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1063-00 - 2250 IMPERIAL HWY EIP • APPUCANTAtipe k ADDRESS 1 W N CEII/TeAL• ki€ s‘wreefao Cg L.'ENrsE cyy ZIPii 1203 (p Ip/ 4 i 440,2 I 0 i NAME kLL2Y ADDRESS SDC.IPlaslai AkJY P ICIA4--461b CITY SEOvIVaD STATEIZIPeA•L1Qa q. S NAME X BUILDING PERMIT Building Safety Division Community, Economic,& Development Services Dept 350 Main St , El Segundo, CA 90245 24-HR Inspection Request Line (310) 322-7069 ADDRESS PHONE CITY STATE/ZIP m I NAME f -k ADDREss aag N. Motu. Mt ' PHO l801C4141 a) CITY 4tEr K fioaCi STATE/ZIP ak 9003 NAME 6 MAILING ADDRESS ia,S 741/ at' �,�.sre%= CITY I (3 /9 TELEPHONE ,r"�,s(/{iyJyf_70p'n— �(J V e 3✓ZIJ/L� STATE /I d _ ZIP �D /yl6 CITY UC NO PLAN CHECK ice 6,3-CD DRAWING NO 5/ • J o BUILDING ADDRESS daco E i PENAL. �I1vY rcL FL TRACT' BI.0)yKICiE /P�LOTiPARCEI 8 TYPE OF CCNSLr USE ZONE S NO STORIES USE OF BUILDING frI. opt GROUP REO'D YARDS 434 SIZE OF CONST 7© q Q} SPRINKLERED NO WET STANDPIPES NO DESCRIPTION OR REMARKS NEW ADDITION I hereby ante under pertly a penury eat I am iceneedd Under ;emblem al Chapter S my CoMmenelng well terse, a In NM aMe47003) a DMlelar3athe pros end Usti. CUY_ Lie NO Deb `J -PO Cam Signature (A/'r" WORKERS' COMPENSATION WORKER'S COMPENSATION DECLARATION //1 I hereby calm under penalty a perjury one a the following declarations9' O I have and will meeden a Certificate idself workers Illiiinnn consent to ban. Mr compensation is provided for by Section 3700 of Inc Labor Code ter me perform a I work for which this pemut is issued have and will maintain workers compenmbon insurance as required by Section 3 In. LaborjCode to me performance of the work ter wean this /permit a issued and pace Carar'�{�/��� Palk1'N r� 1J 11D 2-0/ (Tin section need not be completed d Me permit is ter one dollars ($100) or ass I army that in me performance of the work tor which this permit is issued I shall not employ any person In any manner so an to become sublet, to the woken compensation Lars of Celdorna and agree this It I should become subplot to the eskers compenssbon provisions of Section 3700 of the Labor Code I shell Imope Provisions Dale Signature WARNING 2vie to secure workers compensation average is fin aw7Gl and shall subject an employer to criminal penalties and civil fines up 10 one hundred thousand dollars (S100 000) in addition to the cost of compensation damages as provided far in Section 3708 of the Labor Code interest and attorney a fees J oo / ask T16' err'lol]e"tm BY Abbini a a 2-oMSr - Altr ch R rntrACLE - C/c/ 7#� I artily men I nave ad ma applabon and ebb Mat de stove tint is artsa I agree 10 comply with l sty and coany orernblees and sate laws msalp te budding constructors . y • authorize representatives of Ma city td Mar upon the above mentioned .. �'. ter sapedawl purpeM5 1 FOR DEPT. USE ONLY f-aa-flo -Dab. APPL REC BY pTEz OWNER/BUILDER I hereby seam ureter penatty of penury eat I et, exempt from tie Contractors Lomas Law for the following reason (Sec 7031 5 Business and Protenans Coder AnyAlty or county what Miami a Permit b =wie=O eon improve demolish or repair my structure Prior to Its Issuance also requires the applicant for such permit to Me a apnea statement that he or she is lioerose pursuant to the provisions of the Conbecars (commencing the Section 7000) al Denton 3 of me Business that he or she is exempt therefrom and per bales for the a) of Season 7031 5 by any applicant to. a perms sublects not more than Me hundred dollars (E500)) ) f I I as owner of me property or my employees w do the work end me structure is not intended Professions Code) The Contractors Lice who builds or improves thereon and wit.... employees provided Mat such . ... however Ina building or impr• budder will have the burden a ov purpose Of sue) ) I as owner o1 l e • • • construct the Pfol - .. Lipase Law ... who cony... Lucent )I. ex Law (Chap S salons Cadet or esempaon Any violaton applicant to a corn penalty of ages as their sole compensation will red for sale (Sec 7044 business and does not apply to an owner of e Properly $ such wont himue or Through his or tier own merits we not intended or altered for sue If I it Sold within one year of completion me owner mg that he or she did not build or improve for Inc ant exdufwely contracting with licensed contractors to 7044 Busies end Profession Code The Contractors nal apply rue an owner of propel who builds or improves Thereon and r such protects with a contramrls) license traumatic the Cbntreclors empt under See_ B a PC for this reason Date Owner act BLDG SAFETY FIRE DEPT PUNNING PARKS/REC PUBLIC WORKS CMP USE BLDG AREA CMP USE BLDG AREA CMP USE BLDG AREA W 2 W CONSTRUCTION LENDING AGENCY I hereby seam under penalty of penury that awe is e conskucnon lending agency tor the gMomlance of The wont for which this permit is Issued (Sec 3097 Cry C) - Lenders Mania OF JOB a It AOO S M I FEE CAT M VALUATION ENERGY PLAN CHECK me PLAN CHECK FEE Ys BUILDING PERMIT FEE PLAN RETENTION FEE PERMIT ISSUE DATE rJCJ S -ri-�-e) �) 7 i 'sd y).st` 22- 9/sip TOTAL S READ CONDITIONS BELOW The work authorized by !swan a the Parma a subsea to ail the rags and reputations Sat brit in Me ordinance end amendments of the City a El Segundo W the laws of tie Stet of Calderon in regard to such work end all emeriti. eewo This permit become, null and voa it work is not commented eta one hunted eighty (180) days from data of issuance or if work a suspended at any time dunng Construction to the same prod of am or it any work is done in titan of the City Ordrrlea a Sark lows pawterlp tame Lenders Address DiWadan WHITE (Dcpl) YELLOW (AppYaml due FORM B 102 Rev lit VALIDATION 003? .5L1 INSPECTION RECORD Plan Check No. APPROVALS DATE INSPECTOR APPROVALS NSPE_ EXCAVATION DRYWALL q.11 TO Tv" ✓" Bf( - _ - - FLOOR JOISTS STEEL FRAMING 9. Lo. DO � . LL44taL WALL ROOF BOND BEAM INSULATION PANELS LATH, EXTERIOR RETAINING WALL LATH, INTERIOR MASONRY = ACOUSTICAL FENCE ,` ENERGY FINAL 'b l ILO , REMARKS