- 2060 IMPERIAL HWY E S3A (3) APPLICANT ��� - = 5 PLUMBING9un PERMIT
N4 City of El tdo-
ADDRESS 4r�6 64s BUILDING SAFETY DEPARTMENT
CITY ZIP PHONE I B tlingptiffso f Building No 5-3A
i Tract Block/Page Lot/Panel
NAME
1.5 ADDRESS ` E I cenity that I have read this application and state that the above lnfom tRWn IS correct.
3 1 agree to comply with all city and county ordinances and state laws relating to building
o CITV 'lux C STATE/ZIP O constructio dhereb uthorize representatives of this city to enter up the above
me bo prpr myyy�fo++r 1 epection purposes
I� NAME C __�.L� •1._ '
= ADDRESS PHONE Signature of Applicant or Agent ate
U
C CITY STATE/ZIP
cc NAME PC No No of Plants Resld
= ADDRESS PHONE m�
CM, Date odPrin� a Indus
W CITY STATEJZIP
NAME Mg—el PC Ed
Quantity Fees
MAILING ADDRESS / '2QLj 5 Each Plumbing Fixture
IU J 1
%k CITt-, W L A TE
Sewer
t4 STATE Crq ZIP CITY LF,NO
Q
Water Dispensing Equipment
= I hereby affirm under penalty of perfury That I ant licensed undw Provisions of Chapter 9
V (commencing wait SaVort 70D0)of Division 3 of the Business and Prot at code,am _
my umnseu Mf Water Pressure Regulator
I iceex Class Lrc No
Dote /"/0 - 00 Canis sgnaar Potable Water System
WORKER'S COMPENSATION DEve :rluths
ION I I
I hereby affirm under penalty w poNry one of Me followings Gas System
_I have and will maintain C wrbficate of consent to sae I
x compensation a,provdeo la by Section 37M of Me Labs Code for me Performance
Wine work for which Mrs permit its issued Water Heater
I:. I b9ve and will monism workers'compansabon luaaance as hapa" d cy section Water Heater Vent
y f die Labor Cade, r me parformancs of Me work to which Mrs permit Is helped;
W My workers uraaro caner and polity hum aze wv��a JJ W��
canter Polity Number �W^9FlI/��?
(TMs aeawn need not a canpood ff ma pernlil n ICr one huMreO Jolla,(slab)a less Swimming Pool
_I Firmly mat In die penomenco of the work for which M13 Permit d I shell rot Spa
employ any Person In any manier so as to subject m M chisels compensation
compensatio
y aws of Cwdomie vntl vg ee cow II I should become sub e w n
orprowswns w section 3700 w me Labor Code I Shen to wi hip im iho,e Solar Systems Collector
Provuwns �^
R Signors Solar Storage Tank
3 WARNING Failure to secure workers coin rise
uon coin lawful and anal)
wgxt an employer ro Rlminal genetics antl crvd hoes M untied thousand motors j$100 000) inMaintain to me eat o1 compensab a as provided Ia m Back FIDW Device
Section 3706 of the Labor Cade Interest antl artaney a I s
I hereby affirm under penalty of penury coal I am exempt from the Conuwtom License Low Lawn Sprinklers
to Me following reason(Sac 7031 5 Business and Professions Codef Any city or county
which reams a pammt as compup after Improve demolish or repair arty av Prior
to Rs issuance also squires Me applicant for such permit to hie a aignad amp nt Mat he Vacuum Breakers
or sM Is(caved pursuant to Me pmvpens of IM Conireetora'peas. aw hap l)
(commencing Me Section 7000)of Deviation 3 of Me Business and Prose m Code)or
Mat he or she a saempl Merohom bad Me basis'or his wfeted eaem n Any violation d a
of Section 7031 5 by any applicant'or p permit aublecrs IM appliCa to a null penally ill Vt /
not mom in..Irv.hundred dollars($500))I PERMIT FEE (Sub Total)
Q O I es owner w in.property or my am'"ins,with wage,a an sole compensation well //���(•7
G do Me work and me avuwuro is not mended or adored Ior a(Sec 7oM Business end REMARK3l VX —V v Plan Check Fee Professions Code) Tne contractors Lic,nso Law does I apply to an owner of a property
who builds or improves Masan and who such Cult mmsell or Through his of her own �}
2 employees prowled mat such improvements ae t intended or offered lot sae a Plan Rot Fee / _ LJ l/
W hoverer the budding or affor ,asmeni u sold wand one year of completion ma owner
x builder will have Me burden o1 proving that 1)a or she tlW not x hat or improve for in.
3 Issuance Fee $15 OD
purpose of safe)
C ( )I as owner of ttw property eat skdvsrvely convecting with Iironsa0 contractors to
construct me project(Section 7044Igusiness and Professions Code The Contractors Issue Date TOTAL FEE `+'•Q�
scene Law does not apply loan owns of property who builds of improves motion and READ CONDITIONS BELOW
who contracts far such proleev with a conbacotsl license pursuant to the Contractors The work allthorized b issuance of this License Law) Y permit Is eubfect to all the rules
( j I pm exempt under Sec_ B a PC Io the raaaon and regulations sat forth in the ordinances and amendments of the City of El
Segundo,and the laws of the State of Caldfomla In regard to such Work,and
Data / owner all amendments hereto
This permit Becomes null and wtud if work is not commenced within one
CONSTRUCTION LEND( AGENCY hundred eighty(1B0)days from date of Issuance,or If work is Suspended at
oC hereby dam wdw any time during construction for the same period of time,or If any Work is done
W penny w pe0ury mat Mar a conawrnon ending agency far in violation of the City Ordinance or State laws goveming same
f, me performance of me work for which cob it is Issued(sac 21N7 Cry C)
2
W Larders Name VALIDATION
J
Leaders Address
Distribution PINK (Dept) ; Ow (Applicant) dos FORM P IN Rev 1i'95
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INSPECTION' RECORD
APPROVALS
-- - DATE _ INSPECTOR'S SIGNATURE DATE INSPECTOR'S SIGNATURE
SHOWER PAN� - J! HOT WATER HEATER
SEPTIC TANK PLUMBING FIXTURES
SEWER GAS TEST
UNDER FLOOR WORK UTILITY CO NOTIFIE
ROUGH PLUMBING
GAS PIPING
GAS VENT FINAL
REMARKS
i
t