FICHE - 1170 MARIPOSA AVE EAST (2)APPLICATION FOR BUILDING HERMIT
d90REa$ aPIDB
City of El Sopunder
FORrAPPUCANT YO Fit IN "
DEPT. OF BUILDING NL SAFETY
LEGAL DESCpiPTIaN LD* 'p-
.0t
ONLY
DEPT. USE O
DESERIPn9N: cE WOgK�_ —C � %r ^.'.
PIANS REC D SY ✓
YY
0 TE 41TrU- P � ��• r k
(DATE
�Y 7
CNEENED BY fL"b'GL''
.�iF�, 1 t
/����
ON 'I'M tll OILS
USEif _8U1191N0 r4 .�• G-��•A aLtw a
. AP �iryTA• MO fOA 1t
0NR 4
t/ sISSUEb OA F
_
VALUATION S , '* c'Y -
Px9HE
r
Plan Check Fn s: / 9 � _„__�___ -
_.
0.pLII1rtCT ff T _,� /ai.��y__���. ^' •,�,�
BN�Idin Pernit Fee .$ , e. �.
Siam IIEEfR�Nd _ ,0NONE C^,��„_`.i •E'ef_C�d
`.�
TOTAL.y. `1 -
Ev.Nr;Lfpf
jYPE CarwT
Vora LICEY.E ma • -- JPHINE -
rf
VINE ZONE 5 IISE I9NE. E�f_
OC.jiPLS It_ fityRak. t"�'. -
„` \,•,_,� „_.
^�NO.
OCCOP. LOAb _ �+ ENim
iLOOA War IST 2ND 4/0 OTHER
n
C01MA OM ADAES4� L -t
�y� `, � r
SPAINKLEREP YES b NO T}r
CILVyt1 E._ r O { f/ - IstATE{LCENSE NO
wt Tamps YE3 —b "o ._..� _
YAT STgXNIPE4 TES b MD f]”
YAw"il r eP las 3 /y� ��_
Aeft CP CW` f 'CJXN'�A�,/812E O� VA46
i-I
.•�
acv_. S�IE PE Lot
'�—
✓ ENGINEERING Curb Crossing BY.. ❑
m.'tT _Et P.tLK �7 d� �EI9E BCY eACN! li �� •. �_
WADS
EFM1C l fp[jTAININL f2 OMRIK0101t
Inundded Yew N9 t�!
\ _...LL4 ^�_
aIEn-L- P
advatlon O.K. W,,�
WP4 EOo.1 mD � 6w epil t1i01G
?ARKING SWEl4 Atq'd _..�Sfv.
Sp5Ee5 FTbvlded i
_
SNOW LOCATION SI?E G HDCNT ON BACK
y
Parting on Premises 1.16r �',✓s_ p,..t , >•
SURVEY TO GE Pp0410FD IFGEGUIREGE =.$' _•_�_• (.?
E94TI'iCNl11 LNSPEGTICN REOUTA D C4 T4
INSPECTION RECOR
_ YES t3 No to-
_�_,_
APPAOVAIS
GATE
IN PECTOR _
�%.Je'.
':�"� -.+J 5a• -':Y,� �
EXCAVATION
)'
•'
_*gym ao ,,,_„- '..at�c t
SUB FLOOR
"AMINO
ROOFING
-
L11TN, INTERIOR _
�lLF ;S
PIASTER
STUCCO
Aft n91cni5 O Oku ally ;All d La the luttins w of sonde,
DRYWALL ------ �{t-��
—
� — --
STEEL I
1 —
m .M.0 uwtn uvmt tonne hen% "ll -W.yt end curbt„ PenHt
1. P soots < nstualb. to be a�ItinYd from dry onol.o.e.
WALL j'—'�'
--�
a4ftx.
RGNB BEAM
PANELS
-'
_ �—
I II'7E9N I NO lrC„,T M E 111VE Aegn TNI5 dPPl16A H AHO
STAiE F Trl tn.VE t3 CGaTEM AIIO ASREE TO COMPLY WITN qLL
CM C olla LS qt U S ATE' Vt 5 pEGDIATIH9. EN1W1flQ
P.ETAINITG WAIT.
MASONRY
_-
I FAEDY CEDt FY T1LiT 1 A i PiGFENU a;tlL EO qs pCOUlAEO SY
m Clit tiF E1, EGYr9 sr;D 5TATE OP C /lt�PNA 9A TNAT.i AAr ;NE
nl PR�PID,
Flogs
_I_
tP 4F p"tER LF N19Y9 pFvGNOEb .
•i
FINAL
- --
OF FERtUTTFE --. �'..- .. -: -�'E
CEATIFICAIE OP OCCUPANCY NO. _ DaN.
VILLIDATIbN
1.
_ AW-25N 15 4 8 6 4- A- o k 39.00
APMLICATION FOR BUILDING PERMIT
City of EI aopndo
'DEPT. OF ISUIL01NO & SAFETY
3EWEN LdUtIDK-
001MIERINR -. Curb CmsstnB OX 13
_ Inundated Yes [1 RD 0
tlaVatfon O.H. ]
PARRIN6 - Spun lts 'd
Spaces Provided
Fatkint do premises IDr
INSPECTION RECORD
CERTIFICATE OF OCCUPANCY NO� Oetd _
1
no n� s Df IDa 1170 E. Mariposa Ave
FOR APPLICANT TO VILL IN
LEGAL DUCRiPTION LOT
BLDCN 10"
DES:RIPTION OP WORK Block Wall
USE of DUImINO L. P..Le
w rn 1170 E. bat,iposa
wHIm3 ADDnms
MORE
MOTECY
STALE tACEOSE 110: IF, ONE
FNDINEm
STAYE nEEIIbE YID. IPIIDHE
DE!IRAETDR I.J. PetOY9On
Bd!rtRACTamADDns3 436 Menlo, Eawtboruo
Fall
CITY LIcnat A8561 lamE LICENCE No. _
VAMITION CP LOO S
AAEf�Cf OmO. rISiff OF RLDO.
N0. STOalys I]IDE dF lOY
RONT5ET BACK SIDE:6ET OACRS
WAILS
ml-Cl-ti. REYANUNO ❑ emal lloK p.
guTRYAt COnCrOt:O Block
PLAN SUMMED IEITY welmATIONS
SHOW LOCATION. SIZE 4 IlEltlft CH BACK
SURVEY TO OE PROWDEB, r, RMUIRTD"
Dol+nNUCW nrsPECnDN RInulnmDtaTNE
:YES Q NO p.,
REI>rTARitS
Altonlion la p6likWollY Aalled I6 thb Calt:n0 VP eF alRa.,
Wo l aln town, mnnaelibnP d,ivaNays and mtba. PefmiY
f., wth ty enetnen'a:
dilm.
HRE'f nn,IR1C'PLEDGE tNgT yAVE READ iNI3 APPEICATION AND
STAtE nIAT THE AGu ^+E IS CCFPn? NID It"'t TD CDI�LY WINI ALL
CITY OnO1NA,2E3 AHD STATE UW. R MATING DUILDINO.
1 N AFDY CERTIFY TNAT 1 I PRMLY MEMO AS OC WHD BY
111E CIR CF EL SECUtI00 N1D [1dtE C? SglliOgqHlq pN MAT 1 AM THE
IECAL (I NN OF.' IE 061E D,F'Cfl1Om PRCPRTY.
SIONAtURE 1�
OCT•1L 60 i l a a 9 3 8 b 00 MID
APPLICATION FOR BUILDING PERMIT l
City of El SaOundo
DEPT, OF` BUILDING ..& SAFETY
bem USE ONLY
PC No, IMF MAN ONLY (] _
M0. aF
PLANS
VALUATION 5 DEMOLITION
Plan OcecR fee $
Building PUMIt Fee S 2.00
TOTAL f z 9 t o .710 2 - 0 0
TYPE cotim OAOVP FIPE ZONE
USE ZONE~'IFRdNi SELOpCN �_
SIpE Sn ➢ACN$ itOT 912F� FndAI LtpP �,�X �. 7 ��6
SPRINNLERE:YK Q NO Q
WET OTANOPIPES YES Q NO Q'
PARKINS.:. Specas Rati`d
Spates Provided n!a
CITY ENGINEERING INPOIEMATION
ke c$l -: is tsr."
Location of FEoni PiepaTty Line
i
NOTICE,
WALLS OR FENCES CANNOT ENCROACH
ON PUBLIC PROPERTY,
APPROVALS I DATE I INSPECTOR
EXOAVAi1DN. '
FLODRJOISTSr f __
FRA!AViD
ROOF
IATIL ER RIOA.
um,
DenYA�i _
STEW
FOR APPLICANT TO Flit IN
AooEi 1170 ASE C ooR,SS ➢r ips e ,D. MARIPOSA
E -1 e- OWTIONT a0T Or ion
etN. Hlk 123 TAACr
OFOFORION➢FLNOnN, DEMOLISH 4 unit apt..,
house -- single story
use at umltliNG, Apartments
a,NNFR .MARIPOSA MARKET (Ray ;Lamphere
Gim"s AOmm 920 E. Mariposa AVe
PHONE
ancroiECT
OR. pF$IGIIF0. _
SPAT tiGFN9E�
aR lo l.;, Ntl_ I {
PNONE
BIEINE[R
Aaarss < 13454 Washin tton AV &.
city3 Haatthonre ImoNE OS: 6 -6935
aIYYLIIEtiBt No. 35292 191ATE LICENSE Nd: 246189
VALUATION OF Via O. 750.00
sae aF cons. 25 X 96 lA to aP eaYst.2400 sq. F
No snplu 1 Siin ov EOT 55 X 127.6
Demolition of E4 uSKl apt. house
Only- 'zi70 -9e¢aga d- Lolition-
NN'vkVEhiEGSR6IE Rr OE INUE AND EOna OAP LNiP➢TVISION9P6 �lA\v5 AN Nb
"WRAN'E➢ GOVERNING THIS —f OP MAN Wxt 0E commit, 'I'd WNE
TIER SF fa xEFEili cN NOT. No PFAsoN sNAtl OF AEtOWFO Td PEAPOAAI
OF G t r R InI S ru,Anl. fWY IMF IPW;t EPAOPENLY ➢UCENSEDEASTREE
0U1 L➢ 9 G Cl +UN 'i J111 OF NIF STATE UV41NE5II A PAO•FSSIOMS e00E
fGR \to RI E E' J lcN RIim :FG11GY mvi.)
GNRTME of CO:RPACie,` uP AUiHONISE➢ AQENf
zl.mmaA o an-miFe NEd cuLm
OME �� .� C C.................
VALIDATION 4b,.Fo- 8- 10745.ee
NUV tvD6 3 1 3 3 'r 2 A-01SAIRENT DO" 2,0C
APPLICATION FOR BUILDING PERMIT
City of El SNWndO; CPDWRIN
DEPARIMENT OF NUILOINa SAFETY
DEPT. USE ONLY
APPL MEC'ONY JLB QATI VA/7A
PCNO:,. 51.51 UPC EDITION
Y�WOF It .�.. PLOT PLAN ONLY
VALUATION S.
,PLAN CHECK FEC S 20.90'
EUII I a+.PPRMIT FFIE S 32.00
P N. d
TOTAL 53.9-0�-T�--
TYP$ CONST, gapuo E_.i...
USE ZONE C,. �^�2 PRONTSETSACK.
1.�
IM MU
ACK OTf121 PROM MAP
'REO'DYAROS
SPPINKLEREO YES NO
WE'T9TANt1PtPCS YES NO
PBHK�ti •.SPACES REO'P ,2
SPACES PROVIDED
CITY ENGINEEAiNO INFORMATION
RIIe SSeavatleTgEryiUYtUSP,
r rt[TAII`yLlgtb111t111{IIINiC
NOTICE:
WALLS ON PENCES CANNOT ENCnoACH
ON PUBLIC PROPERTY
FOR APPLICANTTO FILL IN
c
romi [S op aoP 1170 E. Mariposa.
ygjlj
DEAL DESCRIPTION LOT Oh FS 1 a
NLK TRACT —
"CRIrrIONOPwoRK Remodel 3 garages
to okeate l more shop 'x
jgjI,p,Nq.
Retail store
DwNER Mariposa Markets. -Inc
OWNERS.BQIfyT�:
1160 E. Mariposa
PHDN6 322 -2829
ARCHITECT
P DrswNt.
STATE LICENSE
2AP9016 YRATIONNO PI'UNE
t.O NEER
STAT[ LIC6NME
NO PHONE _
CONTRACTOR
owner�,�
ZIP�,�•...
M'Tv ENy� 5.10
N0:
,jrIC[NS6
CCNSTPVCTIOt( LENOER '
ADDRESS _.. -
VALUATIONOP
,512E OP AON[T %u1�2;T rpTEA OEtONST 525 s.f.
NO.STORIES 'i'
PEI'ANY,O
OSFAKTMENTCOPY
HEnCOY CEATIFY THAT I HAUL .RCAF AND EXAMINED'.
HIS APPLICATION. AN4 P.ran, THE GAME TO RE TAUE ARP'
CIUIFCT. ALL "1 1-3 AND ORDINANCES
J\'En NiNO THIS T-L OF 1t1011I:CJiLL bE COMPLIEDWITN
IIET /JtR S"ceirtCt} HE nSIN HU NOT. ICtAfIFV THAT IN
- "r.. HFOR>,IANCE Uf THE IYCDK FJR WHICH THIS PEfl-
IT 11 IS LIVD I SHAtt. tJOT GMP`' Y ANY PaAn QN IN ANY
ANk:in : 1 AS TO IIFC MI 'bUUJECT YO THE WDAKERS'
VuHI:t1EN'7- COI,11'.i.N CATION LAWS OF CALIFOANIA.-
1=vt,,tt:ot ju ATL THAT I AM, PRCPLRLY LICENSEE AS
LSH4�LO b`! St't -TlurJ Y0,1.1 uk THE :STATE SLIMNESS
Nkl I'H:J1:L• - -'T1 OfJ� `.1UE 1 jH FLAIIA [XEMaTION UNDER
� *I:1'a xnSGI.
UNATUIILU 4' +111 +xC,.. .i�:THOHI[ZED ACES
GNATUPEO tlYr +]LH'1.1 '.NEH4 PCHI
ATE ..:•Lr (__.
API Cu ^mbt6b tlTf
SIONAT.ft OF OWNER 11F OWN-- qu.t;4EP
DATE ... , f 1.. ::�.`. L rI.......n ... ... ....:.....
ft. . Form R+aiiCTT
APPLICATION FOR BUILDING PERMIT
r�-t --- ICANTTOFILLIN
�
AbffRLHS OF JO9 11 T6 V,. 1.Inrinn PA
City of EI Sepund0, CRiifutn {0
LP.OAL OESCRIPTION2 LOT
DEPARTMENT OF BUILD.NO SAFETY ..
- RLx. TRACT
-
DRHCRIPTIONOPWORKI Tn ull sh? jjlas i =eion
DEPT. USE ONLY
x 15,
PPL. R C'D R
5720
DATE
US1 OP OUILOINO^ MF
PC ND _
NO.OF
USC EUITION'73
kt
OWNER %I2TjjI08A R M'KC: Inc,
PLANS 1
PLOTPLAN ONLY
QVYNEPRAVDREtA 1160 F' 11Rriyofljj
VALUATIONS'
PHONE
'- PLAN CHECK FEE $
ARCHITECT
PERMIT FEE S 3.00
OP DeSIONER
-'
�RUILDINO -- ---� -�
PJAN_kOTONTIbN FEE S
STATE LICON"'
OR RPOI't]RAtION NO - PHONE
'
�.
TOTAL $3.00
- ENOINEtb.
TYPE C0NST., V -N !O4P R -7 .FIRE2ONER
1TATF LICENSE NO PHONE
LlOr, TONE. - C -2 jrg0Kj8O3AACk
CONTRA&DR.. I'ntman R{ r,
r,
Q !�
21P
5 DE ETOACKS LOT
Elie FROM M P
' REtl'bYAR05
.;CITY Tn PTPiannrl PHONE (o7 b -76
.. 'i
SPRINKLEREO' YES NO -
LSkCUNOO T� �,,,��
_ _.ATV I CENQE`� ��TI* [ICPNSE «D
�'f 7�0,�, L1 .
WETSTANCPIPES YES NO
^. L'CNETRVGTION LENOCR
PAARINO . SPACES RE+rj',0 j1O-CF 8RL9R
NAME�� _
SPACESPROVIDE_D
1�
BRANCH -
CITYENOINUA111O1NFORMATION
ADORERR.- .I...-
'
CITY
- -
VALU Y16N OP J60 S"
- -'. -
HYSP OR CONPT AREA OP CON-
NO.STOAWE .
-
WRTICE: -
REMARKS
1VALL$OR FENCE$OAi:�nTENCROACH
ON PUB41CPROPERTY.
' --
FORMITISSUEDATE n
- R/P Rig. 3s tO hR ingl'nll RA rinnn sz""d
-4'1
nn ? H F7 nnt1dnr1 {lt�_fnni^�r idoSt
APPROVALS -
DATE.
N5PECTOR
ERCAVAYMN
FLOOR JDISTS
SIONAT.ft OF OWNER 11F OWN-- qu.t;4EP
DATE ... , f 1.. ::�.`. L rI.......n ... ... ....:.....
ft. . Form R+aiiCTT
Applicant tiottrt Alexander
BU:IL.DING PEK.MIT �t,
cttyofElSopdndo l.>
6i-dF¢ 3 ?.9 Lomita 322 -OU669
c fr El 5'eyllndo. CtL' 90245�'PH6NE
��1�1�
N
- DEPARTIVIENTOP.BUILDING &SAFETY -
A a
BUILDING ADDRESS - -'-
lnnca
W_
a0 r Maz':tpOSa PHONE
TRACT BLOCKIPPAGE �LOTlPAflCEI
o
C: NAME
C,bhn Alexander
Q'.. MAILING ADDRESS ZIP
clry E1� Segundo, CA ¢9`�TL�y4'SA
LICENSE
RDN'
329 Lomita 90245
.. TAT91ZIP
ti .CITY
@
STAT 266 �`O'.$" "" r L
TELEPHGNE
CITN2D6`!
q
W..
NAME LENS
PH D
APPL: AEC'D BY =R. R,
DATE
'
_..., s ATL�IZyzle
PC NO.
g4i9. UBCEDITION..
PLAN ON LY
rc
ray aRlrm =i..,7000) �m licensed ntler Pr, vi I ns of chaplar H
PLANS
�'
tpomm4neinp w hi 'ot OldZt G of tho Bueingas and P-
lesaoptCodd'- A"41lgnso 1, 1pifTplcannd alf 6188
VALUATION
OF JOB SS $25,00
<
W
,..
ENERGY PLAN CHECK S
.FLAN CHECK FEE S
u
Dbia Cantmcie '. t !
old,
1.
Ih by ni mn empuI mac ves rct W f
I 19 Yet Tq]f6 WII'I D dprol p ral Cntla AnY CVry
yC'N
Whl n ep I t tMl to eeP t 1 Ia 1', _p Id a v. a
tir
WW
.BUILDING PERMIT FEE $ 1.60
p
1 P IOr m >! R ha M hq pP kd I P 1 n1e a
c a t temen[th hv1 11 a adM tfxl pa Ffp nVV N cef Ifih4
PLAN RETENTION FEE S
'"
C iraCl rk Lleen LWICh BICOrn ra h IhSee.lWal Enl 3olihe Q
6 PC.1 Or rhath Pemptlndrelrq Mtla hanf of hA all Ade evtmpbgP.
�— :TOTAL E 4.5 y*)
Aqy 141 ! eE¢ 7a31 SbyaPy pP IIC for aptmfitsM tlth npPneCnt
flWr IIY tot rt nP pyahu d dd n rrlSSdo o01/
TYPE CONST. GFOUF
FIREZGNE
O
❑ I I O.Wb I Ihpp bpd ry, It Y p( Y4esW ih eay -.ti, ft sole
pv tq 'lid Ih W k rtyfh UiaOim PJq P: d10r
_
USEZONE - FRONTSETBACK
sIS 7Qm 9 bP0 T C ( f IlLlceh Laws bl aDpYlbM
vmar alp aadywpOE to br Ianr stN re am abet sn wo Ynw
f! dM
'SIDE SET BACKS LOTSIZEFROMMAP
sail
m q 0a Ins W mp Y pr h p va P O YIP
f Ptl aq Y nd lI t 1 II h W�Ver.0 7NIItl 4 i p M1 I } IdWlihn
ya rP 9IPIIq NP pV n4rLq,ida Yq( 1heCYd Ip V pikPt he
O.
AMPYARDS
`
O'
- dap by ld -I Provbf tlheppNC POf ePi I
Q f Of th prOpady 1 S t 1 a .1h 11 k« q, ..
-
:SPRINKLEREO YES _N. O.
tt ItlbginOt pt ap l tt l5" 7x44 B $P L:. 1-1--1 I —.nib.
1
WET STANDPIPES YES NA
W y rc 1 Ivpropory M olds- pNrelth Padena
wn rP 4 ib ch leatt N t 1f1.I b razed p Jant ro- Me
Y'
k
BPACES REA'b
_ V
c f arsbw- L E
" O lambxm ndef¢ec ,p.$P.b. -fm ih PfddzgP��
-
3
Date Dwnal -
SPACES PROVIDED _
USECFBUILOING. $lower Shop„ _
Z
WORKERS' COMPENSATION DECLARATION
I� III 310- ih t i havq . e_co of t to of up t to scl
aC a s'COa Peosati InibmPCa,ACawrtlli f.h" o eo a f
ge
BIZE OF CONBT: AREAOFCONT
NO: BTDRIES.
IB e, 3800, LOlb.C.1.
Po11w No—Company
DESCRI.TION
OR REMARKS:
p
0 Cnrtilledcopvhhvebylemished.
t r Y
�Gaftltibd
fopyts fi'ad with 3h0 eatlnly bPiidinp Inspeebon mahT
-
y.
ar county - Jpanmont.
hpo"
W
Date APPlkant
oCERTIFICAT[OF
EKEMPTION FROMWORKERS'
_
V
COMPENSATION INSURANCE
-..
C
Thi LCet omodod n cit ea comwod if rho permit (slur olro lt—.d da0an
Y
l$t COI I, ass.
t. ft (y thou tha paHormanta.1 thosvdtk far o;I lhbpnrl11il4 indod,
p
I
--
q:
t shah ObY mpldy apt pl3rmn Illtiny m PCI to ps to Oaam➢fpnl -1. the
Wa kris' emp nsgt to, 1 1 Colio
Dam Apples 'S 1 y
NOTICE O A PLfCANT If, Rarma rap IRIS Co tii ca{ f Ekemptlon,
yb0 b 61ces to rho W rkers' Ca"d,, t n of d1e
PERMIT IE5UE DAI C
REA COND IONS BELOW
rrhq ^rowsipns
ha11b .d., rcv ked otthwittl ..Ply W.Ih -1,P ii SOfihispo -d
s a
CONSTRUCTION LENDING AGENCY
-
q
I hCmby atoms. that there if u sl l tion lmldinp apenry lot rho PIe•
termanCe of Ihk.Wark tar It dp5 m it it IftIon ISea 3097, Ciy, C.I.
Tiv 4d k pulhpri m! by ante f t,I, pamlit is idb;oet 10.11 the colas
2
Londor's
p
opd rep lat'ods. sat fa t1 `�,t crd' a r..s otd dma dmed6 of tho Cily dl
0 SIll.d , aId the I�wi. of rho Sur f Cranium(. rn regard 1e -� h Wgrk„
11 d a llbmandmarltsthamto.
TIT pt—1 henbm S Il d aid 1 k It not C coma Cd Withm dne
Lender's
Ad, .
I Certify IM I have mod ihla.OpplmatloP and ........... nbq inf.I.
2
mailan 14 barf20L 1 npree to Mniply Whh all City old eaanly pNinantaa
hung d n.,hty IIQDI 1 J al I .—,, I, f work Ia sutopthidd at
�..
0 ntl slma Ipwy mini nA to hglWinO <OnilNcbon: apd I a aby b thoriaa
Ib'LsonWtlµas
a.v 1 - S n ir4 I 11 Id- pbrlbd 9f I me or d Coy wdtk is
j
,nY'. 1hi! }tv m ant r gpad tha eb. ainyPnonad,proPCHI
'ctJgn Put lda f f -
done nw otIadar if PCiry OrdinnnbP Or EtatalaWa 9avarnin9 fame.
..
q
y'
t:2 (.(s fly(, ,.-✓1 1 ._' r i
VALIDATION dbl�F 8.10217150
Slpmtur pql rant rAQOn}� Date
�'
:� 11', r r t,U �; (�f c'�'Q a.T
Olstributlgn: WHITE (DOPI) YELLOW IAPPIICant) � .
alsttihutfon; WHITE (Dept) YCLLOWIAppittont)
"'°lino^` —
3rrpl t 7r. Hower
BUILDING PERMIT
City of El Sngln,do U'
DEPARTMENT OF BUILDING
AuP Ess -
Ceres
_,_
CITY ZtP Ne
At,gAl c.Gy !'L 0G0'�1 (�1 4�f17�n0
C lv.. Villa e. F1oWers
BUILDINGAOORESS
r2
11 0 G a ..Mari PH 122-0251 2 .
TRACT BLOCK /P. GE LOT /PARCEL
p
I
C T - ' STATFJZIP
81 Segundo CA 90245
NAME -
d
ucENSE
Ac tie
MAI LINK AGGRESS ZIP
Q It on 0
z
GI BTATC /21R
4'
w
z'
CITY
Los A}�npgLeles
TELEPHONE
6 2-0241 1
¢
- I SE
U
$T `S F5 eLO- o
CI
i
A.qmm FHDNZ
APPL: REWD$y R.B.
DATE 3'.1 62
z
w
Ef TAtr: /zlP
pC NO -
UOC EDITION �.
P
0
re.
f y Irm f t o n ep tl Prov n of Chol.01 H
(qyn ar cleft whh 5ett1 n 7000) is O YtI 3 of the Boone. a d Pro•
fassionaCode,gll Y as salsipfullf m pl`ILj
Li lease I s Los—.,St
PLANS
-
2
PLOT PLAN ONLY
VALUATION
OP JO6 `� 50--00
OaW ^= Contractor
ENERGY PLAN CHECK $
u
fn by ll Ih tl p t h C ntrna U-1 L 1 Ill. 1o•
np p ISt 7'315 Cal 1" B P to C d A YLn"
hh 9 P t 1 I pbved h as -[.
Pi I arcq {n pl T n t.l'lea
q 1 th n i In ad t P t t umyh s flha
C Lk'nyt ICh 9 (C n i 0 a S 7ppp1 Yb 3 I th ts
& PC! n to a hp r a n n I ad PIIaR.
A YN (S Tbi16bV NaO anllp 1 bl sn appl ant
Ylppn "vNar rein ,rain aeaai 14509 poll
QI vlt pry^ 'Papers' y plY M1 w 1thpfalp
Itaa, wihd r• wv kenam i l aeao (l rea mr
I fCia 7ba<l:8 & P ¢ Th C o { Ll L a f apply tP art
in p Ywh b Ic I 0 n a wii eat h. khm
1 I ehn t P6y pa da h aek imp 11ry
acre n ttd 4 r1N 11 h n hu to 9 nip avem Id h n
da ytWblx.. I h b b'a Wix head erP. g fi no
Mt r xewlma It 3 1
❑ 1 l t n Proprry om t IvFF a nl aeon
x b ra t P lha P 1 t I5 , 7WW d & PC th Ca tree - LI ns
La d aI.,s arp p an o a n ro
0a t
>M a 1{ tar seen 1 a,f ..In 1 o ttdtl Irce d o theme
❑ Lnl 4wv 4 , ._
u'
4.
q.
Y
3
O
-LAN CHECK. FEE $
BUILDING PEflT,11T FEE $:
PLAN RETENTION FEE $ —
TOTAL S. 8.5
_.USE20NE
�.
y
2
U
•!
TYPECONST. DAOUP
E— FIREZONE 3
IL
^.ETBACK
OT SIZE FROM MAR
- "' FRbNi.
SIDE SETBACKS f1JG u.'
REG'O YARDS �� {'fy ^-
---'�-
-
SPRINKLERED YES ND
WETSTANDPIPE$ YES NO i
Q
y:
SPACESAEOD
SPACES PROVIDED
bam avna.
�
-
.USE OF BUILOIN6, '
WORKERS' COMPENSATION DECLARATION
1..11 Tly Ifi m ih t I h va al tic on 1 C sa t elf i 0, or
- rs I Cate F Work Ii Compensation I suranca copy thereof
I5oa 3800, Lab,Oi P07.. ` 02WC220610A
Pulcy No, Cq Mt—in l Tea_
O`
u.
_
- SIZEOF CONST: AREA OF 4`ONS7
NO. STORIES 1st. PlOor
Z
ti
r
y;
4
p y .Nat
❑ Certified copyt hp f ndped
❑ Certified copy i PI d Ih th0 Gaon olitlinp mspctotlh dope^ ens
0 ""' — di, a meet.
Oela g �2 A allehn,
OE3CAIPTION
f+an
DR AEAtAflK$'
e, Aiming O1 F,1- nrafrnnl'
-
o
y
¢
y
3
CERTIFICATED' ENMPTiON FROM WORKERS'
COMPENSATION INSURANCE
Tffle 3ettlon head hot N eomplatuc if the permit Is fbrbpe hundred calls.
1$1f3p1 artist: �
I. Certify that in the porfaRRance of the work for which this permlt,s roved,
1 sh II not employ e y pem M1 env p ,a as Ya beLgma sahjaa[t0 the
Workers Compansobon Lry of Calif mia. r
Y
rj
"
0
_ -
o
bale 'Applicant
p
11414 1
NOTICE TO APPLICANT: If, after makin0 thrs Certifmrs. of Exemption,
Va.-'" "'d ....... I et to the Wallow Comp....vea p—ahn of the
Lab Code, you ma Iq,hwilh <bmply Ih6 such previsions or this pond
shall be declined -.k ad.
q
' >
PERt, IT SSUI LA7' S,Ar�
_
CONSTRUCTION LENDING AGENCY
W
p
x
W
I he by N{ 111.1 there Is a e n f lending g tY 1 u' par
fa ee of lha work +ar which this pe It i41-ad (St 3047, ln,. C.1.
r_a dart
No
REA CONDITIONS BELOW
TI rork autl .... d I y s rc of ihn permit it 6ubieet to all lhasule,
nd rht - F t d- d amantlmenls of the City of
EI Scn 1 tl h t :.,I.n -. t C4'1 ma in "laid to - h Work,
and pny1lri,a .etc l,.ete..
This P`rn t becam I d ,,,d I va,k .s not "',need vultn n no
hunrf d 0hty fi4 0) iay t i e at r f w0 k asPended at
.m, t m d 1 t f I a re "'A aft o o t y work is
ion^ nv Hint^^al ih C,Y ON man. -e Statataws gay^ 0tame.
_
la dnr's
AEdmst
I�
e�
I e rtify that I have teed this application tl %l ate n ha ebe. into,-
mol o I correct. 1 agn r um ply with all ty and e ty ordln s
a d it swf MI d g t h ddl g A a, and h aby autha t
tap yts of h �ty o ^.met pan the this" f. nco woo ty
for p RP s q
VALIUATION dbs,Farm 1310211,80
,l s fi tid� 1 11 182
G
8lknetum of APpheaat bf Agent Data
alsttihutfon; WHITE (Dept) YCLLOWIAppittont)
BUILDING PERMIT
Cliyu El6Ap d.
.nn- r.z�l1.�MYY <`" � <���"u.. � - Rt61ENy OFOVII�itlO GAFEtY
yr ✓r�4
m/3�GEL
FIVE ZC:E
Ai. *€W +?IC1F
2C ^�
I
Av Axr yitFF t/,ns/i Myn.6tT //.I:.
oxen
_ ...CL 51(r0.A�o TIV vxonE
4. a REU yv m, Zei &g c P axcxE l +)aa,
G NAVE A/�tLyy N �IK.S ucENSE� /R' %Y7I
ExOE
aREO u",
}EIb77 4 316
WORKERS' COMPENSAMON OEC1.A 11T104 yyEE
CERMFIC— OF EIIEMPMON FROM W FNE-
o COMPENSAMON INSURANCE _
a
BUILDING PERMIT
Clly of EI LDIIe
eEPAR xr OF OWLOINO SAFETr A
---
p _ xMrt xo
vu
�) C _.lJlHi /pd, >• arrvArtcEr
-- - —i,X pr--
G �a¢e a ° —coxs
uAnrce
pE xEW. AuortbN iEMnO
�CFFi_�B /'Prn e
6b^'N ^'mmi n krtn�
FOR DEPT. USE ONLY
r.w.npx oy,oe y _ k c .
�6�% -4 ,
PERMIT ISSUE DATE T—f I — �—
ua� �orx�
aam.ewn
— qCONSMIULMOx EENOINO AO�eN��rt� M .m.nox
�T 'w -C BVIC'`7 -
CRESS
_ —to l -1 oln a V iJ
On 3241a
a N RAC:
� CITY �. y . '
S. o r,
BSE
—
unn''N�.°101
Lm�- S LEPNDNE3 -�z �izi
'
.TES : owls CITY Ll r,
WORKEPS' COMPENSATION DECLARATION
3
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION Dl.: RANCE
3
�LONSTNUCTION
LE401NO AGENCY
(BUILDING PERMIT
cuF m EI sae�.Do
DEPARTMENT OF DUILOINO SAFETY
1"E «° of P NLEL
- ESOME
`
- — �— l�Ea.�o �.
R
YES no v
l-1 OR R—RIS NEW DRwN EP wN
FORD SE ONLY °N
I�.N nE +Er,�paL
1.0-3
PERMIT ISSUE DATE
...a......
wa Vnnm
DD.D °Nj�,2_W 'L GG, sa zn y
111170 E, MARIPOSA AVE, FILE 01/31/07
e�Y�W Plxr�14 M
- Zh(7L, d
,xa.uxs J
u
Be ILDINNGE PERMIT
- eONauvSEiMC� P u�it PNEHf
FA ��GaIId3.
C.:
v
PLAN CHECHIPERMITNUMBER 7
s
11 -70
/iLAc7 Aws
-D
::4
23YZB s. A1cerrl�an
3ib'"
5^o3-!N
Y4'eSt2 CT C;!1-
7/
!!7a E. ti/g,eipaSJ� x
` - -" pwnanEaP.o p�.urw°enr.w�w�
b xa pscsxPr.
�?'x..,,. ll. / /,tn xG-x �... �PUrscrx�orzesrnpse:.- �a,PSamu
Y
_,L_:�_�,.3\ ,�� \ `F d f�""} �" ., i t /,�,i �i'- .���'tif" �,t,.._ r�'�y '�,
APPLICATION FOR ELECTRIC PERMIT
City of EI Segundo, California
1
I
RaangS
GtV TEL ND.
WaTn'"L
EUY7nACtOR r
OOUnQ,OTO R's
�
coifsE xo.
axcne 1y `� � J
-' eC,.Pxt,cFwq�Wn. :i7.�/ n7.7�{•
c � rtoall
rrB11LCO. MEA
INSPECTION. RECORD
_.._ ---. -- APPROVALS
OATE 7MSPEa70R'4 SIGNATURE'
cgaooiT __ I
FICUPLS
Yvan
At[lf CO f OtIFlEli
FIN
FINAL
Plans and specifications and such otharalatRas will enable
the depcomont to asccrmin whatha, the proposed Work
will conform to the requirements of the State Laws and
City Ordinances must be filed.
OGi' _3 5 5 7 8 9 7 B b 14.00
b
APOLICATION FOR ELECT& PERMIT " °ORE55�Il'7� `
17 1
r -e00
City of El Segundo TFLNO,
DEPT. OF BUILDING &SAFETY JU
DEPT.USEONLYxt: tai
=NIT, USE ZONE FIflE 20NE CUNTRAT� S� � - _ —� CONTRA T -- IP
PC. No No, 01 CITY STATE
IROtW By .t-lE• Be, I- itCtJ:lt�t.t} yep LICENSE NO
»���
ryyll coi n olex¢¢n fnfermeil...RhlnHEAVYLINES MOP NO. OF FLOOR
ERVICE- . —.�e.y Ne I tACRI PEA, :r1GTF9,w, ,_,_,_,_,. STORIES AREA
,(({fr oven 206:AM1IP �!1^: Tltf/ II_a,6n 1.2 pURPO.,r
Q <GO ANP
mi I OF OLOR. NEW OLD.
�E+Q1 T017QO AMP 1ljQtl - CO ".1'.i �� Itfu (� RESIDENTIAL
4vf.P t240gMV r 1c,�TL
PA ,�OANO 240 Rt�h4ARK5
&=IITIGNAL ME tl(1 _
�011TLETS _ QNTY �_.... _
t !WITCH �A%
FIR 4W EA I
REQE,PTAi;4E • -''_ OVER 264 2W EA
FI %T RES -
pl.IANCES (D¢ .tic lnxY`Ittinn OnlV__ Ie...r �Grl )N 11e "CO(iO -
RANGE DRYER
VEPI 2D0 NOTES:
PAN DISPOSAL EACH
HEATER I JWIR. RTR.
' MISCE4LANEOUS
.EP T AP ROVA[ UAYL IMb ¢xn SSivnature
tl1.2r. 60X MEATCABE 4A0 TKt PPOtJER rOLE I
BEVERAGEOp ICECREAM CABINET EACN .~ _UNDEFtt Owdb
SIGNS L At LS
SIGN'STRANSFORMER OR.BALLAST BAO CI 111NR..
ADD'L BALLAST OR TRA1011%l 1 , 200.. SL 7VIPE
LAMPMOLDING DEVICE -FIFIST 20 SOCKETS
- 1171 LIiY NO IFiCh
POWER EOUIPMENT HP OR KVA
UP tot HP. 2.00 20.1 t" G.OQ -
t.tm&HP -3.00 fi0.l to ISO .13.00 11 ace ' F�, ¢nlop oll d ara Y:pl b% t.tt adehernm.
6.i to 20HP 0..00 Over 700HP 10.00 x x t S +..IF P L F tlpo:�tl 7 k .II Conlomx xo lF¢tCVUiMmenti
Of t t_L;::.: t'JGtyOfdlnan,.egmuStO¢B(cd..
I t!CilrGV E' =GTWY THAT I HAVE READ AND E%AMINE0
THI- V ?OCA ION AND KNOWTHE6AMETOOETRUEAND
CO.,t,tCT _ AU PROVISIONS OF LAWS AND ORDINANCES
GOVRNItJG TH7� 7YPL- OF WORK WILL BE COt,1PLIED WITH
TEMPORARY SERVICE 10.00 WHL RIL11 wL IFiEO HFREIN OR NOT. I CERTIFY THAT IN
TEMPORARY POWER POLE 12,50 THE I HFOI At 4 O(- THE LLORlt FOR WHICH THIS PER•
MIT I� 1„1010 I.,.HALL NOT EMPLOY ANY PERSON IN ANY
IN CATION FEE ISCO106.201 MANNER SO AS TO ETC= SUBJECTTO THE WORKERS'
REINSPEC71ON FEE,.EA.IBc¢. 106:25! 1C,U0 t4dV Lm „n`a140 ,1PENSATIONLAWS OF CALIFORNIA.
MI50, 1NBPECTION (Sa.i05,tO1 PER HR 20A0 I FURIHEN STATE THAT 1 AM PROPERLY LICENSED AS
SUBTOTAL
ACQUIRED BY tEGTiON 7091.5 OF THE STATE BUSINESS
PLAN CHECK FEE I5ee 705.OI. A PRO'.-'E.,SIONS CODE eiolm'..emotion ona, Beaton
PLAN RETENTION FEE I
PEFUMITFF.U�µ 400 /5..!/Jl”
TOTAL CN RE CXT`RAGTORURAQT URIZE0AUE T
VALIDATION '5IGNATURE OF OWNER IIF OWNER BUILDER)
LMrt
DEPAgTMENT COPY F:Y7j =i" f,�, .•'•+
din Pnxm E. 103 Rev. 0177 ,r
APPLICATION FOR ELECTRIC kiRM.f� AOD f {{{7JJJ .0 �•.A �p� 1 ' .
A60RESS
CYtYCi Ct Scyunda TEL NO
OBP7 DP BUILDING & SAI m -
E4ECTgfOAL p, Ili'
RCPT, USB ONLY SpipdCT4B' — ..t Via.
��CUP TYPECONST, USE20ND FIREdONE coDNOTRES70R'S _ SIP
CONTRACTOR'S
III PHONE .-. -.;-.» GyTY. _ ..- m...•.. -.- -.
-p'(1. No Nu. of. . � ..r• CITY STATE 1
'. Iwu9d By Data _(G[j LfCCNSE NO_ �710ENSE NO.T
r nt to nom rare ah Iniormotlan wdnrn HEAVV LINES NO, OF NO OF FLOOR
SEPVJ.P.E METERS STORIES-___A EA
V 00 h1P SO "PVRPOS6 '
°.R?9Q8MP q. , OF GL00 ,
AMP t On
V A 12Dtj AMP 1SAO _ COMM 0 INDUS RESIDENTIAL
ANFL @OACitY 2Dtl _ R ri1A KS. % '�)}j;
OUTLET5ry ONTY � ♦ -'1
TCH � 'PIRST260 AOd EA. X J 1
ECEPTACLE',_ OVER 20 s720C F.A
APPLIANCES IOOmett a InS1511nAbn_Ont INSPECTIONgFC07D
RANOE I_ D7YER
VER WASHER ,x,00 y .• - AOTEg.
FAN DISPOSAL EACH
HEATER YJTH NTfl.
�MISCEL4ANEOU5 - ~__ APPAOVA4S OA�L -ir JAS
'i1EEPFREEYE00% ritEAT CASE Ai5.1 7EMPOWEq PULE _
BEVERAGE ORICECREAAICADINET EACH UNDERGROUND'��'
r -
OUfH
SIGNS tVALLS �
SIGN'S "R'ANSFORMEq ORDALL G00 CPILI G, _
.ADD LDALLAST ORTR NSFOgh1ER 2A0. _ 6ERVIPE W
LAMP HOI.OING OEVICF±1fI T'tOSOCKETS CO EA ;UTIUTVNtliik! -D Jr.sr��" r;,
POWER EOUIPMEN11 HP ORXVA
up'. ...t HP I 2OO .0.11n50 r ILDR
1 tlo SHP - O,Ap SO.1. to 700.. 1000. Rrare and sP.Etlleat cnt antlsuch h data x..w ncnPubn ifinIrpaHmaal
.-. _ P ttriph,nM8tlW0in 0 ivh01h P1CP tV P tOOrpdplt. .^.-U Ato tlmk vl!t1m M fne10d Ott 20 HP 200D r.+lttr4hnrrTVE.LtIPn^`-
1 HERESY CERTIKY YHA7 I HAVE READ ANO MI
ERANED
THIS APPLICATION AND KNOW THE SAME TO OE TRUE AND
CORRECT ALL pROVISiONS OF LAWS AND ORDINANCES
GOVERNING THI.. TVPE OF WORKWfLLGE COMPLTODWITH
TEMPORARVSEHVICE 1008 YJHE7HER SPECIFIED HEREIN OR NOT I'. CEATiFY THAT IN
�TEMPORAgY POLDER PD E �; = a IxfiO THE PERFORMANCE OP 117F WORK FOR WHIERCH TWPER
INVFJu71OATtON FEE IS 70520) " ° MIT IS ISSUED I SHALL nIOt EhIPLOY ANY PSON IN ANY
MANNER SO AS TO OLCOME SUDJECT TO THE WORKERS
q E1N5P r,TIDN FEF SA I5 n1tlS 211^ tOtlO IWorkiroWO COMPENSATION LAWS OF CALIFUHNIA
IN£PPf:TIDNI 109401 PER HR, 26.70 1 FURTHER STATE THAT I AM PRGPERI,V IIMNSED AS
SUOTOTAL REDVIRE0 OV SECTION 7001.5 OF THE STATE BUSINESS
PLATRCr1ECICFEE 16. 705.51 AN ROFE:SSIONS LOOS I ar Utln pxrmP tan de 5 A Pn
-PLPMREt EN7;tON PEE
__jPFRA1IT FEES _y I. 4.00 7 (,/f_ _
TOTAL II (GNAT G ON AC70RORAIJTHDAIZEl) GENT
i�
VALIDATION 51G ATUUREEOFOWN RI IFOWNEROUIIOERI
nE,6AR7MCNT COPY '�-" - i 1V lln n�`r. -8 �, &Kautl
City Of El SeOpndo ./
DEPARTMEfIT OF 4
BUILDING & SAFETY
OUILDINGAPD
;E•
�TP"TE/
,$S-
TRACT BLLbCKIPAGE LJO'TIPARCEL
Q ;Iv
NAM
Al
(+'
LICeNSE
O
ti
P1AILINfi A09FjE L Al
-- -$TATCIZrP
C
CITY TELEP�1p�VE}
U
STRTE LJPf t�0� . CITV
4�C.;N�
,•C Nsk
Y'
�,
No.( L No, of Plem RESIDENTIAL.
s ATLIZW
N E.C. ED P Data - COMM,— INDUS.
atl r Inat u e Provisions of COapter 9
icemman��p m", S ct Y000) of p vl ionrI of the 0u9neta and Pro•
e,,
SERVICE
N0.
EACH.
FEES
fpaon.Chde,a if o Ilfnaandefl
LmenehCen Li Nnis tc
NOT OVER 200 AMP
2.50
Date _ Cadlrecto it )01 -(
201 TO 400 AMP
5.00
in.rdw Nli tnet it ncenmctN LtY Se L.Wrpltnp la.
�CIIO:n0O5
A01 Tp 1 ?OO AM1fP.
10.00
µY'M.rewan -WIT, 1tO5, lecnd Prlryl ICada: AnYCIiY
kh .palm O.COmimp, m,l PrPW.de Im repsr dnT ltNe
OVER 1266 AMP
15,90
Ih 0 Ip 1 MfE Ni0 rogV Nth Opp Mt i i h pint 9 1 le 9
Mips fenit ttw \na al Ht(9 scan ry to pp9vlt in9
PANEL BOARD
2.00
LkpNL IG D.fCOmm/ J�rpo hae9 idpdY fD 0 ,nit d5
O'.
M PCI a o:ae h s ae n rer 0 d p� but I Ua II oq pan
AM vwl of bas )0315 by pny pplle [ f9 pv n 6 b tha eppliwnt
t0 aem+pnWry Of notm9ra Npl h gNtltlolleb la00fA�ii
ADDITIONAL MIZTERS
6WiTCH00AF LS, t,91 1.n Wrvlcdc t1 vl
1.06
i-
L] I, weNtpµn 9tlMnr:petN m% Plpy -! W hvnpe '1' h eblp
amanMtip, p tlp u pa k to tha i t M1 1 t t pq II red lot
FI tse t' 16.00
dtld ti ., tO.OD
ale IMc. TqN b d t C -I C-11- ip c L tt Uµ d s to, -oi% ro In
nvelar p[prvpn yMi C nip i agwh ape hW9 kn m•
OYe GOD e 1 3250
tld :c�atae.! 7390
�•;
ail Ihreusn n em Y f. r4ndq Net 1 P tt bi in•
twidld flNgl el 11 hOkaW Yy 6 Itl e0 Imp W Id Wttt n
p d1 li ncm Iy lra
OUTLETS GNTY
cY natnst
aw Yruupiaarrawt renec.�m 4 t i
LIGHT OUT
Q.i HOwn! it. PrOWtty, 1 WlVernl \ 0 Ilh llp d49n
t to so..M,,7777 M Iwtlslt Twa B. &P.c. Th Go t s`,k
SWJTGH •OUT LET
FIRST a0 Et 40p ER.
Lewdde nut ripp 9+m:ldrpa vvmbbmfdo am"llne9 eq
ykq camecuf Nhpprolern Wth tncwrtll qP nt im the
RECEPTACLE - OUTLET
OVER 20 @20e EA.
- C❑ernrtewcta'as r of u mo ewrrS.ele.
, .6.8P.0 ror lhirrew9n —
1 %TUflS�
Gie o— —
APPLIANCF31Gon c.t c ln:talalion OnlYi
•
WORK C MPENSATIpN OECLAflATION
f+ANGE DRYER
1 hereby aR.- then 1 Nava a eJrblwate. of pbment to sel 6; are, or
pVEN
LYASHER
CattilkaYa Of WOekaa'COlnpenptiDn ineunnee,0 eeerbl(bd dVlFlataOY
fSae.3500, Lab, C.1
FAN
013P03AL
ETCH
�/.
POIkY No. Ganpe y��r-=-- {1 —+!—�
HGATER
L "J7'R.
HI'11.�
ii
6
❑ CaNified copyi h b/'furnlcir0d.
CJ C."Ill, d copy Is filed With the muntV building inipecdon ll-lt nt
TEMPORARY SERVICE
10.00
+,Igo
or tovnty
,Y,,PORARY pOWEHPOLE
12.50
DNe - Applkant -
POIER EOUIPP.IENTHPOR KVA
$d
CERTIFICATE OF EXEMPTION FROM WORKERS'
U0 to 1 tIP
3.00
20.t is GO
G,00
O
COMPENSATION INSURANCE
This eaction deed not be eomplated if tho pabnit is for one hundred dllole
T.t tDBNP
300
E0.t [p /00
13.00,
k
15IODJ Pr1eN.
Idamfy Mat in
SA io20HP
4.110
Ov_1100HP
2004 -r
a
ifleperformence of the Wink for Which th•i oinnitb raucd,
1 h.11 not employ on pe on in 9n nor doll.toeto o aubjicf fo the
WorkeA' C 111 h LAVA of Cdl1 Tn[i f
.
bala PQ}kartt L
EJ7lRKa. BUG
TOYAL it
^ "1
NOTICE AP LICANT. IY ahor hi kin6 [hlrC rtli d910 of ampUOn'
yqt lhhuld bKodw spbicbt ib ilia WprkeA' Cemp0.11 prbvh drtof the
lab Coda,
u
PLAN
CHECK
jp
_-
you mutt toHhWVthobinpfywhh suchpMv Jonserthit permit
shNiMdaeni ed tavoked.
PLAN
RETENTION
CONSiRUC710N LENDINGAGENCY
- PERMITFEE
afflbn thin there is a dnatrudicn Jendmll o3enb% "Yet be pen
pERM171iSUE Dq7[ O y',?
7pTAL S i":7
rmance of the work for wMcb ihb pa +mlt Is issued (Sae,3007; Cl C,1.
!
READ CONDITIDWIEELOW
Nhanby
n &p"' ` - --
The —k — houtcd 7dd
a
.d "loumR mt forth n ma ord a ax sntf ainadd;ncots bt the City of
e t fy Ilt hevo�Pl t o i p\9 th t rho iEI
S Frt 4 and the Tdw% D the St- of GNifetnla In kcaard 1n Such Work,
I ag t0. cbmd'y Whh aU city d uni•, Ofd n ncc§
d state IhWt IBhnp to build n0 crtMtNptlon nd h reby pulhorl£e
and bl(01Y1 hdenit thin, a.
Tfi19 perm it th tomb n II ono vold f 1 o k fa not mmoP d Within ono
^2, , in wc, upon he bb a mentions property
hard d alGhty 11001 day tram rict of n o, or f rk i cpnndcd bt
ony f dunnq Cdnifnr f en ter the 5nin po tad by t MP if riy N'arklf
L
ddno in elmlorl4fthoCty Ogmancdbt Statol— Go"thinq snide.
ppleantor Age r Dart
VALIDATION ribsrFbbn E403 Rev. 7180
Oilhiiwhhn: GREEN (17,.m.11 YELLOW JAppllcbntf
f "'.^ f_ „jy
ELECTRICAL PERMIT
C"' " EI Segundo
1 7 2 EUIIDING SAFETY DEPARTMENT
�H.H mmam°H.n+i ,, a° aunxnTv
°y —/� —� fnnl:n�E Ul menl fer nCOVOn
p.iD �,[�MDa% OUA TV
CERTIFlCATE OF E%EMDTON OM'•IOnItEPS' 100.00
COMPENSATION INS CE
C mM1eenpnrone°e wlbmnF'<1eE HIH°°Mraaa (�S�Nlµr�ln�> —'
.� 1 He DexonnxwallM °W'max'° nri
a �y H:ry Dmmn m enr mennee p a> anV>�k^ ro
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• men ro,.NV, �N>wmmm,ww ls. .w"�0i cw� - �'rO'QV _o
�� auuM� reH°n >ucNe
VAUO:
1170 E. MARIPOSA AVM, -1
APFMCANT
qq n n 1, R 4 1
"Oz.66 31b
tit
8
—E UCENSE
pry —mp
WORKEWS COMPENSATION
❑wmdrobn WY m. 3-143✓
G
CERTIFICATE OF 01ITMMON MOM MRKERV
gpENSA=NINSUWICE
ApPOan
CONSTRUCTION LENOINO AGENCY
in mNl FEE olmuertylomtaemntlnwon
IbrN
Sy em Im A4m1
MECHANICAL PERMIT?�
Oily Of El Segmd.
BUILDING SAFETY DEPARTMENT
PFAMW FEE PAm TALI
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pESS - - -- "
MC(INI(.AL YCHMl7
Of El Segundo
BOIL NG DEPARTMENT
p1v Lpk„ir — `_1-- I— PN`O/rip fJ'T
W NAME ___�C� /(, �. T4t -1 I'✓ —%_
ADDRESS ? pypN
C _ STATED" o24
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NAME
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tl
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by ulhad d p fanlelhtia IthL l Inr upon Naelm
Y Ivr bepogbn laumosea.
le IL.
'psk.4
AODRESS PNONE
9�ut AVPlkenl rA9ant
_
CITY ATFj21P
P.C. N . No of Plnu pool
Deto
V,M.G. Ed Ouenaty Fees
W
NAME
_
I.aDDRES
u'`{
PIIDNE - —
Cltt STAJTE/21P
NAME 1 �•'1.�
IUNp ADOpES , `r
Fuel bumin hush A I.
S
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STATf�'a 29,2
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Conditi —d Celfhq All
Vent
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S
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WORKER'S COMPENSATION DEC TION 1-
meNpt Meq DMmlmea marmu,eo .mw:/k �I
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alnap�rowNNVW Iman�uaaeipodmvMmaam:a,egnA
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v.arhJ-- '�i%.Yiup
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w?.!� Vgac�nay9gp.t.owem..l we .
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Eve oralivo Coolar
Vedhllon FOn
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Flrd Damper
Smoke Conlroi Damper
1 Mmy arc.m mm.r pm¢ry d MrM mar
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r I Ia'"a'
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Thenncstot
PERMIT FEE (a. TOtvA ��•nl
pEMApi(9. PLtn Clrvtk FOa
Plop RuL Fee
lowanco Foa SI500
—�
IOmro DOIn I��TOTAL FE
pEAO CONOn10N3 DEl0W
Tho xrorknutnwiaod byluuentndlmW parmll is nuelaFi l0 a11N
dtegulvtbnaeOtlMhln NOOa ancea nndsmammenta aline Clly al I. El.
Sasunao, and 1n010wa01 tno SWIG 01 CalifgnWin rdgaid to aural wwk and
a0 omaMmonls hereto,
ThlapmilbaognmmmaldYOlaawod:Iaut mmmuncodwilnlnono
hundred ol0hty (rotspj tloys hem dtto bl Wsunnto, orllYrork is euspendOd al
onrmmaaukp iruuetbnkrUroumOpeaotl olama, -1 esy yrkbdOna
mvWationol Me Ciry 0rdlvancd m SW Wwaguvo.Ing came.
W
p
CONSTRUCT LENDING AGENCY
n lNG
nmap na nmxge0mryrm
.Pe.rcm�armua xkknororp.maxiwadtsec. »pa.Cm,n
MMau AOSeia
VALIDATION
ouuGU =n o01LEMicO IorF�i TELWW IKCfwnl tba aOHM 1F105 nn lM
r t
r
ALL AVITACATIONS :MUST: BE FILLED OUT BY APMUC NT
,APPLICATION FOR GA,SIINNGG PERMIT
;1
City of E Segundo, California i
$UILDING DEPARTMENT
TO '.THE PLUMBING INSPECTOR OF "M Crry OF M SEOUNDOr r�
AppLcaUanla hereby mad a. form permit ta conetruot and'idalnlf thn WOrft barolno{tog aet torfb.T1Qa apDlloa..
Uon is made eubJeot to the YoUodring cbndltlona, Whlob ore bareby agraeQ ta by tho undawlgnrQ sppllcutt and ,�
Whlch ebaU he- deemed cundittens entarmg into the drarelso of the r"WIL ..
pTRSTr That thn pormiC done not gmnk say right or priWtega to construe[ on fnatnllibo Work herein deaaribad
ar aRy purtfon tbtreat upan any etreek alley br oehor putillc elaca ar porUan thnreaY. +.
:SECOND: Thar the permlE doe0 uof grahtaay rfght or':prlvaego to uaa an7 g the worA therein din.11,e4 or
any' pbrlfan fharao{ {ar ohy purpazca }hat 1e or may be
ham We pnht6ltCd by prdlnantln of the City of,OCl 9e$un+
do, Q, Otto Labe,
r CUBE D'ix On usamnarp TYOn'OD.a'
r
/,( Stmt y..
Job ..Addres..� /- /�.�_,� .- /- a✓�.,;�tr- usam•�, -� �TE?�Ll'S Ci...,::., Avana6
TlsrobeYa Namo ...,_._." .4.....a. .y,�+'..itr' -.-- •...,.».... ««:..,:..,«.. --.
FlambetM1 Add-, �.�- _ Pho
$1a1e Lketwa No... ....,_,.�.,,. " _ CIEy lit— Na. ,.
Owrier's Add.A
F 46
�'FYXTDDj.E9 Protal -""`---J'yyf-'''y
noun tube � ,. lvaeh fioya Fornat. ,._ Floor dmtn
Shower .�.+. Wator cloaote ,�� D1ah 10—p
LAYataiy .._..w. l Water hantera — eR - - -•r Ftotrigarator DAii. 1ounWas
(Kilehoh one auuata Water nettehor Dental lnv. �.
STNICS(F7aor ,.,_�._...�.. Sewer E°`'• Sand trap _ Saito taunt.
((( Slop - Cosepoot , Aitscelkneova
Additional thfarmation �.._.::...:.�...... _
Eellmnta at asEti! Imposed wdrh g,e z '
T five MIA Me Love appllentfon and linear tM cbntbMe tbcrnoff the anme d cornet. T further btata
the ant tamillarvith the Iaav;.:and amhaamanta thereto, earning plumblpg and 6�q 11ttiag vAlhm Oin City of
,j `4 EI Segundo, and State of Calflarnia tnd that tho abovo work vjl b pc fart d In eartbtmity lh0
- �APFUcan4
SIGNED—
FOR DEPARTMENT USE ONLY
PLUMBING VRRMrr NO. �x_.l~� S` nFpLtaA%ION
,
'. :•'
Data ti Fan S..-.- Fe.... nY,_;_.,._ „�,.....,.,,_,„„_,._,_,�.,,_...
1000 -1148 -
1
APPLICATION for PLUMBING PERMIT
City of FI Segundo, California
DEPARTMENT OF WILDING a SAFETY
FOR APPLICANT TO FILL IN
CESSPOOL Q $2.00
$
SEPTIC 7AHK G
-_
- PWMGING PIPING
Wlnmur nzrunES F�qA 1H1
EEEPACE PIT C^} $2.00
$
_ —�-_
_
SEWEHISI Q 51.00 Caeh'
_�__
$
Il
$11SC.
STATEN 1aT.
f.
10
A --
WATER
$
0 fi
WATER TREATING
EGUIPt... '
$
_
DAS SIKH
$
WHIM
$
DENTAL UNITS
$
DISHWASHER. ".
$.
UHL FOUNTAIN
FLOOR OMIILSµ
FLOOR SINKS u
S
._�-
GARBAGE OISP.
$
Q C7
HITCHEN SINK ,• „
$ 116161
,._
IAUND. TRAV'S
$
(y(�
Z
LAVATORIES
SHOWER ..PANS " "
$
_
SLOP SINKS
S
�—
URINALS " " "
$
WASH. VAM
STAIICPIPE
_1
.z..
YlATEA CLOSETS
PRIVATE SVIPd1,11NG
POOir °,�im a °ePPoiane"si.m010.00
$
—
CESSPOOL Q $2.00
$
SEPTIC 7AHK G
EEEPACE PIT C^} $2.00
$
J
MINTENANCE PERMIT $20.00
$
$11SC.
S
I PE mfr
°TATEETHAT 1HEIA'OGV�11S COMECT Ally AGREE TO 0 iP�Y \Yitll AND
CITY GpGINANCEE AND STATE (Apia pEGUNTiNG PLGAIGle
1
OF N'D
AEGOEM
PLGI.mRG
AD AD EAGrapa
EN
GGxrnncron'E
CGxmncronc��_35rGiici�sExG.
PCCaoaE
CIfY UCEtGISE IIG.
OF MS. f IN NEIGST RIE9 A
sin
E c. ARup 4
No. OF No. GF
MET= FAMILIES
Nn'+ rml ry DW BLDG. p
pRimm BY DATE F
PEf',9r fG 1 -CTE ISSUED /j ,,.L
INCUSTRIAL
Wa9TE AT"VAI
C
INSPECTION RECORD
APPROVALS
sEP19•58 50959 c— I s ti .00
APPLICATION for PLUMBING kluiIT
City of El Segundo, Callfornla
DEPARTMENT OF BUILDING SAFETY
FOR APPLICANT TO FILL IN
NO. —Mn— FEES AMOUNT
OASSYSFEM .'e .51
...........OUTLETS .AO EA) -A 6 4
— •'~ A—., ar AI;vlpVOn of PSR.Ob
Ot- p VuniP Ptnp CACH S
Sass _0 S6A6 ci<M1 6
—_ WI p '—r 051.tlO ._
SY M T e4,' EACH 15
PERMIT PEE
V/ A9 1 1
PVSYCIE
0[G01
PLVMeiNO PIPI NO OSR.00
s "
li'u'
YJITMOUT PIY.TURES
EACIt
S
— --
'6HtlWER PANS,__
OAR S;NK
vwlifi4
SLO ^SINKS
S
OATHTUtl '
'1 "
b
6
,�,�
M11WASHEfl
WASN. A1ACN
11'CDOIOIAl
ORINK.
S
5fl'✓,TF laBATIOR
WATER C6OSET3
FOUNTAIN
��"+
6
Bt.
FLOOR ORAINS
6
ENCFPECS:OC� =lAluls
PERMIT PEE
V/ A9 1 1
PVSYCIE
0[G01
Lnu4p. TRAVa
s "
li'u'
LAVATORIES "
S `O
U
— --
'6HtlWER PANS,__
S
vwlifi4
SLO ^SINKS
S
HOLD,
CEC6l['.O ST 5%,Tc—op Am
URINALG^
6
,�,�
WASN. A1ACN
11'CDOIOIAl
STANDPIPE
S
5fl'✓,TF laBATIOR
WATER C6OSET3
S Y
��"+
Bt.
LAWN SPRINKi.ER SYSTEM
ENCFPECS:OC� =lAluls
ON ANY ONE METER 52 00
11NCLUOINO SACK FLOW
6.
PROTECTION VENICE)
Va;. 9�kra. ar IOVER6 C�5R.00
Dtckliow Prav .RO EA.1 PpR D
..,
PERMIT PEE
V/ A9 1 1
PVSYCIE
0[G01
IN0.8WE081[8
8101
— --
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vwlifi4
Owl. m
HOLD,
CEC6l['.O ST 5%,Tc—op Am
11'CDOIOIAl
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5fl'✓,TF laBATIOR
alst. FgaU U,II.
Bt.
ENCFPECS:OC� =lAluls
1 "ME" TiLRT1TT Veil T .AYE READ MD t1UYIpED iNlB AFPLICATICN Mb
RNDN 111[ SANE 10 8E IRVE MO COnRFCT. ALL ERO'i191CN1 OF LAW. ATO
M8109CU MYSNINC T.le TTPE CE WOM WILL eE CCMRRO WII111111G
M. a! =Ee N[REIN M NOT. NO PI"" NUIE BL ALL0J1[D T(I FGiORJ
WOIIR VAaLO TI11S P[ARIT IN VIOLATIOJN f W.E UB011 CODE CE 111[ aTATE
0/ CAIITP U1 1 NR1N[R STATE iWf I RN EWDT[WlT lit[R1E0 k9 RL
WIRN 0 4' i1CM T RLa Of C aiFtc eual ES9 ayn0 [aSIOW FACE
lOR CtAI 4EUPTJOH OIA 8L N i064) )� � i..
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WORKER`S WA7EN9ATIONDECIARATU)fi
t Aygbj;,rllm nl li MNV UP +ha.P� IW rs4N. lixrfl�:ibai
1V >keYV�'tivri��F NL`e.'S U tNYa d�+`�{^ , a`aJ.SM C>,
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uT�,fief myl aaawhax nlnu':a fir'. �jm-enan
.y
CQ1iiflCAT CF E%EMPTION FROM IlORI(Fg5
4114 PEN3ATION INSURMfCB
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SFf�A*t�coT'JYwCI1
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WNMUMON LENFR13 AGENCY
�
rry 4b)pV q'r1.R14v R'Gi'L mi9rL�aro rytl lT4avlGar„pcRM
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� + ";� i � nerefna�aT sr �u^�re+ezw
�l
PLUMBING PERMIT��
City of El Sepndo
BUILDING SAFETY DEPARTMENT
s7
e.
�l
PLUMBING PERMIT��
City of El Sepndo
BUILDING SAFETY DEPARTMENT
s7
3<
8 7
PLUMBING Segundo PERMIT
6 Qty of El
BUILDING SAFETY DEPARTMENT
4U u3 57 k(l
7-o e
�p
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.1 uL- 51.(1 I )-ill
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N. .1 —1�— N—
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WORKER S IOMRE.SANGN ECI-ARATION
P p wry
So.
wo, Benema wl.—
CERNFICATEOF EXEMPTION FROM WORKERS
CONST—ON LENOING AGENCY
EWnKl-
PEIIN
I— F, A--
T-
Of ll, 11, - a
ucANT eR ' r
9fr
Ac�llnv�rj'1 °�s' PHO�/2u<roS�
6 RaS2 �E)P�L __F
No. Ne, of Plena �• Pe Imo_
PC �-1r eels_ Cwnm � InOUf.
' I� Ouonui Foes
Ea:k Plumdn Flalare
g
AeGPFBS —.
clry – . P�iln
3
MDPESS NONE
—
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womr GHPPedeq E alPmom
uNG AeGPES •D• x ���
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mw 3 • /5 r-rL
Powelo WelorS rem
WOpKEq's COMPEHSATIQN nATION
l
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m aaur�a.,
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CONETPVCTION LENDING AGENCY
SMmmlll Pool
PLUMBING PERMIT
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