1142-00 - 2031 MARIPOSA AVE E (3)APPL,cA € rry icr/1 me (yI-1 tt el
ADDRESS 'S 52 i'iin4inen+rtl
Nit)ziPC:A 96;14 D c ?4 Q -
ADDRESS.) 7J� '/7,n•F�rxe tHON
.�
CITY E o Q STA
NAME
Ltr d& aLt-C-&-Sk& Oa 42-0 iY
tft Co°
ADDRESS
PHONE
BUILDING PERMIT
Building Safety Division
Community, Ecanomic,BDevelopment Services Dept.
350 Main St., El Segundo, CA 90245 -
24-HR inspection Request Line (310) 322-7069
:10J a5Q,-99.)•i PLAN CHECK ACE//7tR-"" SLIP Gil�� / / C ' BULLRING ADDRESS an,& I F• /Lla-r/ 7(iC_.
TRACT - BLOCK/PAGE LOT/PARCEL -
CITY
STATE/ZIP
NAME
ADDRESS
PHONE
CITY
NAME a
STATE/ZIP
MAIUNG ADDRESS
neve
CITY /^ l/r TELEPHONE will20 WET STANDPIPES
TYPE OF CONST T
USE ZONE C'
GROUP ,
REO'D YARDS
NO STORIES
ra
USE OF BUILDING (wit
SPRINKLERED
SIZE OF CONST.
r
UBC ED.
YES) NO
ZIP ,061
STATE CITY UC N di/ DESCRIPTION OR REMARKS:
YES — NO
NEW I ADOmON I ALTEFjATION
I(CerrirMmeing with of herebyalmm under petaaY ape jr.y area1am licensed ever prates,° StTen2.h¥I - pro Y-e1Ye 17
Division 3 at the Business and Preemies add
my Mete ishIuPNlafjne edecL %�% -72i tw n. _-. I I/i•. _ .. _ I I en n. _ , .
NO
77
L Cans. gaiG <LeLLS
Sic Corny r
WORKER'S COMPENSATION DECLARATION
CITYr
NAME
DRAWING NO.
I ram? Mal I have reed the al>Ole:aeon old state me de above adernuen is coned I
I hereby affirm under palely of peen one of he following declarations •• • • agree to comply with and county ordinances and sin Inca Mang to Wtmr9
I have and willsmaimeind s certificate on consent of to woo Co for wormers non I e , ern err e,�y `(', '
mm*01*fruprorlddd Aar b1'Sapmi 3700adte Leiser Caw tar Onepe Iv sae 1�///tJt71y�/J //JAM--,- \N^/•-et.
of the work for whip, this ports is aced (y� APT: i—
I have end will maintain welters' compensation insurance a required by Section V
3700 or the Labor Cow, to the performance or the work for which this perm
My wp Isar and ppKYn / 'A/
Comer i Policy Number $4 YVY -v/
(TM ro sepn need not if mis be completed e permitfor one hundred tiara (S100) or teas
I certify that in the performance of the work fa which this permit is issued I shall not
employ any person in any merrier e e to soothe subject to the workers' compensation
Laws of California. and agree that if I should Marne subl to Me worker ' peen
provisions a Section 3700 a sae labor Code. I shall I Irk plyngry6m//peg
Provisions n, / A//� r PLANNING PARKS/REC
Dab / !l/—a) Signature 'W wll�Y V\ oi
WARNING. allure 11�� segue workers' compensation coverage is unlawful and Mall CD - PUBUC WORKS
subject an employer to criminal penalties and Civil fines up to one hundred thousand
doles (3100,000), in addition to the cost of compensation damages as provided for in d
Section 3706 of the Labor Code interest and attorneys tea
construction. end hereby authorize representatives of this city to enter upon I. above
green* of Applom or Agent
APPL REC BY
I hereby Slim rinwr penalty of penury mat 1 sum exempt from i.eIContractors License Law -
for the following reason (Sec 7031 5 Business and Professions Code) Any pry per county
with requires a print to cone/vetoes. improve demolish. or repair any structure. prior
to its (nuance, also requires de applicant for such permit a file a atoned statement mar he V
or she a kceneed pursuant to M provisions of the Convectors License Law (Chap 9
(commencing the Section 7000) of Devon 3 of the Busmen ere Professions Code or C
mat he or she is exempt dierelrom and the basis to Me alleged evempoon Any violation ti
re Section 7031 5 by any Mohave for a permit subjects the applicant b e evil penalty of
not more man live hundred dears (3500))
( 1 I. as owner of me property or my .... wren .� .. as their sole compenetron will
do the work, end the structure is not i .v er . . per see (Sac 7044 Business end
Preston Code) The Contractors Li `, does not apply 10 en owner of a properly
who builds or Niorovea thereon. are w sits work himself or through his or her own
at s
employees.
provided that din ... :.. �... not intended or ollered for sale II
however. ere budding or i .. , .site .. w in one year of completion me owner
builder will have me burden . proving mat or she de not bond of improve for Its
purpose of see)
() I. as owner of the • piety. sum exclusively contracting with licensed contractors to
Oneuct me proyict Siceon 7044 Business and Professions Code The Contractors
License Law does not apply teen owner of properly who builds of improves thereon and
who contracts for such projects with a contractor(,) license pursuant to the Contractors
License law)
() I sum exempt under Sec_ e a PC for inn reason
Date Owner
BLDG SAFETY
FOR DEPT. USE ONLY
FIRE DEPT
DATEI/(//j o
CMP USE
BLDG. AREA
CMP USE
BLDG AREA
CMP USE
VALUATION OF JOB
4i
S.M.I FEE CAT e
BLDG. AREA
ENERGY PLAN CHECK
PLAN CHECK FEE
BUILDING PERMIT FEE
rG
0_1. o tic,.
'are"
PLAN RETENTION FEE
TOTAL
PERMIT ISSUE DATE
CONSTRUCTION LENDING AGENCY
I hereby Minn under penalty or perjury that there is a coristrucion ending agency for
Me performance of the work tor vi idll this permit is issued (Sec 3097 Cn Cl
Lenders Name
flijh
Lenders Address
READ CONDITIONS BELOW
The work authorized by issuance of this permit is subject to W the rules and regulations set form in
the arenarice and emendni.us Of me City a El Segundo. and sae laws of the State of Caaprpe m
regard to such work. and all emendmere mreto
This permit becomes null and void it work d not ddtmuenced tether one hummed eighty Or days
'rem date of issuance or it work is suspended at any one dump nuebon tor the same period of
time, ore any won is done in violation of the City Ordinance or State laws governing same
Oadmtmon WHITE (Dept) YELLOW (Appeca t) (Ds FORM B-102 Rev
193
VALIDATION
p1— 38y.. octio�/ r -'
INSPECTION- RECORD
Plan Check No. "
APPROVALS
DATE
. INSPECTOR
APPROVALS
-'
CTOR
�DA-
1D/Y'/ �.
EXCAVATION
.-
DRYWALL -- - --
�I "u_
FLOOR JOISTS
..
STEEL '
(
. -
WALL
FRAMING ;
q to -3 .0-
ROOF
.._
BOND BEAM
INSULATION
Th
I.
PANELS
1
RETAINING WALL
LATH, EXTERIOR
LATH, INTERIOR
_-
MASONRY
-
ACOUSTICAL
- . ,
FENCE
ENERGY
FINAL
^{
t1 G1)
'm
lib
,/
REMARKS
4
I
,J [.i (..) \
APPUCANT 95
ZOSHEL AIR C000itlde.fjvt(e U
ADDRESS
14fn26 S• og y7A1£ AYE
CITY
70.22.EwcE'
ZIP
CI* 'G'oSo2
L. Me
PHONE
:Io_S23-0_%j
.NAME
LCC
oADDRESS
MATTE
3Ii cow ,{yp E
I
CITY EL SE6kj1'tD0
STATE/ZIP�TECk 4332 yV
Y
A
=
La
t
NAME
ADDRESS PHONE
CITY STATE/ZIP
iit
o
W
NAMEJOuDECOI. QJSI.IEg_ Ait Comp.
ADDRESS1gb2G S. AIOiZMftgN.IVrarNE 110•S23.9916
CITY Tea Aucz
STATE/ZIP closet
ca Q
cc
CI
La
NAME pis gEl At COuotTitwtA43
MA1JJNNut�OZGRES. MORJNAU9. 6 AVEpI�
CITY TQe ixt4 C.6
TJ histE21-a6016O
STATE�A nPg0502
CITYtIg 2
/p L
hereby on
(commencing
my Utensil ism
License Cow
Date 2.
under penalty of penury that I am licensed under provisions of Chapter 9
with Section TO(p) al Division 3 0l the Business and Professions Cotle. and
fulJoroemil n
`_`O Uc No l
lee 1 Contr Signature
2
O
s-
LM!
C
O
LS
y
CCmammon,
k
CDam
3
WORKER'S COMPENSATION
I hereby alumnd
uer penalty at perjury one of
_I have and will maintain a candidate of consent
compensation, as provided for by Section 3700
27a work for which this permit is Issued
31i have end will maintain workers' compensation
3700 at the Labor Code, for the performance
My wo/keire��' compensation ispuurralence cart r and
GenerywG. CJJD�LVE415 i�rfolicy
(This section need not be completed it the perms
_I candy that In the pedomande of the work
employ any person in any manner so as to become
Laws of California, end agree Mall! I should become
of Section 3700 of the Labor Code,
Prov{,
isionL.lu Jae Stria
DE ARATION %/
tl
the following dearatons To
to seglnsure for workers' i�
of the Labor Code, for the performance
insurance as required by Section
of the work tor which this permit is issued
policy nu. beer_ ete_H a
Number (ion%'I/L e7
is for one hundred dollars ($100) or less
for which this permit is Issued I shall not
subject to the workers' compensation
ject to the en' compensation
I short f hwdnimnnp to
/i•�
WARNING: Failure to seders workers' compensat crage is unlawful, and shall
subie t an employer to nominal penalties and cwll ii up to one hundred thousand
dollars ($100,000), in edditon to the cost of compensation, damages as provided for in
Section 3706 of the Labor Code, Interest and attorneys lees
W()
0
..•n
it.
C
I hereby affirm tinder
for the following
penalty of perjury that I am
reason (Sec 7031 5 Business
permit to construct, alter, Improve,
also requires the applicant for such
pursuant to the provisions of
Section 7000) of Division 3 of
exempt therefrom and the basis
by any applicant fora permit
hundred doers ($500)),)
the progeny or my e
the structure Is not intend
The Contractors Llama
thereon, and who d• -
Metsuch improve • - . ,
or improvem - -, d within
the burden of • . t he or
the pit •. , . exclusively
✓• ... ... Business and
- at apply to an owner of property
such proper with a mnraclor(s)
under Sac_, B 8 PC for this
exempt Irom the Contractors License/1lm a
and Professions Code) Any city or My
demotun, or repair any stru '. e, prior
permit to file a signed sum ant mat he
the Contractors License (Chap 9
the Business and Prof - ons Code) or
for the alleged a than Any violation
su tests the ap• cant to a civil penally of
ith w-. - as their sole compensation will
oil .. for sale (Sec 7044 Business end
,- apply to an owner of a properlywho
su mseti or through his or her own
ere i ed or offered ton sale. it,
one year of completion, the owner
she did not build or improve for the
contracting with licensee contractors to
Professions Code Tne Contractors
who builds of improves thereon and
license pursuant to the Contractors
reason
which requires a
d its issuance,
or she is licensed
(commencing the
that he or she a
of Section 7031,5
not more tan live
I, as owner of
do the work, and
Professions Code)
builds or improves
employees, provided
however, the building
buider will have
purpose o1 sale)
( ) I, as owner of
construct the project
License Law • • .
who contracts .
License
() I - xerupt
Date Owner
ili
Yr
CONSTRUCTION LENDING
I hereby Winn under
the performance of the evrork fa which rml
Landers Name
AGENCY
agency for
1 c 97 C )
Lenders Address
t
0 0 2 iIECHANICAL PERMIT N
City of El Segundo
BUILDING SAFETY DEPARTMENT
Bung 2031 E. MARIPofa A+eu�iding No.
Address
Tract Block / Page Lot / Parcel
••-•
e
I certify
I agree
constr
mended
that n have read
to comply with
ion, and hereby
pr
this application and state that the above information
all city and county ordinances and state laws
authorize representatives of this city to
r in lion purposes
212.6[94
is correct.
relating to budding
enter upon the above
Sign :/1e
of Applicant Or Agent Date
P C No P
k N-5 - X of PlansV Resift
-�fy ��N��o
Date Y2-fr Comm Indus
i
U M C Ed
Quantity
Fees
Fuel burning heating Appl
Air inlet and Air outlet
2201,•&./V
Conditioned Ceding Air
Vent
Hood
Boiler or CCi repressor Htccr POMP
7L
.50. fop
Air Handling Unit
Evaporative Cooler
Ventilation Fan
Incidental Gas Piping
Fire Dampererr
itt—
Smok Control Damper
3
/ S dv
Smoke Detector
2•
al r6t
Thermostat
Z
et>'�
[/�.67
PERMIT FEE (Sub Total) / 4 44.nC� t�
REMARKS Plan Check Fee / -fr
Plan Ret Fee it OD
v '�
•
Issuance 00
Issuance Fee---���
p� �7 err (���$15
Issue Date y/�! //Jd TOTAL FEE
READ CONDITIONS BELOW
The work authorized by issuance of this permit Is subject to all the rules
and regulations set tort In the ordinances and amendments of the City of El
Segundo, and the laws of the State of California in regard to such work, and
all amendments hereto
This permit becomes null and void If work is not commenced within one
hundred eighty (180) days from date of issuance, or if work Is suspended at
any time during construction for the same period of time, or If any work is done
--- - in violation of the City Ordinance or State laws governing same
N
Distnbubon GOLDENROD (Dept.) YELLOW (Applicant) dbs FORM M-105 Rev 1/95
INSPECTION, RECORD
DATE
INSPECTOR'S SIGNATURE
LOCATION
DUCTS
COMBUSTION AIR
CIRC. AIR
GAS TEST
VENT & CAP
BOILER
DATE
INSPECTOR'S SIGNATURE
REFRIGERATION
AIR CONDITIONING
FIRE DAMPERS
DUCTS
CONDENSATE LINES
MISC
z
1599
ALA)
REMARKS