1042-02 - 815 NASH ST NVERSION 124000
Ukase
Any
tepee
to fie
Contractors
Duaneas
for
pensadon.
7044
apply
week
mix
provement
burden
IrOI
lantractors
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
law to the tollov. a reason (Sec 7031 5 Rumness and Professions Lode
oy or county whih reguees a penal to construct, after • ., : dertldlsh or
any structure Pro to Ito Issuance also requires Ina a..:..." la such permit
a signed statement that he or she us licensed puree. • the prowsnns of the
License Law (Chapter 9 (commencing with ' 7000) of Diu• 3 of the
and Praess ens Leal or out he Or She Is : a therefrom are Dee bears
the alleged exemption My violation of Sec 7•- 5 by any applicant for a permit
acts the applicant to a art penalty of not ...: than five hundred togas ($500) )
I as owner of the Property ormy..n•yeaswthwagesasthensolewn-
will do the wok, and the stru .re Is not blended or offered for sale (Sec
Business and Professions • • The Contractors License Law does not
to an Owner of properly iddoe
s or improves thereon and who such
tensed or herself : . • In or her owl employees pmwtled that such
maim lS are not cot:...: a offered for sale If however the buddag or im-
is sold PALM . - mar of completion me owner -Sumer as IWe the
of wawa, Mal .: Or she ad not build or Improve br the purpose o Sale 1
es owns • . property am exclusively contracting with licensed con-
ws d cons - the project (Sec 7044 Business and Professions Code The
• - : law does not apply to en owner of property who) dads or en
proves
pursuant
. and who arntads for such protects with a aMtracta(s) license
.. : Contractors License law )
exempt under Section B 8P C for this reason
Date Signature of Owner
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under proIaons of
Clio 9 Commencing with Section 7000) of Division 3 of the Business and
Prof Lode and my Icense is in toll fora and effect �a�,/ 37550i8 - '
License pass License Number :7°3i
brIature of Corrado
I
p
err
tom
Is Issued
WORKERS' COMPENSATION DECLARA
aeby affirm Wit Walt/ of perjury one W the following d bons
I have and MI mantamtos a bfitate of consenteelhnsure •workers
panacea, as provided for by Section 3700 of the Labor Code 1. . :
of Me wok for whichea Period Is Issued
I this
and wee mantam workers compensation insurance TS
7W pl me Labor Lode for the Dertamanee or the work to wTra III I
My waken{' compensation Maur�•cerrler and policy n .'.. a -
Gamer S+4i/•C r
'k �emit l' R
I nstocn brow- mum own
I certify that In the pedama,ce of the wok for which this permit Is Issued
not employ any person In any manner so as to become flitted 10 the workers
salon laws of California and agree that d I should become subject to the
' compensation provisions of Sec 3700 of the Labor Code I shall forthwith
wIM pmwaons
TI,,7a_ 0
be Signature of Malta,
WARNING, FAILURE TO SECURE WORKERS SA
COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN YER TO
CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARS (Tide 000) PI ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR M SECTION JILT OF
ME LABOR CODE, INTEREST, AND AT7ORNEyS FEES.
I hereby
for the
Lender's
Lender's
CONSTRUCTION LENDING AGENCY
affirm under penally of penury that there Is a construction lending agency
performance of the work for MIci this permit is issued (Sec 3097 Cyr C )
Name
Address
I certify that I have read this eppliraton and state Mat the above information Is
earn I agree to comply YAM all my and county ordinances and state laws re -
hang bating construction and hereby authorize representatives pl Mrs olv
to en upon the above-menironad
(/ ny mpl SPedn s
'7�0a
a'g Mat of ADPIRMI a Mai
BUILDING PERMIT
BUILDING SAFETY DIVISION
COMMUNITY ECONOMIC & DEVELOPMENT
SERVICES DEPARTMENT
350 Main Street
El Segundo. CA 90245
SITE ADDRESS ��'- ��•
%15 No(+k Nash Skee--I4
S TEl l IDENTIFYING NUMBER
ASSESSOR PARCEL NUMBER
Ka, PAGE PARCEL
APPLI jNT/CONTACT RSbra
D Uec.aw.'��i.,q.V 3i•�i �
C..►4c CI 6Iv.ec L
DATE
10/7/Or
0 55
I3tlo Cn.b�; IIo Ave��1�'ga.J_9iob
P�iO' E {JO
CITY
TOrfay .ere
STATE
CA
ZIP
91950/
PROPERTY OWNER - i
Careict2,,, 5.1-c<.II
pjiQN[ANO
CCb./�0�15V/VJJ /—gf7 i7 A7
DRESS
I bb'1(0 V I -. -Pole llCi co.
CITY
PaLci.Fc.-Pa(bcJs
STATE
'CA
ZIP
9e&ta
ARCHITEC r
PHONE NO
ADDRESS
CITY
STATE
ZIP
ENGINEER cr
s<-e- AfelicA4-F7CaErf1a-
PHONE NO
II
ADDRESS
CITY
STATE
ZIP
IroIr1
CITY LIC NO
�`CONTRACTORS NAME
Y D1 feLOW'd\ lndose3
J e'B-
y!^DDRESS
map Cahnii/o AreC58
HONE NO
-iio 0
C
fahGe
STATE
CA
ZIP
705o/
PLAN CHECK/PERMIT NUMBER,or 't%� -
LMYUSE
tlLW AREA
AREAITION
BLDG AREAERA40N
WORK
FD, EN UAL
RCIAL
�
/ �� / •�
Folio)
I.MV USEUl.
LMY USE
DESyRIPTlON0
X5e/iSM%<
�g/¢�fbYi�7�
C—Q aliQnr.v LaJ Dl L,/!9n E /
REF I
GIPIS)
64FIRESPRINK`ERS
TVPEISS)Q•F%�C_1QNSIRUCrIOI
SOUIMRE FFOOTAGE I
NO O�FIST
RRIES
ST`_A'TIISTICAL ll�7S1CATIOr
UNITI I
CODS N EFFECT
$ ]L 3J `co.
PLAN CHECK FEE
ENERGY PLAN CHECK
$ (/ ,79
7 NUALUATIISN
$ 44-5y .
kEC�IYj[JUM1Ey, g
/(
1
INITIAj.S�
DATE O/I^// I/.,—
1 1'I Ito.,
$
PLAN CHECK FEE
ENERGY PLAN CHECK
S
REVISED VALUATION
$
AL.EIPT NUMBER
INI IIALS
DATE
PERMIT FEE
6 , RETENTION FEE
I/'J� /`A/J
SMIP FEE
ACCELERATED FEE
TOTAL BUILDING PERMIT FEE
$ i/SI ipyq��
!
$ Lam/
4
$ 7, 35
$ tr
f�
$ / � 32'
FEES PAID
DISI PAID
WORKS FEES PD
PERMIT OBTAINED
APPROVAL
APPROVAL
APPROVAL
WASTE APPROVAL
on ti /b2
SCHOOL
_ HEALTH DEPT
f, SANITATION
FIRE DEPT
C —j PUBLIC
r-1 SCAOMD
_
r—I OSHA
ram' INDUSTRIAL
REC NUMBER
INITIALS
elDATE
IN
re
A�
4191
6
NO
INSPECTION
DATE
INSPECTOR
REQUIRED BUILDING INSPECTIONS AND APPROVALS
BI
Loobon and setbacks
82
Sala EnpmeMS Approval
83
Foundation/Trench loans
64
Structural concrete slab on grade
65
Based floor framing
96
floor
Under nsubbo
B7
First level floor pdathng
l
BB
Second level boar sheathing
09
Thbd level floor sheathing
B10
Roofsheaemg
811
Concrete dock
1st Gran M
2nd Grout bfl
3rd Groulbfl
4th Grout IA
•—
812
Steel earning
B13
Fre Dept have inspection
B14
Budding Dept frame eepecbon
B15
Fire spmkbr angers
B16
blsubbaNwamer stppmg
817
Interior blnandIor drywall
8121
E+Oerdr lam
819
Rated SoorCCeding assenrbhes
820
Rated wad assaMbes
821
Rated opening protection
B22
Rated shall construction
B23
T-0ar°IMMgs
B24
La Mnage
B25
Planning Dept Approval
826
Fre Dept Approval
827
PublicinalWorld
1 7
.18.
/7
/2 �/Vf��(/�
8
B28
nspl honApprovalp
Foal Manny vlspecbon approval
DESCRIBE COMPLETELY THE INTENDED USE OF ALL SPACE APPLICABLE TO THIS BUILDING PERMIT
The following statement must be signed by the Building owner
(When approved by the Building O1Bcb4 the owners agent may sign los permits other than the Initial or shell building permf
We Me applicant or future buid ig occupant Lunde a hazardous matenal or mixture cantering a hazardous n atmbl equal to Or greater than the amount
speared on me hazardous materials Warner/on guide? Yes or No twee
II the answer to the Weston was yes 1 me proposed bidding or nodded btlUy be within 1000 feet of the outer boundary al a school/
Yes or NO lean
I have read the hazardous material kitamabm guile and the SCAGMD pamirmg UTe iE51 I understand my requirement under the State of Ca5bmra
Health and Safety Code Sedan 25505 25533 and 25634 concemng hazardous mateas reponng Yes or No war
NAME SIGNATURE
INSPECTION NOTES.
it-0Z bero rpvGepe lamre°r5"C!i
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