- 201 DOUGLAS ST N [APPLIC NT - .. Q ,7 6 2PLUMBING PERMIT
City of EI Segundo
iDREss- raJ BUILDING SAFOY DEPARTMENT
Building No.
-t:,L2�1✓}=-.L.�.LL_J����� '!" L r. t V'- VA
NAME raCl Blom/Page 01 a1 q
t _
a IADDREss --- PHONE-_ --��-- Itenity that I ve lead this apNwalbn and Mate that the above Information is
_ _______-_,._._.—_ �._-_._ __,—.,____ @@ )mid-a«.•sry qr{y nni,ail our mat'.Any 0(usnrt¢ea one elate gene mating lO builft
CI1Y STATEIZIP y Construct, ,and hxrot_',ulhorizeroprNeMallwaofIN City toardwOpen the a "
�' - ---------- .- mien,llo
NAME nr e property
rAOpp_eplic
yaln me ktio—n pu�rposes.
C JADDRESS PHONE T g ur Agent ..
to---.
. Q CITY STATEIZIP
¢ NAME
P.C.No.�✓ No.of Plans-42-
Resid
i x ADORES$ PHONE -
---------- ---- —. Date mm� Indus.
w I t, ly PTATEIZIP
y-� ✓/;�/Aye
l� -y A C P.C. Etl.\' —
4 Ouantily Fagg
MA1�7� GADDRESS Each Plumbing Fixture
91,
CI
-
yl T
I herebyanYm under penaM of Oliver loot f am enmsed time pension of Chapur9 Water Dispensing Equipment
V (camnendnpwM Sectlm lOOp)ol grisbn 3dlM auskwafam ,dasebnsDma,and
Cry kensels Nlf'ernnd A affect
ucense Cbss _Lb.No. Z°�_- Water Pressure Regulator
ogle 1� cone.Sewer+ Potable Water System
WO KER'S COMPENSATION DECLARATION
1"uby anum YmN penalrydpd(wy rued Me 1011owkp dedarmm - Gas System
_Inave and win mainlanaprsi(iqb otmml le Wuel rhea'
x COmpmsaboh.As provided for by SKIen,3] 1 at M.10oonanm
O of Me xorkta wh"Ws pemil 13A.Md' Water Heater
L�15irs end na meMtaN wpkers'Core old 0n �r e,",e ned by Seclm on Me Lol
lar Water Heater Vent
ly 00 bor Code,for ate pedormancaoi we work lawNeh rhu l,emio Issued.
x Men-Ln7,-rn"' bsuruK°,sanbr pOpCy
C Tamar.t/may y't. �4 _"._- /f,- Pol Nunn "1 1�1 J OLrI.Q
�` Ome section reed tier be mrnpebd it The,pools is for one hwwrr3 doses(5100)or lee Swimming Pool
_Icerby Maln Me prdamenpdNe woIX fa whkh Wf permhls issued.I shallml Spa
U OlrlpbY e'ly peAm to any mannered"-OaCe", nlp aVbted b Pe N'4rRer¢'ce 'ns.uorl
(y Laws Of CAdamla, epee her e i stood become su I IO Me worY.eu'CempauaYon y
poMewna 3]oodrM Lobo Code,Ie had r IM°w 'y w;M me. Solar S slams Collector
"
_ �f) _c
oat _-_Synenae 1q1}M \" _ Solar Storage Tank.
3 WASNIN F rob�+wofken'mmpen"Ica l6varape is unbwtuL and alsa0
svblect an employer to aumrad,enelfies and nvi Mee up lO one hundred Moorland
dones(stoo,000),in amnimroMe msl of mmPena+uon,dwmpea as pmiadfan Back Flow Device
Secmn 3706 of Me Labd Code,interest and ananey's ioee.
I hereby One.under,Whayd"rjwy Mar l am"ma
la ke IoawMg basin ISac.]03L5 easiness and emc.T.n,aa c Lawn Sprinklers
Proleepme) rya "ounly
xhcn laeuresapermii to cOrlsWCl,aa<q impure.demolish,a mpp ysto Ctu .pier
t0 ns uswnce,also regabes ate appsunr for olds permilbbee nerd nabmenf Math Vacuum Breakof3
or she n hCensm µaslant to Me or hbneolthec4ntracKv nse LevelLChsp9
(wmmemm�g Me Section]Opp)olpivlsbn 3 d Me Bvsln am Pro1'.1Wns ome)a
Mat ha c shO Is esempt Vwbbom e,e bun Ia M spud mempmn.Any vidawo
I Section 703L5by any Opp .m apermnsu atlw eVWoarno aGad pena:ry of
mf mole Man lee nwarsa d• a( )).) PERMIT FEE
W 1)I,es 4wrw ofInd popery ry, ,bye wiM wages as Mon sob mrnpenseYon..If (SYu :'olag_,
t, do Me work,end Me¢bud n.Is t e d or o m for WI!(Sec.IOH BOsinesf Om /e
Prde¢fmns Cme).The Comma r to does nd opply ao an cwno o:s paopeary REMARKS— Plan Check Fee
J ; .he budd.or enpoves tneleon.a In uoh wak bmsea a ImOupb we a he,men
empoyees.pmvMed Mat wch ovemle a Ml ntdnded or mered lo,Ole.II, Plan R9t.Feb-hoverer,Me buM,np O'uh eme116¢01 nTan One year daomplemn,Ind wade
2 I babel wdl hart Ole bwde Awing Mel Aeapw did col dn'4 or,•npvare tw Me q*!REjADOC
Purple of sub) IaeLLanee FBe �1CO.all 4perrym
,e "d m
vsrvtly0 "clirvgwM ecenswd ceMadOu to QV—
qyIssue Date TOTAL FEE - `—Lean"Lew mlaelae fo en woe of opery wise bu,d,aro,,nuhad,aµNOITIONS BELOW
wM<onaa wnw]Ipopds-all aconuecfe(¢)feense pwe"et to Yla cent/"lo,e
Lkeau L 1- The work authorized by issuance of this,droll Is subJed to all the rules
(1 1 am mmpt raker sec_a a Pc Id ova been___-___ and regulations set forth In the ordinances and amendments of the City of El
Segundo,and the IP a of the Slate of California In regard to such work.and
Data _ - 4NLAna,' NI amendments hereto.
--' - This permit becomes null and void If work is not commenced within one
O STRU ADING AGENCY hundred eighty(1PA)days from dale of Issuance,dr it work b suspended at
W IMrebyadvm enn41p A,,1r,(L�� al!:aYemn¢VrKapn bn0inq egenyb any time during construction for the Same period of time,m,if any wwk tsdone
dw)wlcenance d uw'w{' awep,"'• ,bwW Is"'ioa> c in violation of the City Ordinance or Slate laws governing same.
`
`a - •-.•--.-_.- -- — VALIDATION � '
L+nWn Addmsi _
0,01W-un P114K I�:repl) YEF.ie: 0 x• ,ug) dos FunM P-nod nee. 1M5 -
INSPE4 IQ.N AECORD
a a�
�-_.T'. en�rTno�r clrweTUaF _ 'DATE I INSPECTOR'S SIGNATURE
SHOWER PAN HOT WATfRHEATER
SEPTIC TANK — P!UidBING FIXTURES
SEWER GAS TEST —
UNDERFLOORWORK �•— UTILITY CO.tIOTIF'F_
ROUGH PLUMBING
GAS PIPING —
GASVENT fINAL
REMARKS
I
�� PLUMBING PERMIT 98 0 0.0 0 City of El Segundo
BUILDING SAFETY DEPARTMENT
� o,.u.l:•.. I'S .1 .�� ..11.rwirn Nil
.
------- �• Sj�- Tract BIak7 age lotr
NAA1E ) /1 ��./�
w � pamw
��"" - T--��-"-`.a�r�'�P Icen11y 1hatlnave naJ this application and slaty lMlthe Wwe Mbnnatlan Noorreet.
2 ADDRESS � ,` ,j,� ,__,
Y1 W^. \N 7S7fYt 'C" _ v _` Ipmea rn mmnly vriln on fi and nssNs nrMMncMi am Mafe taw/raMsksabnuildinn
__._...._...- --- 7 H
o Cl Ty - F:a.J STATE)ZI �C�IL- consinitti0n,end hereby authorize repratonladwAalhb oily 10 en4rlapon the above
mentioned property for Inspection Wrpossia,
1- NAME
a•V ADDRESS_ PHONE _ oAp-p_ht=d nt or Agent Oate
a
Q CITY STATEIZIP
W NAME ----_�-- P.C.No.� No ofPlans Real4__
Indus.
NAME
NAME . S P.C. Ed.-
I Quantity Fees
� Each PlumbingFiklure
bd ' _�P
Tl2S Sewer
Q¢c SA fi 'AT r
I M. CI7Y LIC.
s raby,arum urger PeMky,d perjury f wl I.licensed timer prarisbm of chaplet 9 Water Dispensing Equipment
(Sty my n ns,is in iN Section 7000)Ol Dirb:on3 W lM Businesf and Prdesacns Coda,and
my aeons•is th hasC_
License cuss�lS.Cc. -J---Lie Na. Water Pressure Regulator
Data\ G.+ <� Conte Sgnam-- ��, potable Water S stem
WORKER'S COMPENSATION DECLARATION(j
I Mfeby ahem under Perot,d Perjury tiro d Me face wig Stec au,aws: ` 616 Gas System
_I MvM ea is mainmin a ceMkat.a consent e,"I snap.la..",a t
canpe-5,16w.ns provided for by sachem 3,00 a the Labs Coal.la Oro performance
O tit'(work fa which ON,p0mulls Issued. Water Heater
ti nave enO wee maHuhwa\Ors'rompensa0n:nsurante,aregWred by aaclion i
laver CCtla,lau'�e wrlormaKe of thaw«kI«wr.n e�h pormilbiaavad. Water Heater Vent
MY way•rs PMHSan uu��W Whr and pa ymlm r
y I c.man` Ilyn! a�° C K3 Namar: P�4 l ID,
J Swimming Pool
Sti (This section naafi hot tie mmplsted sew permit Isla we hundred dollars($100)or foss
C —1 artery Nat in fire pedourance a the work Im which Nis permit is issued.)shill not Spa
V q.,'aey any peraan In any mamgr eo as to trecome Subject b the workers'compensation '
y Laws of Caklania,and agree that it 1 ahouir become subject to the wod ets'cornpensaaan IW prowsb of ns Secwn or aw 3700 L,ubr CCde,I M oompy such Nose Solar Systems Collector
cc Dale___ _if Solar Storage Tank
3 WARNINII:Fadurs b secure workers'compensation mvetece is mlawlul.Wshag
wtlect an amPityel b aimmV.penalties and Nita(miss up bane hundred thousand Beck Flow Device
ddxn(a109,000),IS addition lo pw=lol compensation.Star gesasproidedlaus I
S-90 3105 a Me Lobar Code,inbred aM Oeorfw(s lees.
Ike,eby ale"uMer penalty of perjury Seal l am exempt Iran me Camactou license Law Lawn Sprinklers I
fa use following lesion(Sec.7031.5 Business am Pbfesaons Code).My city a count
which revues a permit to construct.oral,improve,demolish.ce repair any simis e,pilot
to Ili Issuance..11.raeukes Me aPpb(.hI fa sudt permit o file a Ported srs(amem Nat he Vacuum Breakers
craft,Is enss4 pnsuanlb Ne proviiwmdthe Conuactorslxensel. (Chat,9
(y:mmennN Ina S..bon RD0)of ON¢lon 3 of 0.euemess eM Pr ss.�ns Code)or
0 t he a she Is r a wnpl Nabfmm eM See bnis la an aaegM mpbon.,any viGeaar `
o15emion loll 56y any applicant la a PernN subjects tM'IS and to a ciW pe al y of C
rd rnae Nan lire hundred dollars(5500 .) i PERMIT FEE (Sub TOteq_1.t/5•
�� ()L as oenera the property a my e fZebs with gas as their sole compsumaton will
ra do me work,am this toucan.e,norm ed..m uq 1or sLe(sec )Dora Bvsiness and
—1 Professions Code).The Contractors Licensor Ones nor apply so an owner a a property REMARKS Plan Check Fee_ t
5 I who bmUs of improves theraen,and who ssurh work NmseY o,Wough Ns a het own �.r[•\ i
In employees,Dlonded that such knprov ems.15TImlonded m Offered for S.W.It. Plan Rot.Fee.,
Whoxever.,n.butl•Arga,mp,ovem is sold wi)IFtJana yen,d[mlMelroq en Owner.
2 Lwkter wAl have Nebwdenol vino uutha a dd col build a,mprove for to Issuance FM $1s n0
cwpocs of saN) iIp" �y �j O I)I,as Oancr of the Dr M.eat/W4saosN euvnasa d IS mnbacbrq woe formed cmnboaola to
f _ TOTAL FEE 1 �/�•k+t" t ccnsuuc.dApu,ec -eons an Professions Code:two Convactas IeDUa Dale
license few dO cot epPry to en owrwr a proPeM wM bmldt a anyneres tM,aen,am READ CONDITIONS BELOW
wM mabach Ia Such prof-is wzh a convaclo(s)Ennse paauam b She Caerac sir, The work authorized 'nuance of this rmil Is win b a8 the rules
license Larq. by Pe (eat li
I 1 t eat aaempl tilde(ssc_0 a vc iamb wasm____— and regulations set forth In the ordinances and amendments of the Gry of El
Segundo,and the ishat of Ihp Stale of California in regard to wch work,and
Data- _rTvner all vat is permit hereto.
'- ----- This permit becomes null and void If work IS rat ammenced within one
CONSTRU TION LENDING AGENCY hundred eighty(180)days from date of Issuance,or If work Is suspended at
I".b anam uMet my hmo during eonslruclion for the same period of time,or if aniwork is dolls
r panaW,A�.r NOl Noroh mnsvucsenkMingagenry wr governing same.
� ^ ( in violation of the CityOrdinance or Slate laws �
N.pplatna-edwsakld rmit ssus0 5-.709%.CN.C)
W
,r Lenders firms- --- YALIDATION
Lenders Addins
[a5fupnwo PINK (Dept.) YELLOW(Aypkcau) dW FORA P-108 fqv. 195
INSPECTIPJ4 AECORD
APPROVALS
nATe I INSPECTOR'S SIGNATURE _ DATE INSPECTOR'S SIGNATURE
SHIMMER PAN HOT WATER HEATER
SEPTIC TANK PLUMBING FIXTURES
SEWER r _ GAS TEST _
VNUl1,tllNn n�nK VTI,1_ITV rn NnTIFIFn
ROUGH PLUMBING i
GAS PIPING _ _ _
6ASVENT FINAL r
REMARKS
i
1
V.,q���ifyc"
APPLICANT '�r-. - PLUMBING PERMIT -
�Jl4x �jL.11&afr fit` �� City of El Segundo
ADDRESS BUILDING SAFETY DEPARTMENT
CITY �ZIP�� PHONE c�yv� Bul ln9 ^01 � budding Nu'
Address
Tract BxMk/Page Lot I Pu
NAME
W �- - `--'----------------------- -- if certify that i have read this application and mate that the above information is created.
� I ADDRESS P/(ONE
ra _ _ yt :.usvv,uon,an hJig.ivy:7.r•:�r•eds...�:k....f INS CRY
upon:OW si::.y
� DtTY---_�_�-�----_�—�__�_--�STATFJZIP-��- —� p COh51fut11af1,Andh Yaulhofiia rlpfesenlaitve6 of lhpWylo.Mar apart ties above
_ 4 mend a pro/peen lot spec{bn purposes. / p
NAME l i i� .�% gV
ADDRESS
Its
Is
amre of Applic,ml or Agent Date
CITY STATEfZIPIt
�—
NAME _ P.C.IN No.of Plans n Reid_
2 ADDRESS _ PHONE Oat m.� IrMaO._
//
CITY---
ei S.Lwm _
W C I 7l/J�y"y�`
NAME WI tur-I TWC P.C. Ed. qT ._ OUentity Foes
MAILING X TVS u .�.�L Each Plumbina Fixture
CITY/� LEPHOy
�_ Sewer
o Syr T' Z a CITY LIQ NO.ra: S l /
/Y U ✓
Water Dispensing Equipment
Q I hesone eoem in seetnalry of pdury 0M l Orr setthan led Bu boa,% ponsgnt one Code.s
V (commendrq wim Sacwn7000)ol DirabnJol eta Buarossam Prdeasbn'Code,and
license
my keis lnmylc. a!If- a r_C.�iy Water Pressure Regulator
t ce slate�— uc
Dale 2d _ Cosa.Slgramry potable Water System
WORKER'S COMPENSATION DECLARATION T'1Q_ r aG
Lyaltemunderpnaly 01 p4wy ale of m.loMwiq deameumss: � � Gas System
e30 and win maintain a cerlaKele of ransom b San
insure IN wos('' / YY
Z Pit bon.es ptmWW IN by Secnod 0700 dale Labm Cure,IN me pedmmarge
0 I me wmkta wnkn aalyamhbbsuoE. Water Heater
ti Iluve end vra mahlda wMcb'compensation hsuF.Aw..S reguvW by section Water Heater Vent
y7000I me Lebm Ced.,I0,m.padormnnced lln work for w1wh this permit is issued.
WMy n. ker'rnmPutsaann laswanca eraser�po&yno be,yy
4. Comer.�L.-e�a� Psi Nrmm.r: 'i N Swimming Pool
(rw s : neat calaccamp:okd X en calash b IN one huntow Ees.,,($100)or less
b _I wish,mar In M pdmmwccw of the well,IN which ME,pam l Is issued.I than not Spa
U e•npoy eery person h airy m.mwF so sa b bosom.auDJecr b me waken'eOmpn'aaat
y Laws a Cakanla,and n still.all it l Should bawroO$object to me vioske 'Whaparmsaon
W poNsgn3 dsettbn J7dodln.L.bm L:ode,l shelf lanniv �mDp(1n moan Solar Systems Collector
k Prorsbns.
ODale .20 4 _ sgtnbra _ Solar Storage Tank
3 WASNINe workers'eanpn:FeAfrot state sntion ern ,a tnbwtuL eM shah
dollmsan empbyelbaminatWewit of compl sop to crew 11dtnWHed Back Flow Device
Sd ho($t00A00),In addition Co to Code,
cast of Wrap ey's le,damages as provded Ice m
I Secbm J708d Na Lama Cure,hlewsleW aaanet's reef.
IM,?by exam under pnafry d partly met l am exempl lmm me Cen:Iacbrs License Law I Lawn Sprinklers
Ice an[allowing reason(sec.7011.5 Baseness and Pioless»ru Code).Any aym crony
winch Focuses a pelmu totanslmM,altar.Impose,demolish,w repast yabucbre,prior
to asusuanco,atfobaikoa theapF`¢ml for wa.pane lO Me a si 'cashmere ma•he Vacuum Breakers
or Shen licensed poraant to in.Newubea of the Commetmsa nsa Law(Chap 9
(wmmendrg W SOcb"TWO)of Denim J of the 9omro5 ,ed Profession Cure)cf
11,11 She is stainer tMFMtcen and The b.,;.for the gW CMmpWn.Any vblaoon
of Section 7011.5 by any aponanl IN a psr atble the apphco nt b s one penalty of
not man man Ire hundred dolws 50/)1.) PERMIT FEE (Sub Total)
WO I,aSOwner of me pNsrry pm m e ram wages an mob sob wmpnsanonwnl ,`w
O eo Ca wok,end masuoaman tvxe moneted car sob(sec.70M Oushesa and REMARKS__ _ Plan Chock Fee_
r P141e5}qr6 Code)The CMNa a6 nfa Ww dOfSMIO?py lO an OMRrdaDFf,%ry
J I wno limbs of Impovos mereen, wno dins rush work mmsH or W wgh Ns or ncr own
4 ¢rr.~,ea,p.wded man gorevane ere rgllmerdeaa dllem7loF aalo.x, Plan Rot.Fee_
Ira nbwtvet me bwldngai mtvnenps coed wtmfn ins yam dcompkhon.fro owneD
} I bAber wlp na.e uw not WOvhg that he re Ilia dd not Wad or unpvn We ale _ Issuance Fee Sf¢.QQ
Pwp;e of sale) n r
O I I )I.n.sumo, the poprty,am eaann,y comtacuog Aim licensed cnnuaama b
con3uuctw goct(s.cusn7Wi Ousirwsa and Professions Code.The Contorts lasoa Data TOTAL FEE_
Lq . doe'rotaPpy b an0wnef Olpnxnywh0 mnbsm anaovaa mason,and READ CONDITIONS BELOW
who roach Ira aWt prelecb wN•conuadp(s)license pombe N b ale cmwatl0b The work authorized by Issuance of this permit Is subled to all the rules
Lv se Law). and regulations set forth In the ordinances and amendments of the Cityof El
I am.tempt weed Sac._B 6 PC IN ace.rosson Segundo,and the tat.of the Slate of California In rapid to such work,and
! Dine__-_ _owner all amendments Insole.
-- 'Ibis permit becornes null and Sold it work b not commenced within one
CONSTRUr ION NDING AGENCY hundred eighty(160)days from date of Issuance,or 11 work Is suspended at
w IMreny antra tndorproga ryabr mare le econsaucwn kmm�p ayenry lea any time during constructbnfor the same period of time,or If any work is done
du pMamerq.el m.wo:k Iv w INe In violation of the City Ordinance or Stale laws governing came.
p prema b bsvad(see.3091.C1v.C)
W
v teroen Nar b_ VALIDATION
Ladms Addr.a5
D9o0mmi inky. (Dept) YELLOW(Applicant) 00 FORM P-Ilia nay. 195
y
rc.
INSPE&JO N" A'ECORD ,
r-- A AL
V- DATE INSPECTOWS SIGNATURE UAlt ANSFECTORZ 5iGUATU'.L.
SHOWER PAN _ ,' ..»._- HOT WATER NEAT£R
SEPTIC TANK PLUMBING FIXTURES
!EIVEP `__ GAS TEST
UNDER FLOOR WORK UTILITYCO.NOnr-IE
ROUGH PLUMBING ._..-
GAS PIPING
GAS VENT �__ -- _ FINAL � ^
REMARKS
Ir r
1
rl r