- 2240 IMPERIAL HWY E S04 \ CITY OF EL SEGUNDO ELECTRICAL PERMIT APPLLICATION
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1
3 6 a ELECTRICAL PERMIT
APPLICANT City of El Segundo I'
BUILDING SAFETY DEPARTMENT
ADDRESS ��r'L'V �i Buyping -
/s 3 Addy 2z o Ee rr��2/fk. Jfu> >� : o
CITY ("1 1+D Z {p0�NE 7 Trael - - -Block(p�9 I.ol l Fennel - -
NAME i cerdly that I have read tins apphcabon and state tllal the above infq rWdiOn b correct.
IS: 1 agree to comply with as city and county ordinances and sate lasess reletlng to bull lg
3 ADDRESS PHONE C construction.and hereby allIrMn mpreesmetry of this city to enter upon the above
o mentioned property for inspection purposes
CITY STATE/ZIP ri 12-22 Z 79p
C,
V NAME -
,,, mluo of Daps
ADDRESS PHONE
c CITY STATEIZIP PC No - - No.of fplere R®Id
III-
NAME N.E.0 / Date Comm Indus.
ADDRESS PHONE 1�41('/1 SERVICE EACH FEES
a
W CITY STATE/ZIP Service Size
NAME ILSDN CC6C-1Xr(— Service __ r voo velts, - _ 60.00
Additional Meters 5.00
MAILINGADDRESS �� /d.u. nL
s�r�Jt' Panel Board l000
CITY TELEPHONE -
oc c SWITCHBOARDS (other than service sections)
STATE ZIP CITY LIC NO 35.001
-
!V 7
ze I Iwraby,slim under peruM of peduy,Mel I am licensed under WavMsroa of Chapwr s - - - -
.�j (cwemenco,g wIM Saceon 7000)of Dwlalon 3 0 me 9u1meu and Professions Cade,and Over 600 Volt Sections
my bcaae rain fucxft -
mic Uc N 77679 in n965.00
Dar 22 Cons Signature Y
OUTLETS
WORKER'S COMPENSATION DECLARATION Switch LI M Rece acle .50
Li ht Fixtures .50
I Mnby Mum under psnaby W penury vow of Me lddwmp Mclaretrons ``
_I nave Sand wa melnwn a umbras of consent to sea Maur,for worl.ers� Appliance DOmeelle 4 00
x compouebon,as provded Iw by Section 3700 at the Labor Coon for Ina Frenchmen Appliance Commercial 8.00
Q of lin'e work for which me perraa Is blued
{j move erro wall MbMMSM workers dampeallblon Mnwunco,as equaled!by S.cban
y 3700W Me1abW com,iw me POWER EQUIPMENT HP OR KVA
perlormmn of cos work for whicr,cos permll a IsauM
W My wwkan,lI'oomrpen 1dn laurarlw/p)a/r��1e,and policy numbs aAle ` 2 R
P 650 50 1-100 HP 33.00
U4 C.Rnr�„ys (O �r YT Policy Number � �I l
(TN.sectwt need trot be edrnplMd d Me parmrt a for one hundred dollars($100)or less P 10 00 - Over 100HP 50.00
Q _I wily,Met re Me performance of Ma wore for which cos pence,a Masuad I shW1 mr, P 15 00
b.a empty arty psnon m any manner so u w become sublecn fo cow wokers-eompansatlun
y Laws of Ceklornla.erd agate Met d I should Oacome sublaw to me workers comp,naetlon Power POIB 20.00
t>C prwls,Ohis W Section 37W of Ire Labor Code,I shell IOMwlih comply wIM those Pow r Pole 20.00
c sae as'2°l2 �/ SgMppp g mmumcatlOns,'Emergency, Control Systems, moka
3 WpRNIN :Faltiva fo samws wOrken'rompensat cov p rs u wN.end shall S na m
subject an employer to chminal pmW"and rnll Ilne p to one hundred thousand
dollar.($100.000),m addan.lo Ow cast of compensation m d fo,daages es provider In QUANTITY
Section 3706 of the Leeor Cods,Interest and anwmey's lees Control E In1 ment for above systems
Mraby Mum under perwlty,W pemay Mat I am...m,I mom Ire Contractors Lcanse Law QUANTITY-
or Me tMowmg re son(Sec 7031 5 Business and Professions Cods) Any city or county Investigation Fee 411 100 00
which maintains a permlt to construct alter,improve,dampish,or repair any Structure,pnw
to 0Iewar .enter fegaeea pN sapbcent for suCl penall 10 as a signed anbm,nn met M
or are Is sowed pwsuem W dw pmvlsmnS Of Ire Comracturs License Law(Chap e
(oemmentstp Saw Sectm 7000)of DIVIs,on 3 W Me Business and Professions C el or
mat No an she is uempt marandr,and NO basis Ior me alleged...motion wmmon
of Section 7031 5 by arty applicant to,a Miami,subjects the applicant, vll pencil,of
act more man 1w.hundred doa.n(SSWJ))
( )1.u oww W Me property or my employees with wages en able comp inuumon wig PERMIT FEE Sub Total
0 de me work,and Me amfClen I3 un intended.l line,. sale(Sr, 7044 Buamesa and ( )
�s Prolossons Coma) The CMnth` a's Ucanse Low no,apply,.an owner of a promrty
Q who binds onmproves dwraon,and who doe m won NmsM or through his or her own REMARKS Plan Chao k Fee
ompfoy.as,pawped Mal such ma coo- � ana not m,en0ed or omemd for sale II,
W h...cop buedrmp or rmprov.an and wMMm one year of completion,the owner Plan Rat Fee
Duldeh w111 have Ire burden Of p, g coal he oI she did no,Dad of improve for Ire
�S purpose W Sala) �s __
Q 1 )I,u w ansrMarti W a , n excnuwely contracting..in win licensed .a esues IS1mmee ee 41500
construct one,protect 704,1 Bumese are Prolesslons Code The Cm1nWM13 ''
lacander Law t apply as m Owner of propel,who,builds or rmp,ovea Hereon, d Issue Date TOTAL FEE
who contracts ..an preach won a contractoga) win..pursunm d In.Conlas
Ixenas - - READ CONDITIONS BELOW -
( ) I smpl under Sec_ B A PC fw this reason The work authorized by Issuance In this penult is subject to all the rules
and regulations sat forth in the ordinances and emendmants of the City of El
Date Owner Segundo,and the laws of the State of California to regard to such work,and
all amendments thereto.
CONSTRUCTION NG AGENCY This permit becomes null and void if work la not commenced arlmin one
WI heresy ream under p.neny W partury mere s a wsoucson rndv,p apmry fw hundred eighty(1e0)days from date of Issuance.or it work is Suspended at
G cos pMormanu of gw wwk lor w nn p=t ra,.sued(Sac 30g7 Cy C) any time during cMlalruCllOn for the WfM period o1 time,Or 0 any Work Is done
2 in violation of the City Ordinance or State laws governing some.
W Lender.Name
Asides
VAUUATION
moonSir
Distribution GREEN s BLUE (DM I) YELLOW (Appllcan) dns FORM E.103 Rev 1/95
»>.n�� . � ..JV^4S' .._..� '( tl... . ..�.. M iln .n...�...�..N.r��s...w.V.y •iYrar.vvx-...n.�•ry.�..n.-..� i.
INSPECTION RECORD
APPROVALS DATE INSPECTOR'S SIGNATURE NOTES.
TEMP.POWER POLE
UNDERGROUND
ROUGH
WALLS
CEILING
SERVICE
UTILITY NOTIFIE7
FINAL
REMARKS