105-97 - 1910 MARIPOSA AVE E(3�0) u9k5 -15°`1-1'
APPLICANT SCO 1 1 S \ \
ADDRESS
2 31 —l%eef u3 �pe ; vt: etc
CITY %et
, 4 3 I G L I clr4-5)-P/! s
'J/[J1T PHONE
00 / 12 71 1 e
NAME
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ADDRESS 2 Z Z I conYh,ll �� 1 U•-S $3 -1
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CITY tl STATE/ZIP CA q'/Sa'/ /
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et
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NAME Rra (1 L. a c.L- c/' rt y rig
F� ADDRESS / LAJ,L4T L_i s PryH IIv 1 /S 552-t
CITY 701 sA O/c, STATE/ZIP7 Y1 n ?
WORMERS' COMPENSATION, I CONTRACTOR , I ENGINEER
NAME 0-4Cog\ 0 V°NW, L.Y\c.
ADDRESS / 7 eza &✓k cs 1./LrPHONE'so 321-a
CITY IOr f`� /f /1 STATE/ZIP{C, spy
NAME Tr' . 4 L. (' oo 0A s T
MAILING ADDRESS' /
/ Zr ( Grt4\W
(� n f�
A Qr 'a Ul'I t /O.SV
CITY/d,.4 5 COt1,
T P N71si.L/�00e-lS'-
STAT�� ZIP
\V D
CI503F7
( /Lig0 7
I hereby affirm under penalty of perjury that I
(commencing with Section 7000) of Division
nin
my license Nlocos fiforend effect 13
License Class LIc
am licensed under provisions of Chapter 9 _
3 or the Business and Pro1fessions Code, and
No 1 3V L7 '.-1
l C%
,. �
Date 3 -'l - ct . Dana Signature .-a%.C. v^}
WORKER'S COMPENSATION
I hereby
DECLARATION
the following declarations to
to sea -insure for workers jai
slim under penalty of perjury one of
I have and will maintain a camfIcate of consent
compensation. as provided ler by Section 3700
t work for which this permit is issued
I have end will mat n w rspensation
of the Labor C e
My work 'coin 1 rend
Comer.
(Thal sett need not be completed if the permit
_I certify that in the performance of the work
employ any person In any manner so es to become
Laws of California. and agree that if 1 should
'provisions of Section 3700 of the Labor Cods,
Provisions 3 - `I
Date 1 - � 1 Signature
of the Labor Coda for the performalfto
insurance, as required by Section _
of the work for which this permit is issued
pricy numport.
gay Number W` 01€Os35
is for one hundred dollars ($100) or less
for which this permit is issued I shall nol
subject to the worker,' compensation
become subject to the workers' compensation
enh those
I shall forthwithhcomply w)(tit
s/ J_ k/ t / /
/�FcJ� ✓iKl �•(•j'\
WARNING: Failure N secure workers' compensation
subject an employer to criminal penalties and
dollars (S100,000), in addition to the cost of compensation,
Section 3708 of tiro Labor Code, interest and
coverage is unlawful, and shall
civil fines up to one hundred thousand
damages as provided for in
atomey's fees
LENDER I OWNER$UILOER i i
I hereby affirm under penally of perjury that I
for the following reason (Sec 7031 5 Business
which requires a partial to construct, alter, Improve,
to its issuance, also requires the applicant for
or she Is licensed pursuant to the provisions of
(commencing are Section 7000) 0f Dwblon 3
mat he or she a exempt thereon and gat basis
of Section 7031 5 by any applicant for a permit
not more than five hundred dollars ($500)) )
() I, as owner of the property or my empl yeas
do the work, and the structure is no into ed
Professions Code) The Contactor LI a
who builds or improves thereon, d •
employees, provided that such Impro is
however me building or improvement i old
builder wit have the burden of prove • that he
purpose of sale)
( ) I. as owner of the properly exclusively
construct the project (Sectio• 044 Business
License Law does not rep • to an owner of property
who contracts for such . rojects with a contractor(s)
License Law)
O I am exempt der Sec B 8 PC for this
am exempt from the Contractors License Law
and Professions Cosa) Any oty or county
demolish, or repair structure, par
such permit to file a • statement that he
the Contractors - . Law (Chap 9
of the Business - ' Professions Code) or
for the a14., • exemption Any violation
subjects ...,.. cent to a civil penalty of
with : ges as their sole compensation will
or o • . red for sale (Sec 7044 Business end
•-' does not apply to an owner of a properly
such work himself or through his or her own
are not intended or offered for sale If,
within . ' year of completion, the owner
or sh' . 5 ' . bad or improve for ale
co a• ng wan licensed contractors to
and 'mansions Code Tiro Contractors
who builds or improves thereon, and
license pursuant to the Contractors
reason -
Date / Owner
CONSTRUCTION LENDING
I hereby affirm under penally of perjury t there
the performance of the work for wh r
Lenders Name
AGENCY
is a construction lending agency for
t I sued ( 3097 Car C)
Lenders Address - -
a ehtiima
BUILD! tPERMIT
.1050
tit S
City of El Segundo
DEPARTMENT OF BUILDING SAFETY
I51N CHECK NO 05— may'-/ I DRAWING NO
LDING ADDRESS / 91 [^� E n,Ave, it
TRACT - BLOCK/PAGE " LOT/PARCEL
TYPE OF CONST
USE OF BUILDING
WET STANDPIPES
GROUP
REO•D YARDS
I SIZE OF CONST
QM above information a
ones and state laws relating to budding
I_ construction, and hereby authorize represenlaaves of this city to enter upon the above
menrperty r Inspepben purpo
▪ j�(� �v�y
2-7-57
Signature of Applicant or Agent Dale
FOR DEPT. USE ONLY
APPL REC BY
rn
t ut
O.
O.
BLDG SAFETY
FIRE DEPT
PLANNING
PARKS/REC
PUBLIC WORKS
2
CMP USE BLDG AREA
CMP USE
BLDG AREA
CMP USE
BLDG AREA
VALUATION
W
Ma
PERMIT ISSUE DATE
000-
SMI FEE CAT If -
ENERGY PLAN CHE K $ f
PLAN CHECK FE / U 4J .4c
BUILDING PERMIT FEE - IS 1 0 L IIn• b��-}(-�y
PLAN RETENTION FEE � $ �y,• UV
TOTAL $ a 1 1 '1 • lD4-
3 frh
-READ CONDITIONS BELOW
The work authomed by issuance of this permit is subject lo all the rules and regulations set forth in
the ordinance end amendments of the City of El Segundo, and the laws of the State of Calforna in
regard to such work, end all amendments thereto
This puma becomes null and void if work is not commenced within one hundred eighty (180) days
from data or issuance or it work is suspended at any time during constualm for the same period Of
time, or f any work is done In violation of the City Ordinance or State laws governing same
ALIDATION
- REC P OF ORD. #1235
BY c DATE3-S=qi
Distribution WHITE (Dept) YELLOW (Applicant _ des FORM B-102 Rev 1/95
05.9�
tZMN RECORD
I•
Plan Check No.
APPROVALS
DATE
INSPECTOR
APPROVALS
DATE '
INSPECTOR
EXCAVATION
//
I
,1
DRYWALL, -
-
7ti(� 7
FLOOR JOISTS
L �(/�{
STEEL
FRAMING
WALL
-
ROOF
BOND BEAM-
'
INSULATION
PANELS
LATH, EXTERIOR
RETAINING WALL
-
LATH, INTERIOR
MASONRY
ACOUSTICAL
FENCE
ENERGY
FINAL
AAtomti/,
1-3, it
, r {f�
REMARKS
00*C Feet Nell . 4 ok . . 50�..�.�ri.. - ' .