PANTO Ii nl
I see* that in the performance of the wed for which INS penmil is issued
employ any person M any manner so as to become subject to the workers'
colleen inn laws of California and agree that if I should become subject to the
workers' compensation provisions of 3700 of the Labor Code, I shall forthwith
comply with Mose prows^' a •
pp��
/I-1i-01 `'�`�•
Da a Sionature ofApplicant
IDwARNING FAILSECURE WORKERS' COMPENSA
!ION
COVERAGE IS NAAW1LEL AND SHALL SUBJECT AN TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS ES PR IN ADDMON TO THE COST OF
COMPENSA nom DAMAGES AS FROWNED FOR IN SECTIONMAOF
THE LABOR CODE, INTEREST, AND ATTORNEYS FEES
CONSTRUCTION LENDING AGENCY
I hereby affirm under
penalty of penury that there Is a construWdn Iendlnp agency
for the performance of the work far whkii IMs permit is issued (Sec 3097 Cr. C I
Lenders Name
Lenders Address
I certify that I have read this application and stale that the above information Is
coned I agree to comply with all a county ordnances and state laws re-
tabne to building MstNdWn and y aiitrgnie representatives ot t s ON
d enter upon the above-m lbnt poses A
lie if -PI
D to Signature of Applicant or A
BUILDING. PERMIT
BUILDING SAFETY DIVISION
COMMUNITY. ECONOMIC DEVELOPMENT
SERVICES DEPARTMENT
350 Maln Street
El Segundo, CA 90245
Insbertron Request line- 1310152
SITE ADDRESS
)( 1310NUMc , I0Pf21AL /4,16
SUITE I1DENTIFYING
ASSESSOR PARCEL NUMBER �y)�L��-/�
APM PAGE WITE rI I r'V
APPLICANTI CONTACT PERSON
MM PP13 ruts
DATE
n
� �- LI T
ADDRESS'
) 310 E - IMPt1 n t
PHONE NO
b40-282'
CITY S5/�/�..rr (�,,7�yI• Iw/T 0
/OPERTY
STATE
Ce
ZIP {p[2'/j1
OWFER
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PHONENOC
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4/ I - I10I
RES7r�11
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STATE
CA
ZIP
630 24 c
CITY
6L,S f.CiiiJOO
ARCHITECT
PHONE NO
ADDRESS
CITY
STATE
ZIP
ENGINEER
PHONE NO
ADDRESS -
CITY
STATE
ZIP
CON tRACoTO(RRSS NAME
6
CITY LIC NO
ADDRESS `
PHONE NO
CITY -
STATE
ZIP
PLAN CHECK/PERMIT NUMBER:
/ /
NEW (ESIDENTIAL
Z —° /
LAIP USE
BEDS AREA
•(MP USE
13LUG AREA
COMMFfC1AL
1C
imp use 11la• AREA
;ON
ALlENAII(IN
DESCRIPTION OE WORK(�J�� s#9/7'
)( tit crt/ r writ) r,1 foam L E, ! a S 09 FR o4 r
oP 6UILo/,-i4. AIPKOAI 12" LL ctrftts
fTn Say G. M C) CbnPoPa c
(Nos)- ILLurI I A/v, rtt1)
REF 0
OCC GROUP(S)
eYPE(S)OP(.UNSTNUCI Ili
SQUARE FOOTAGE
NO OF STORIES
FIRE SPRINKLERS
YES NO
STATISTICAL CLASSIFICATIOI
NO
UNIT(S)
CODE IN EFFECT
SV07�°
�kJ / s
PLAN CHECK FEE S
ENERGY PLAN CHECK $
di 5' Liz
/,VALUATION
'RECEIPT NUMBER
I INITIALS
DASE
$
PLAN CHECK FEE $
ENERGY PLAN CHECK $
REVISED VALUATION
RECEIPT NUMBER
INITIALS
DATE
PERMIT FEE f
RETENTION FEE 4
SMIP FEE $
ACCELERATED FEE $
TOTAL BUILDING PERMIT FEE $
SST
�T �//f 3- d
5 U �/4'� V
4:7, —
Zv
Y ✓ - 4 7--
FEES PAID
DIST PAID
WORKS FEES PD
PERMIT OBTAINED I-1
APPROVAL
APPROVAL
APPROVAL
WASTE APPROVAL
N. SCHOOL
_ HEALTH DEPT
SANITATION
FIRE DEPT
ri PUBLIC
r� SCAOMD
M OSHA
INDUSTRIAL
RECEIPT r-v t,.
/A (X,�
IINITIALSE_/�
1•INALEU
tic
/
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34151.
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NO
INSPECTION
DATE
INSPECTOR
REQUIRED BUILDING INSPECTIONS AND APPROVALS
BI
Location and setbacks
B2
Sods Engineers Approval
B3
FoundabanTrent loons
64
Structural concrete stab on grade
B5
Raised floor framing
86
Under or insulation
Bra
First level Moor sheathing
BB
Second level floor sheathing
B9
mud level floor sheathing
810
Rod snoalnna
all
Concrete block
1st Grout lift
2nd Grout rut
3rd Grout kit
4th Grout lilt
612
Steel tramng
813
Fee Dept frame inspection
B14
Building Dept frame inspection
B15
Fare spookier hangers
BIB
InsubionAyeather skipping
B17
'Manor lath and'or drywall
B18
Extenor lath
819
Rated floor/Ceing assemblies
B20
Rated wall assemblies
B21
Rated opening protection
822
Rated shall construction
823
Lbar caings
B24
Lot drainage
825
Planning Dept Approval
B26
Fee Dept Approval
B22
Public Wens Dept Approval
82B
Final Bmldmg inspection 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 approved by the Building Official, the owner's agent may sign for permits other than the Initial or shell building derma
WA the appacant or future building occupant handle a hazardous material or mixture connect a hazardous material equal to or greater man the amount
seedbed on the hazardous materials information guide? Yes or No task,
If the answer to the question was yes, wta the proposed buldng or modified laohty be within 1000 feet of the outer boundary of a school?
Yes or No teal
I have read the hazardous material nlprmabon guide and the SCAOMO permitting cheat's' I understand my requirement under the State of Caktoma
Health and Safety Code Section 25505, 25533 and 25634 concerning hazardous malenats reporting Yes or No tear
NAME SIGNATURE
INSPECTION NOTES:
ti. •?rot
GROUP
CITY CF EL SEGUNDO
EPT OF BUILDING & SAFE I Y
,t5ADORESS O e177 IZ l
OWNER S(e✓l-r_S Li C ELCONS-1�-V 2,j/
TYPE CONS
c'ERMANEN i
iLfE _
//-4 �( 0/
ROUTING
DATA
ARCHITECTURALJQTO' je
"PG'l ST4i,'DP9D
=L=t;l RICAL
MEC'& PLL",/BING
)RE PRF','-r FIO ''
LANNING
'9L IC V/OR: 3
TEMPORARY
PLAN CHECK Nf// 751 of
SIGN [URE
CITY OF EL"SEGUNDO
DIV. OF BUILDING SAFETY
APPROVED
All design & Installations shall comply with 199' ED dsCf t
81996 ED NEC Tho approval of permits plan, and
specifications shall not be deemed an eppro' al o' a
violation of any of the provisions of any code• or Doll
enforced by the city. No changes or altoretwns shall ode
on these plans without written consent of the Departmem of
Planning and Building Safety. If a field inspection indicates
the plans are Inaccurate, then approvals may no longer ou valid.
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IN OF EL SEGUNDO
r. OF BUILDING SAFETY
APPROVED
ED NEC.The approval of + •'
apuunw„v„+.....11 .._
e
1 tl nol any of the ora,c.•anao
i'tun.-. 1 '�• r ,. - .
with loe' •"=P•PCNMC
pndtED NECshall comply
tp68f : -no en c ,O0 0,. r•ude
rceC by the lily No chr+`+��" �" "" nt"`' • ;; al
these plans without w.tt cc t F • 'es
Planning and 6u:ld rc dak t� r gel , n „ -slid.
the plans aro Inaccurwe the- Kttt•tuvar ch„,
)I3daindwo3
LAYOUT FOR FOAM AND PLEXIGLAS SIGN AT
1310 IMPERIAL AVE., EL SEGUNDO, CA 90245
G.M.D. COMPUTRACK
CALIFORNIA STREET
G.M.D. COMPUTRACK
20' (THESE LETTERS ARE LOCATED HERE)
CITY OF EL hEGI NDO
DIV. OF BUILdING 4AFETY
AP P R .D -V
All design & Installations shall cotitpNvdth 1,77 r-p Jr
& 1998 ED NEC Tho approval of perms p •
specifications shell not be deemed Kr
violation of any of the provisions of urn -c • T
enforced by the cit. No changes or alto. _ •I
on these plans without written consent c
Plonnma and Building Safety If a h&c
the plans ure inaccurate, then approvals m:
SITE PLAN FOR FOAM AND PLEXIGLAS SIGN AT
1310 IMPERIAL . AVE., EL SEGUNDO, CA 90245
G.M.D. COMPUTRACK
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C1Ti, OF EL SEGUNDO
9 4OFPSUp['V�I�.Q® `
Aferre
F" • V UBcN�NMc
)designytnstallatlmla shall comply °"tc1997E ED.
ED Nn.C. 7hr appr-va 04p ar rp a., of any
&ope0 , h0a" shall PO, .• t ecrre a .ry r n,
iat on 01to it • It J ' tr , fl
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LAYOUT FOR FOAM AND PLEXIGLAS SIGN AT
1310 IMPERIAL AVE., EL SEGUNDO, CA 90245
G.M.D. COMPUTRACK