1136-99 - 2300 IMPERIAL HWY E R-1r
APPLICANT
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NAM Q 1AI IRE&L CO --
t4419%R7
ADDRESS /. Y W 4ebu PHONE(118)(dfl.(%3O
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1
CITY (j 41 f,.n STATE21�P-r r ,
7YflVW
Y
NAME
ADDRESS PHONE
CITY STATE/ZIP
ENGINEER
� PHONEh
ADDRESSDD 1�id Burled h14)145101L
fntilMOP tEACii STATE21P CA t1 t.4
PP 1100'"'1 Y Wed`' `'���I
L. CONTRACTOR
NAME
MAIUNG ADDRESS
CITY
TELEPHONE
STATE ZIP
CITY LIC NO
I hereby
affirm under penally of perjuryt a rem licensed under prow- beans of Chapter B
(commencing with Seaton 7000) of Division 3 of the Business and Professions Code end
my license is M full fan and effect
License Clan Lie No
Data Cony Signature
WORKERS' COMPENSATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally or perjury one of the following declaration
=1 have and wit maintain a csrmkW of consent to sel+mure for workers
compensation, as provided for by Section 3700 of the Labor Code for the perormacee
of the work for which this perms is Issue
I have and will masdam workers' mltpensabon insurance as required by Sateen
3700 of Me Labor Code for Use performance of the work for which this permit is issued
My workers oomp.rtaaban insurance earner and policy number are F
Lamer Policy Number
(This section need not be completed it the permit is for one hundred dollars (S100) or leas
_I certify that in the performance of the work for whi h this permit is issued I shell not
empty any person in any manner so as a become subject to me workers compensation
California
Laws of and agree met if I Should become subject to the workers compensation
provisions of Section 3700 of the Labor Cab I shall forewent comply with those
Provisions
- Signature
WARNING Feature to secure workers compensation coverage is unlawful and shall
subject an employer to criminal penalties end cell fines up to one hundred thousand
dollars ($100 000) in addition to the coat of compensation damages es provided for I
Section 3706 of the Labor Code merest and attorneys lees
"
I hereby affirm under penalty of penury that I am exempt Iron the Contractors License Law
for me rollaway reason (Sec 7031 5 Business and Profession Code) Any oat or county
wham requsn a permit to construct War improve demolish or repair any structure prior
to its issuance, also requires me applicant for such permit to tie a signed statement that he
or she a licensed pursuant tome provisions of the Contractors License Law (Chap S
(commndng the Section 7000) of Division 3 of the Business and Professions Code) or
mat he or she is exempt therefrom and the basis for the alleged exemption Any violation
of Section 7031 5 by arty applicant for a permit subteen the applicant to a ovil penaay of
not more than fete hundred cotters ($5W)) )
I,
() as owner *Me properly Or my employees with wages as urea me compensation will
do the the
r
S
W
3
C
work and structure is not intended or offered for sale (Sec 7044 Business and
Professions Code) The Contractors License Law does not may to en owner of a property
-who builds or improves thereon such work and who does suworkhimselfor through his or her own
employees provided that such improvements We not in or offered for sale If
However the budding or improvement is sold within one year of completion the owner
balder will have Me burden of proving mat he or she did nor build or improve for the
Purpose of sale) w
( ) I as owner of the property am exclusively contacting with licensed contractors to
construct me promo (Secbn 7044 Business end Professions Code The Contractors
License Law does not apply to an owner of property who builds or improves thereon ono
who conbects for such projects with a contactors) license pursuant to the Contractors
License Law)
O I am exempt under Sec_ 8 a PC for this reason
Date Owner
W -
Ca
J
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there a a construction lending agency for
the performance of the work for which this permit is issued (Sec 3097 Cm C)
Lenders Name I
-
Lenders Address - -
cce/q
BUILDING PERMIT
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
PLAN CHECK NO — -
BUILDING ADDRESS /' goorir(,R rtid '
DRAWING NO - -- —
TRACT BLOCICIPAGE
LOT/PARCEL L..-
ce
V
TYPE OF CONST
GROUP
USE ZONE
REO'D YARDS
NO STORIES
SIZE OF CONST
USE OF BUILDING AEe.. f_....SPRINKLEREDC/'
ES NO- -
WET STANDPIPES
YES NO
DESCRIPTION OR REMARKS
NEW
ADDITION
ALTERATION
SefiuMIQH 0 tfhtau(tg, sumps cot Usi Ewf4
1144Uffok tufu tOAKAVZ i DPI 'D — Ul
Billet eouwfatou5.
a
I y that I have reed me s pecat n red state that Ow above information at ormation canon I - certif-
ee to comply with ail (Ay and county ordinances and stab laws relsMlg to Melding
bunion. and hereby augmnze represerhbeves of ma city to enter upon Ow above
ter inspection purposes
Signature of plant or Agent
Date
APPL REC BY
(s
Gin
CG
O
BLDGSAF
FOR DEPT. USE ONLY
FIRE DEPT
PLANNING
PUBLIC WORKS
USE
CMP USE
CMP USE
•
PARKS/REC
BLDG AREA
BLDG AREA
BLDG AREA
VAL
W
hTION OF JOB -Y...
SMI FEE CAT %S
ENERGY PLAN CHECK $
PLAN CHECK FEE
BUILDING PERMIT FEE
PLAN RETENTION FEE
TOTAL
PERMIT ISSUE DATE
READ CONDITIONS BELOW - The work authorized by issuance of this permit is subject to all the rues and regulations sat form in
me Ordinance and amendments of the City of El Segundo end the laws of me State of Caldonaa in
regard to such work and all emendinents teem
The permit becomes null and void tt work is not commended within one hundred eighty (10)) days
from data of issuance or it work is suspended at any time during construction for me same period of
time or If any work Is done In vlolatin of the City Ordnance or Stem laws governing same
ALIDATION
Diarmuaon WHITE (Derr) YELLOW (Appilcanil
dos FORM B 102 Rev 195
INSPECTION RECORD
•
Plan Check No.
APPROVALS
DATE
INSPECTOR
APPROVALS
DATE
INSPECTOR
EXCAVATION
DRYWALL
FLOOR JOISTS
STEEL
FRAMING
-
WALL
ROOF
BOND BEAM
PANELS
INSULATION
RETAINING WALL
LATH, EXTERIOR
LATH, INTERIOR
MASONRY
ACOUSTICAL
FENCE
FINAL
ENERGY
REMARKS
APPLICANT ,.
CPCik 4 eivOl tie/ ID b c tf)
ADDRESS I ,yy
5'112 taf4 -Qu6 Su• LOD
w N N P,ecH ZIP
PHONE
(114)4A5 -.612.
IARCNRECTI OWNER
�IAiA�ak4tbE/1N slcia45 Co. i
L S, .5wiy� PHONE( I4(41-n3QQ
ADDRESS lam �K/ 1 �l "
!
CITY / 1 V pi
STATEJZIPC*
NAME
ADDRESS
PHONE
CITY STATE/ZIP
ENGINEER
NAMOrseE-A,,
9 '°U,
ADDRESS PHONE
'Mils(' ibinp VEALAI STATE/ZIPa /1q7�
Y "L.,rrTl
WORKERS' COMPENSATION I CONTRACTOR
NAME
MAILING ADDRESS
CITY
TELEPHONE
STATE ZIP
CITY UC NO
I hereby Warm war penalty of popsy that I
(commencing wtet Section 7000) of Dlvison
my license Is in full lore end effect
lane Class Lie
am licensed under provisions of Chapter g
3 of the Business and Professions Code, and
No
Date Cons Signature
WORKER'S COMPENSATION
I hereby affirm under penally of perjury one of
I have and will maintain a certificate of consent
compensation, as provided for by Section 3700
of the work for which thb permit Le issued
have and will mamas, wwheta' comppaabon
3700 of tie Labor Code, for the performance
My workers' compensation Insurance loner
Caner Policy
DECLARATION
the following decimations
to selfiroun tor workers
of the Labor Code for the performance
msurary as required by Swoon
of the work for which this permit is Issued
end policy number we
Number
(This section need not be completed d the permit is for one hundred dollars ($100) or less
I cents that in Ina performance of the work for which this permit is issued I shall not
employ any person In any manner so as to become subject to the workers compensation
Laws of California end agree that d I should become subject to the workers compensation
or Section 3700 of the Labor Code I shall forthwith comply with nose
Provisions
Signature
WARNING Failure to secure workers compensation
subject an employer to criminal penalties and
dollars (3100 000) in addition to me cost at compensation
Section 3706 of the Labor Code interest and
coverage is unlawful and shall
civil lines up to one hundred thousand
damages as provided for in
attorney s fees
W(
Q
said
Swho
%.
w
Z
3
0
I hereby edam under penalty of perjury that I
for me following reason (Sec 7031 5 Business
ant exempt from me Contractors License Law
and Prolesadns Codef Any city or county
demolish or repair any structure, prior
such permit to file a signed statement that he
me Contractors License Law (Chap 9
which requires a permit to construct, alter improve
to Ila issuance, also requires the applicant ter
or she is licensed pursuant to be provisions of
(commenting the Section 7000) of Division 3
Mat he or she is exempt therefrom and the basis
of Section 7031 5 by any applicant for a permit
not more than live hundred dollars (S5W)) I
f I, as owner of me property or my employees
do the work, and M aeuctun is not intended
Professions Code) The Contractors License
builds or improves thereon and who does
employees provided that such improvements
however the building or improvement is sold
builder will have Ibe burden of proving that he
purpose of sale)
() I es owner of the property am exclusively
consvuci ma prompt (Sedan 7044 Business
License Law does not apply a an owner of property
who contracts for such protects with a contrarian')
License Law)
( ) I am exempt under Sec_ B A PC for this
of me Business and Professions Code) or
Ice me slieged exemption Any violation
sublecrs me applicant o a am penalty of
with wages as their sole compensation will
or offered for ale (Sec 7044 Coyness and
Law does not apply to an owner of a properly
such work himsef or through his or her own
are not intended or offered for sale if
within one year of completion the owner
or she did not build or improve ler inc
contracting with licensed contractors to
and Professions Code The Contractors
who builds of improves thereon and
license pursuant to the Contractors
reason
Dale Owner
WI
0
xwl
CONSTRUCTION LENDING
hereby affirm under penalty of perprry that ben
the performance of the work for which this permit
Lenders Name
AGENCY
is a construction lending agency for
is issued (Sec 3097 Civ C)
Lenders Address
BUILDING PER IT
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
PLAN CHECK NO
BUILDING ADDR
TRACT
DRAWING NO
3(a- 9,
loco rV WINSIku - k% i (I )
BLOCK/PAGE LOT/PARCEL
TYPE OF CONST
GROUP
USE ZONE
REO'D YARDS
NO STORIES
SIZE OF CONST
USE OF BUILDING elf
SPRINKLERED
NO
WET STANDPIPES YES NO
DESCRIPTION OR REMARKS
NEW
ADDITION
ALTERATION
,1/ytf��puMvy tto` �(�1�Gfrpy(�1(��tp ��sunors roc,{ US}eldb,
twrkk
�t aktv.r u(1ucouNfaiou6•
for
1 certify that I have read alai end an pert the
above INTabm is coned
agree to comply with ell ally end co ordinances and stele laws relating SO building
Vucson and hereby aahaise repraaentab vex of Mrs bay to enter upon die above
property inspection purposes
Signature of
or Agent
Date
FOR DEPT. USE ONLY
APPL REC BY
C,
swi
CC
C
BLDG
FIRE DEPT
MN?
PLANNING
PARKS/REC
PUBLIC WORKS
V
Z
C
N
CMP USE
CMP USE
BLDG AREA
BLDG AREA
CMP USE s
BLDG AREA
VALUATION OF JOB yc'`'
SMI FEE CATS �l jt Zesis /be5f
$
CO
ENERGY PLAN CHECK
PLAN CHECK FEE
BUILDING PERMIT FEE
PLAN RETENTION FEE
TOTAL
s ! . 'PA 50
t ala ill
`AVE 4
PERMIT ISSUE DATE
READ CONDITIONS BELOW
The work authorized by issuance of the permit is subject to all the rules and regulations set forth in
Me ordinance and amendments of the City of El Segundo and the Imes of the Sate of California in
regard to suCh work and all amendments me-eo
This permit becomes null and void d work is not commenced within one hundred eighty (100) days
Iran date of issuance or if work is suspended at any erne drimng construction for the sane period of
time or d any work is done in viofeedn of the City Ordinance or Sob laws governing *erne
ALIDATION
Distribution WHITE (Dept) YELLOW (Applicant)
doe FORM B 102 Rev 1195
APPLICANT
Cit. l, a ylI 41 (OONm flA tErs)
ADDRESS I
4112e bop PA • Si. ►co
ITV ZIP
1410411101100 t(oaii GI2( (list) QM -lily
ARCHITECT OWNER
NAMEQjWjM s(s�is Co
lI
ADDRESSfSf1Lgas
L h 4 Jgab PHONEI leek3m
CITY 0, 4/,s tu4 ,pj STATE/ZI`Pet
PM'
NAME
ADDRESS PHONE
CITY STATE/ZIP
ENGINEER
NAM fin. ..'•
ADDRSIPHONEhWIQS-y1L
ginNi•s*vkI"ic ylyeie^ STATE/ZIP cA 6 `+�g4Q
WORKERS' COMPENSATION CONTRACTOR
NAME
MAILING ADDRESS
CITY
TELEPHONE
STATE ZIP
CITY LIC NO
I hereby affirm under penalty of perjury that I
(commencing wet Section 7000) at Division
my lianas e in hA force end effect
License Class Lie
am licensed under provisions of Chapter 9
3 of me BUWese end Proleesions Code and
No
Date Conti Signature
WORKER'S COMPENSATION
I hereby
DECLARATION
the following declarations
to set insure for workers
affirm under penalty ot perjury one of
I have and will maintain a cerefl ate of consent
campensatlbo, as provided for by Section 3700
of the wont far wheal me panne is issued
I have and will maintain worker. compensation
3700 of the Labor Code for the performance
eareMy workers Compeaton insurance carnet
Carnet2. Policy
of the labor Code for the performance
insurance as required by Section
of the work for winch Was permit a issued
and policy number aI
Number
(This section need not be completed if the permit
I Certify that in the performance of the wont
employ any person in any manner Mr as to become
Laws of California and apse that a I should
Section
is for one hundred dollars ($100) or less
for which this permit is Issued I shall not
subject to the workers compensation
become subject to the workers compensation
I shall torawah tcomply with those
ns of 3700 of the Labor Code
Provisions
Signature
WARNING Failure to secure workers compensation
subject an employer to Criminal penalties and
dollars ($100 000) in addition to the cost of compensation
Section 3708 ol the Labor Code interest and
coverage is unlawful and shall
civil fines up to one hundred thousand
damages as provided for in
attorney s tees
CC W
0
i
:T
W
x
3 I
O
I hereby earn under penally of penury that I
for the following reason (Sec 7031 5 Business
am exempt from the Contractors License Law
and Professions Coder Any city or county
demolish or repair any structure prior
such permit to Me a signed segment oral he
the Contractors License Law (Chap 9
which requires a permit to oonsbal alter improve
to its man= WO requires the applicant tor
or she is licensed entrant to the provisions of
(C mmemmng me Section 7000) of Envision 3l
Mal he or she is exempt therefrom end the basis
of Section 7031 5 by any applicant for a permit
not more men live hundred dollars ($500)) I
() I es owner of the property or my employees
do the
the Business end Protessions Code) or
for the alleged exemption Any violation
subjects the applicant to a civil penalty of
wall wages es their sole compensation will
or offend for sag (Sec 7044 Business and
Law does not apply to en owner of a propery
such work himself or through his or her own
are not intended or offered for sale II
within one year of completion the owner
or she did not build or improve for the
work end the eaucture re not intended
Professions Cods) The Contractors License
who builds or improves thereon and who does
employees provided that such improvements
however the building or improvement is sold
builder will have the burden l proving That he
purpose of sale)
( ) I as owner of the property am exduswey
construct the project (Section 7044 Business
License Law does not apply to an owner of property
who controls jar such projects with a contractor(s)
License Law)
(I I am exempt under Sec_ Ba PC forma
Wntractng with licensed Contractors to
and Professions Code The Contractors
who builds or improves thereon and
license pursuant to the Contractors
mason
Date Owner
WI
ea I
WLanders
.A
I
CONSTRUCTION LENDING
I hereby amrm under penalty perjuryofperjurye ry that se
the performance of Ole work for which this permit
Name
AGENCY
is a construction ending agency for
is issued (Sec 3097 Ca Cl
Lenders Address
4 C(eft or
BUILDING PERMIT
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
9
I.
PUN CHECK N%/ 3 - 9� DRAWING NO
BUILDING ADDRESS Soto 9t4f'0q AL, 4/1 rp_11)
TRACT
BLOCI(IPAGE LOT/PARCEL
TYPE OF CONST
GROUP Gt,
USE ZONE
REDID YARDS
NO STORIES
USE OF BUILDING Of %c.c.
SPRINKLERED
WET STANDPIPES
SIZE OF CONST
umth
NO
YES NO
DESCRIPTION OR REMARKS
NEW
ADDITION
ALTERATION
Al ft
tiwokk, tuba ') &A'C04l st DM IPINL► U
`6fik(EO 1f, t C?UNWIG%0.
a
I tartly that I have reed this n and state that the above Womedon b bored 1
spree to comply with all city and co y ordinance, end state laws relating to budding
moon and hereby eumonse representatives of this City to enter upon pN above
1144 pr for inspection purposes
Signature of ApplKam or Agent Date
APPL REC BY /
BLDGCFE
FOR DEPT. USE ONLY
FIRE DEPT
PLANNING
PARKS/REC
PUBLIC WORKS
1
CMP USE
CMP USE
BLDG AREA
FBLDG AREA
CMP USE •
BLDG AREA
VALUATION OF JOB C
SMI FEE CAT # Nay 1a
it
ENERGY PLAN CHECK
PLAN CHECK FEE
$ 1a'
sI
so
BUILDING PERMIT FEE
PLAN RETENTION FEE
S
TOTAL S
PERMIT ISSUE DATE
READ CONDITIONS BELOW
The work authorized by issuance of this permit is subject o all the rules end regulations set loan In
the ordinance and amendments of the City of El Segundo and the Laws of the State of Cantons in
regard to such work and en amendments the-eto
This permit becomes null and void it work is not commenced whin one hundred eighty (180) days
from deb of issuance or it work is suspended at any time during construction for the sere period of
time or it any work is done in violation of the CM Ordinance or State laws commune same
ALIDATION
Distribution WHITE (Dept I YELLOW IAppicant)
des FORM B 102 Rev 1r95
.l .
APPLICANT
OPOI, < V411404E0 CAIVQ t0.($1Lt)
ADDRESS
5112 41!£p M) J. bra
pityZIP PHONE
V.O -lilt
1 :11 LNu°'.6 AC •` u.41 (' IQ)
ARCHITECT OWNER
NAMEsII'lf t1E{,N
iDi(c)t Co.
ADDRESS l k F 4L ccl�Uli t) PHONE/-1�'
J)01,cl /
CITY/.r !t(" ,n �l STATE/ZIP - ,
NAME
ADDRESS PHONE
CITY STATE/ZIP
st
v
I;AI
NAM H n : oo
ADDRESS 11r(? 4(1LSA :J IIq PHONE/ZZ1'44YJi S'7,lL
CITYu ItAISttI Mom, ACM STATE/ZIP aI qz4,.4a
L
WORKERS' COMPENSATION I CONTRACTOR
NAME
MAIUNG ADDRESS
CITY
TELEPHONE
STATE ZIP
CITY UC NO
I hereby affirm under penalty of perjury that I
lcommendng with San 7000) of Dyalon 3
my In is m full force end effect
Ucense Class Mc
am licensed under eremitism of CaepM 9
of the Business end Professions Code and
No
Date Cony Signature
WORKER'S COMPENSATION
I hereby affirm under penalty m perjury one of
I have end win maintain a ceMkate of consent
compensation as provided for by Section 3700
of me work for which this permit is issued
- I have and will memtam warkera compensation
3700 of the Labor Code, for the performance
My workers' compensation Insurance carrier
Cancer Policy
DECLARATION
the following dedaretlons
to ssadnsure for workers
of the Labor Cope for the performance
insurance as required by Section
of the work for which this permit is Issued
and policy number are
Number
(This section need not be completed if the permit is for one hundred dollars (S100) or less
I candy that in the performance of the work for which this perm) is issued I shhell not
employ any person m any manner so as to become subject to the workers compensation
Laws of California and agree that if I should become Subject to the workers compensation
provisions of Section 3700 of the Labor Code I shall forthwith comply with those
Provisions
Date Signature
WARNING failure to secure workers compensation
subject an employer to criminal penalties end
dollars (St00.000) In addition to the cast or compensation
Section 3706 0l the Labor Code interest and
coverage is unlawful and shall
civil fines up to one hundred thousand
damages as provided for in
attorney a lees
CC W
ca
W
3
O
I hereby affirm under penalty of perjury that I
ror ter following reason (Sec 70313 Business
am exempt from the Contractors License Law
and Professions Code) Any city or county
demolish or repair any structure prior
such permit to file a signed statement that he
the Contractors License Lew (Chap 9
which requires a panne to corativa alter improve
to its issuance, also requires the applicant for
or she is licensed pursuant to the provisions of
(commencing the Section 7000) of Dwain 3
of the Business and Proreseions Code) or
for the alleged exemption Any violation
Mat he or she is exempt therefrom and me basis
of Section 7031 5 by any applicant fora permit
not more than live hundred dollars (S500)) I
() I as owner of the properly or my employees
do the work end the structure is not mended
Professions Cade) The Contractors License
who builds or mproea thereonwho and does
employees, presided d that such Improvements
however the building Or improvement 0 sold
builder will have the burden of proving (net he
purpose of sage)
( ) I as owner of me property an, exclusively
construct the project (Section 7094 Business
License Law does not apply to an owner of property
who contracts for such protects with a contractors)
License Law)
I ) I am exempt under Sec B 6 PC for this
subjects the applicant to a evil penalty m
with wages as their sole compensation will
or offered for sale (Sec 70.4 Business and
Law does not apply to an owner of a property
such work himne or through his or her own
are notintended or offered for sale If
within one year of completion the owner
or she did not build or improve for the
contacting with liensed contractors fo
and Professions Code The Contractors
who builds or improves thereon and
license pursuant to the Contractors
reason
Date Owner
W
ca
CONSTRUCTION LENDING
I hereby affirm under penally of
of perjury that therea
the performance of the work for which this permit
Lenders Name
AGENCY
a construction lending agency for
is issued (Sec 3097 Civ CI
Lenders Address
ri 11' (.r1/ee��
BUILDING PERMIT g
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
PLAN CHECK NO
912
�
BUILDING ADDRESS 1.060
DRAWING NO
t'I�11
TRACT
BLOCK/PAGE
LOT/PARCEL
f
i
TYPE OF CONST GROUP Y
USE ZONE
REO'D YARDS
A
NO STORIES SIZE OF CONST
USE OF BUILDING off v,c.1111001
SPRINKLERED
t`ai
NO
WET STANDPIPES
YES NO
DESCRIPTION OR REMARKS
NEW
ADDITION
ALTERATION
iu41tt\ Cf feitil((I,;r -apm(t F)tk ui!JA) 4'IEt:A
F.W'L:NSry et siUlq'G)c t OM Thjs: _- to I
frcedetboden L iM`.1 (Duo/IJ(tAO.
IL
I amity mat I have reed this appllecon and state that the above information Is correct I
Leonia to complywith all oy minty
ty oanelaws s end state relating to building
Construction and hereby authorize representatives of this city to enter upon the above
rryensone prr9perp for inspection purposes ` gag
Signature of Applicant or Agent pate
FOR DEPT. USE ONLY
APPL REC BY,_
i 11
Q
O
BLDG'SAFETY "` FIRE DEPT
fr i l
PLANNING
PARKS/REC
PUBLIC WORKS
CMP USE
BLDG AREA
CMP USE BLDG AREA
CMP USE
•
BLDG AREA
VALUATION OF JOB t» i
SMI FEE CATN 4P%s
MJ
ENERGY PLAN CHECK
a X'"
PLAN CHECK FEE
s till L ✓50
BUILDING PERMIT FEE
PLAN RETENTION FEE
TOTAL
PERMIT ISSUE DATE
READ CONDITIONS BELOW
The work authonted by issuance of this permit is subject t0 all the rules and regulations set forth in
the ordinance end amendments of the City of El Segundo end me laws of the State of California in
regard to such work end all amendments the eta
Tins pawl becomes null and void it work re not commenced within one hundred eighty pm days
horn date of Issuance or a work is suspended at any time miring 000allucbml ha ere same period of
time or deny work is done in violation of the City Ordinance or State laws governing same
VALIDATION
Distribu ion WHITE (Dept) YELLOW (Applcanp
dbs FORM B 102 Rev 1/95
DUPLICATE RECEIPT DUPLICATE RECEIPT
CITY OF EL SEGUNDO
350 MAIN STEED
CITY HAIL -FINANCE DEPARIMENi
HEADER MESSAGE LINE 1-10
,r
REG-RECEIPT 01-0023400 C Nov 3i ;9%
CASHIER ID B 3 57 phi A Nov )2 1939
5504 PLNG-PLAN CHECK FEE 'L571 5=
PEN CK 113E-99
TG'i.'_ DUE
RECEIVED FROM
P2S ENGINEERINC-Lki0'd4
CHECK 5371 5:
TOTAL I Nl;FED
C'UANCE DUE
:371
0 0:
HAVE i NICE L'•
DUPLICATE RECEIPT u' PLILAIL RLL; r T
ell oi el Segundo
DEPARTMENT OF PLANNING
AND BUILDING SAFETY
350 Main Street
El Segundo, CA 90245
(310) 322-4670
APPLICATION FOR ACCELERATED PLAN REVIEW
I hereby acknowledge and request an accelerated plan review for the following
drawings: Plan Check No. / /3 to -
I understand I will be charged $ 75.00 per hour, payable at the time the plans are
issued, in addition to the plan check fee paid at submittal.
Signature Date
mote__
Requested By: ID thC.A1LE
Address:GM- tVu4A NJE c 103 City: thikIfIlltifON 45EACI * Cit. 6(2649
MISCELLANEOUS RECEIPT
Accelerated Plan Review - $ 75.00 per hour x....e, $ 4 fa
Plan Check No.
Project Address:
Issued By: Date:
JOB ADDRESS.
Way ci eV Yratdo
DEPARTMENT OF COMMUNITY, ECONOMIC, AND DEVELOPMENT
SERVICES
350 Main Street
El Segundo, CA 90245
Phone: (310) 322-4670
Fax: (310) 322-4167
Date: C.P - S - 0-D
Dear Client:
Please be advised that our permit files indicate that your Plan Check No.
will expire on the date indicated below per Chapter 16 04, 16 08, 16.12, and 16.16 of
the EL SEGUNDO MUNICIPAL CODE. The following information was used to
calculate the expiration date
02S-00 , w/
PLAN CHECK NO . i(3 (P -9
PERMIT EXPIRATION DATE:
OWNER: 24y Ph c-i,vt
Should you find the above information incorrect please contact our office at your
earliest convenience Unless you take action to extend the time limitation per
Section 107 4, your permit will be cancelled and your plans returned at your request
or destroyed.
7-r� - v7
Thank you for your cooperation in this matter If you have any questions or need
additional information you may contact our office at (310) 322-4670 extension 411 or
395
Sincerely,
Hansen, Director
unity, Economic, and Development Services Department
Wry e dAC 2• FB .