- 2240 IMPERIAL HWY E S-4 (3) AP ff�r 3 PLUMBING PERMIT
Cify of El Segundo
AD Ess , J t BUILDING SAFETY DEPARTMENT
CBuilding 11 �- �—
ed lock Page 52 dt l Parcel'
NAME ��
W I certify that I have ratio tills application and state that the above Information Is correct.
2 ADDRESS PHONE I agree to comply with all city and county ordinances and state laws relating to Cuilding
C CI STAT .l O const Mlon,and hereby authorizer resentatwes Of this city to enter upon the above
"l me any for I spectlo Ljposes I--- /
NAME
ADDRESS PHONE
= gnalure of Apphca r Ag t - Date
cis
c CITY STATE/ZIP 1
W NAME PC No I No of Plans Resld
ADDRESS PHONE
o Dat Comm`. Indus
W CITY STATEIZIP - - -
N R PC Ed
r(1, Quantity - - Fees
u L ADO ES�S Each Plumbing Fixture (I12,
2 /L LE HON �n yy�/alV;-1 Sewer
o T� V -
V -CITY LIC NO S TO
Y
Z l hereby amen underpenallyolp"arty Natlam loaneedundar Water Dispensing Equipment
prrnist of Chapter 9(mmmenctnp wain Section]000)of ONaaon 3 01 The Business ad Prdeass ubne Code,end - - - -—
`ry,ficaaO1a'" Uc NO 1458 till Water Pressure Regulator
L.aursse Class
Om° Conr Signal., Portable Water$ stem
WORKER'S COMPENSATION DECLAR ION
I hereby aim under penadry o1 Penury ane of me following dederetems I I�� Gas$ stem _
_I have and will main..a cotubco.of connect ro uaaneure for work..'
x cis pensaron,As provided far by section 3700 0l Me Leaor Code.lOr the Performance -
O ork for whch as psrrtut a asswo Water Heater
,C I have and will main.an cookers' ......n mSuranee,The rerlured by section -
y37M of me hater Cade,for The pertormms of The work for which This permit a a u s l Water Heater Ventat --
caeerh 'comp °been.swanecy Npolicyumb number
Cy coo o/ Pill NumberrAZ r
(This section need act be completed it me pa not to 11 one hundred"lots($100)or hiss Swimming Pool
O _I century Vat in the PMormenco Of the,work ter which Ws barred a is., I sacs riot S
rJ employ an)'pa...in arty manner so as tp become subject to m or e workers'c°mperaetbn
y lawn 01 Cmilom..ono agree Ner it I should become subject to The workers'companaeaon l
W provisions of Section 3700 of me labor Code,1 shal to db mmpry wilt ° Solar Systems Collector
bC Prov¢mns _
It Dam Sig
naa,r Solar Storage Tank - - -
3 WARNING:Feature IO s awe vro ken'mmpenul °rage a latleffCand in all
subject an employer to criminal penalties and awl fines up to onsttu2m Thousand Back Flow Device
dnlera(3100,000),of Addition to me cost of compensation,damages as provided for in
secaon 3706 of Me Lahor Come mteraw and an.."..leas
I hereby beam under penalty,of perjury,mat I am axampt from me Convenors Linens.Law Lawn Sprinklers
for The Indonesia meson(Sac 7031 5 Business and Prolaamona Code) Any city Or county - -
waacn plasm.a permit to construct.slier,improve,demolish,or repair any sauclupl,pner
to as issuance,and reauves The applicant for such permit to lilt a signed smmment Nat he Vacuum Breakers
Of sir°a licensed pursuant To the provisions of the Contractors License Law(Chap 9
-(commeneug Me Section]000)of Divamn 3 of me Biumase aria Protosmons Coal or _
Nat he o s 0 is exemptby an applicant and ire basis lief the meallegedpp exemption Any mason
of sarnon]031 5 by any applicant to a permit suDlaclrThe applicant to o curl penalty of
flat men Than five hundred dollars(S500))) j PERMIT FEE (Sub Total) 0%
W ( )1,as owner 01 men property or my l mpbyeas wan wages as Their sal°contaensnn0n.,if
O den The work,and The forandrs m not inwww'or onwe for sale(sec 70aa Busmen end REMARKS Plan Check Fee
�+ Professions Coda) The contractors Licn�. fka Law does nm apply to an owner 01 a property
go who bmbs or aprovea Nerse n,ofol wh.dope such work himself ar through his or her Own
employees pcavdad mat such im /°menu are not mmnded or ordered for safe It Plan Ret-_Fee
V V
W_ however,as building or improv em a sob wfmin one Treat of completion,the owner
Z budder will have ma burden a roving mat he or sae did MI build or improv°Ion The Issuance Fee $1 S 00
3 purpose Otsale) '
O i )I,as Owner OI the pr ray,am exduswely convacbng wilt Itcensed contractors to Q /J
construct Me project n 70ae Buvn°se and Ppllesatons Code The Cmnranon Issue Date TOTAL FEE Z�_z J
Li[eram Law races apply To an owner of property who pufbsor, improves therecn,and ..__ READ CONDITIONS BELOW
nvacontracts loturn prolprojectswitha contradicts)license punveni to file Conveno
.ro rs
contracts The Work authorized by issuance of this permit is subject to all the rules
and re ulations set forth In the ordinances and amendments of the CI of El
asa O I erne ex jet under See_ B 8 PC lien tub r g City
Segundo,and the laws of the State of California In regard to such work,and
____ r all amendments hereto
This period becoriies null and veil A work Is not commenced within one
CONSTRUCTI LENDING AGENCY hundred eighty(1e0)days from date of Issuance,or If Work is suspended at
WI hereby Maio under penalty a Pe That tnero is a consuuaien lending agency fir any time during construction for the same period of time,or If any work Is done
2 me pedormanco Of the werk Ion ah ma perms Is fulled is
3097 Cm C) In VIOISIIOn of the City Ordinance or Slate laws governing same
W
� Lenders"°'"° _ VALIDATION L,
Lenders Address
Dignbulfon PINK (Dept) YELLOW (Applicam) dos FORM P-Ica Rev 1r95
INSPECTION DECOR®
APPROVALS
DATE INSPECTOR'S SIGNATURE "DATE INSPECTOR'S SIGNATURE
SHOWER PAN HOT WATER HEATER
SEPTIC TANK PLUMBING FIXTURES
SEWER GAS TEST
UNDER FLOOR WORK UTILITY CO.NOTIFIED
ROUGH PLUMBING
GAS PIPING
GAS VENT FINAL
REMARKS
IT
APP,LyGA1N�To ��� -CAC ___ MECHANICALty of El u do —1
ADD1�1 a j�/1 BUILDING SAFETY DEPARTMENT
Of ZIP �02� PHONEf) ABu-lldin�g "" d Ing N
(�1 Trdp Block I Page Lot I Flareef
NAME
3 ADORES I NE I candy that i have read this application and state that the above information Is coffee..
I agree to comply with all city and county ordinances and state laws relating to buildingtD CITY C n TATE/ZIP— j consh, ion and hereby orae representatives of cots city to enter upon the above
�� ar' Red openly t ins ci art4arbe sus
i— NAME G_ 1
ADDRESS PHONE = aa:ure of V-Pil ism or Agent - " Date
V
c CITY STATE/ZIP
W NAME P C No � No of Plans Ratio
? ADDRESS PHONE
o Data/23 Comm Indus
W CITY STATEIZIP
NAME U M C Ed
Quantity Fees
MAI RE Fuel burning heating Appl
cc TE E
o EPHO P(O(�-T171G o Air Inlet and Air outlet
Iva TE 21F7�.�iL�-y CI LIC NO _
'1V /
a_ Cdntlndnetl Ceiling Air
at I hereby emrm uhdef penally W penrury coal I am trpnsem under provisions or Chapin 9
V (rommen-Iq aetlon 7000)of DNaron]of me Businessrr.�0 Prol.s,sms Cope,and "—
my hceme lam II Iofc�gCalJect ^�yY Vent
lJCemus C'IiV U.
Na r JVV
Data Contr Srgnatur; - Hood -
WORKER'S COMPENSATION DECLARATION
t hereby exam"ram"penally or pmlury on.01 M.louni eocaratiohs 7 Boiler or Compressor
_I have and we my a candidate of mnaent as s.Mmsu.for wwkat.
Z compensation,as provided for by Section 37W 0l In.Labor Cope,for he performance
C at eworklorwtitcmmmpermrtramuea Air Handling Unit �.
z \LI have and win mamwn vwvkM'mmpansatmn Imuremse,as iequbao oy Seaton
H7 of the Labor Code.Im the for IV J anca of Me work iw wNCM Mia pefmrt to issued
Z My workers' mbmt wur tar anti pohrcy numb; G' Evaporative Cooler
Canter Policy NumberZI
(This secen n need flat be Completed II Me permn a It ono hunEua dollars(5100)or use
C _I Morey Mal ofpro performanm of the work far which Ms permit Is issued I shelf.1 Ventilation Fan
rJ employ airy poison In any mannor so as to IMMdm;sublaa to th workeri pa ensWkyr
y Laws of CWl a,and agree mat d l snood bamma su as to ma rkera' p�ensmwn --
Y provisions of Section 37co or Me Labor Cope,I ana111 y m p o:e Incidental Gas Piping
PnaYlatana Ib If ,O Dale SlgnaN
3 WARNING.Fmlurotsedumworkerimmpensaiir-,;rage,suma u andshall Fire Damper
subject an employer to criminal penalties and civil: up t one numr 0 inousand
dollars(3100.000) m stomach to he past of compensonon,damag s provided form
Seam 37N of me Labor Code interest and anomery's lees Smoke Control Damper
I middy aatrm under penalty of penury Mal I am e.am01 loom vu anba or cfs Lleeme Law _
iw me rotioswg mason Ise; 7031 5 Busmev amp Prdaeasron opal Any pry or county
Smoke Detector
wn¢n requires a permit to cocotte alRq improve,tlamops or iepan any almawa error
to as Issuance,also re,eres me applicant for such p..i n LI.a signed amlem inl min he
or she is licensed pursuant tome provisions or me Con con License Law(Chap 0 Thermostat
(commenanq Me section 7000)et Division]at me s,nesa end Protnsions CoOer or
mat he w she rs exempt main m ardi Me tmao me alleged animation Any violation 7
at Section 703t 5 by any=pace,,he a perm, brats the apasCam t a owl penalty of �J O
tt not more than We hundred dollars(s500)j) PERMIT FEE (Sub Total)
I ) as owner of ion.prop.rry or my amp ties with wages as men so,e com0enzauon will
0 do the work art the structure to nor m data or oaered for sale(Sec 70sa Business and
�+ Professions Code) The Contractorr, ¢ens.Law does not apply to an owner of a pmaerry REMARKS Plan Check Fee
who bmltls dr vnproess mares 0 was does such wort mmsan or-spoon his or nnr own
ozloyem,provraea Mat such Is
are not Imerted or snared for sale IL Plan Rel Fes
tL nowwar,me bmtmg or into
Yemeni is sold within one year m completion,the ownef
Z baker will have Me mid of proving mat he or she Om not bald or imprme for the Issuance Fee $15 00
tD I purpose et sale)
( I I,as owner al the rupemy,am eaoluanafy contracting wen licensed contractors t
construct the papa (Section 70aa Business and Professions Code The Contractors Issue Date TOTAL FEEE���ff
License Lew Mae not apply to on owner of property who busts or Improves meteor and READ NDITIONS BELOW
no conuacls 1 such protects wait a mnexcmgal acense puuuanl to Me Contractors
Ums as Law) The work authorized by issuance of this permit is subject to all the rules
OI em exempt under Sac_ a 6 PC for this reason and regulations set forth in the ordinances and amendments o1 the City of El
Segundo,and the laws of the State of California In regard to such work,and
Date Owner all amendments hereto
CONSTRUCTION LENDING AGENCY This permit becomes null and void if work is not commenced within one
hundred eighty(180)days from date of issuance,or if work is staspended at
WMreby Mum wart penalty ai paprry Mat More is a construction lending agency lot any time during construction for the same period of thee,or it any work is clone
? h.performance of Me�per s Issued(Sec ]007 Cry C)tee. s Issued(Sec ]om Cry C) m violation of the City Ordinance or Slate laws governing same-
Lenders Name VALIDATION
Lvnpen Apmesa
Distribution GOLDENROD (Dept) YELLOW IApWKam) dos FORM M 105 Rev 1195
:i'vm�±. ,�}�'t Zni,� .. .r.r2Cn�•' .�_ :`��.,...... :'i':, Aa,.t.�.r �:-:.'-'•7 c, w: .. . � 'n_ .'as _^ ..�.•.. .:a'+�'.,. .v-�... �. .
INSPECTION RECORD
DATE INSPECTOR S SIGNATURE CATE INSPECTOR'S SIGNATURE
LOCATION REFRIGERATION
DUCTS AIR CONDITIONING
COMBUSTION AIR FIRE OAMPEI"S
CIRC AIR CUTS _
GAS TEST CONDENSATL LINES
VENT&CAP MISC
BOILER
REMARKS
APPLICANT MECHANICAL PERMIT
men, km"I-- City of El Segundo CLft-T5
ADDRESS -'I t� � » ST 9- BUILDING SAFETY DEPARTMENT"(E AoAy6
CITY /�/V�^ ZIP p�9/� PHONE Building'-y ,�^ Building No ��f�
�i4R W� I°l 0 .6L0-OOC rep�L�'iV
Tract Block/Page Lot I Parcel
NAME
W
ADOR SS HONE--- -- I eeNty Ihal T ova road:his ad DI atian and elate that the soave Information Is crorretl
3 ' -
E, I agree to co ply with i at ana counry ordinances and state laws relating to building
C_I^ , STATE/ZIcG
NAME ur g_
Lmoen HlirrUunC i prOanpde Rh e! ae Cp9noZne rDeIIpfrDe0s9eenpt a0ves 01[h4 tlry to enter upon Ne above
v
CZ-
ADDRESS PHONE = 51g-a:u Apd¢nnt or Agent Date
v
= CITY STATEJZIP
a
W- NAME p C No No of Plans Resid
cp ADDRESS PHONE
p Da Comm Indus
W CITY STATE/ZIP t
NAME U M C Ea
Quantity Fees
MAILING ADDRESS 1 i ( 1 l Fuel burning heatingI -
cc CITY TEL pPyE _
c SF(5 O Au inle( and Au outlet
a. STATEe7 j ZIPgr)2 G CITY LIC Nq
c rC 4 (/
It Conditioned Ceiling Air
a; I hereby scam under pen"W peflury peel I am bcemed under provisions or Chapter 9 _
La (cono m w"wait Swoon 7000)o1 Dmmmn d o/me Buvnese end PloieMmn.Code, a
my losnsa4 nil _ ed �r Vent
Lmensa Class Ls No 7
Data Comr Sign r Hood
WORKER'S COMPENSATION DECLARATION
I hereby affirm..Car pamlry of penury one.1 me IOIlowmg denaratmns Boller or Com resSOr
1 have add will maintain a carirlmale of cansam t0 sell unsure lo,workers
x compmsaaon,u probed 1«by Section Woo d1 the Woo,coda b,ume penorma sce
C of me wed to wmtlt hers modern uruued Air Handling Unit
F- a ana will mllnialn workeri mmpensavon Insurance as rein",ed by 5enlpn
y70a a/min Laaaf Dade,tar die pmnafmantm a/ere work tot which m13 pefmli 6155aea
W y wonTen - panaen yrbrr�cmner and parry numeTrye Evaporative Cooler
Corner -t L.1 Policy Number
g (Tnn section need not be completed of me permit is for one hundred dollars(St W)or less
C _I cm"met in me pedmmance o/me work Jer which inn permit is iswea I sbad not Ventilation Fan
U empby arty person en airy manner so as s ba<oma wbpct workers'cdmpensanan
y Laws of California,ford aprec stand I Should becomes o�a workers m an3ation
W prwdmn,of Sxbon 0 00 al me Labor Coda I shall f run mmpry h Die Incidental Gas Piping
lid Pro ismn3 g l3 4g
ODate Signature
3 WARNING Failure to secure workeri emmpensavo info age Is Iawbl orbs an Fire Damper
Suofect an employer as cnmmal panaliies and clan L es up to one hundred thousand
dollars(3100,000),in adaiuon to the cost of eompensanon,damages as novided lot in
Section 0706 of me Labor Cade mount am enorney's lees Smoke Control Damper
I hereby affirm under penally of perjury mat I am exempt ram me Can
s License Law
to,me toothnng reason(Sac 7001 5 euvnass and Prdteaamns Coaal A city of county Smoke Detector
wh6h remand.a permit le construct,otter improve Zn.11sh,ar reDOlr ny 3ttuctbe prbr
to ris¢suence,also remora.me ap,l¢ant In such pemn l0 idea d su;lidw met he
as she 13 bcdmed pursuant s the provisions or the Contractors La.$ se Law(Chad 0 Thermostat
Icommenang me eacadn 7000)of Orvnion 0 0l the Business a Prphssions Codel or
that he Of 5M i5 exempt malellom Md ma Oazm ear ma a'e0 ,amDliOn Any notalian
of sateen]0]1 5 by any applicant Iw a pelmn subjects in ppkcam:o a uini penalty or
not more men live M1undrad dollars SSW)))
W ( 11,de owner mf the property or my employees wit ages as their sole compensation will PERMIT FEE (Sub Total)
p ido me work,am me Sroorm is mi intended a end for sale ISec 70aa Business am REMARKS Plan Check Fed
Professions code) The Convector,License w does nor apply TO an Owner of a property
Who builds or improves thereon,and who as such work himself or Through His or hnr own I V V employees provided met such rmprou ants are not emended momenta or sab if Plan Rat Fee
W However cite buumne or Impmvema Is sob-min one year OI tinolm on the owner
.Z puddler will have me burden of pr ng mat he of she do not build or improve for me Issuance Fee $f 5 Bg
�+ pwpb.e of sob)
0 I )I,as owner Of the pro" ,am exclusively contracting with licensed cdnvanors to C
construct me panda IS n 70aa Bus,mss antl Pmleesson.Coue The carnivals Issue Dale61!1 TOTAL FEE J�.
License Law does Oct a pry s an canes b1 preachy who bass or improves thereat and READ CONDITIONS BELOW
who contracts$or such projects with a commct/1 �
pu,suant iO me Conuaoms i J
Loans.Law) The work authorlZed by issuance of this permit is subject to all the rules
O I am exemp,from Sae B a PC for muand regulations set forth in the ordinances and amendments of the City o1 El
Segundo,and the laws of the State of California to regard to such work.and
Data mr all amendments hereto
CONSTRU ON LENDING AGENCY This permit becomes null and veto if work is net commenced within one
hundred eighty(180)days from date at issuance,or if work Is suspended at
W i Is arum undo penalty d erryry mat mere d a conSltuctmn lenomg agency,for any time dunng construction for me same period Of time,or if any work is done
Zme penOfmaMe of me{war or whbh and permit is issued(Sec 3097 Civ C) inviolation of the City Qldlnance or State laws governing lame
Lenders Norm VALIDATION
Lenders Addreu
0.1.0uuon GOLDENROD IDirpi) YELLOW tapW.m) ass FORki M 105 Rev 1,95
_ �' "7':- � — _�44•-. u.. I j'P ...:1 '�.# _ . „i• ___::�G,v ;,I�jt, :.i�d-6•`_:.�'-:Y�'rf SiK�:f�3y�"!�p1tr uP s.i� � .. �t°.
INSPECTIONP.REC.OR®
GATE INSPECTOR 5 SIGNATURE DATE INSPECTOR-SSIGNATURE
LOCATION REFRIGERATION
DUCTS • - ' - _ AIR CONDITIONING
COMBUSTION AIR FIRE owpEP.S
CIRC AIR DUCTS 1,'1
GAS TLST CONDENGATL LINES I _
VENT&CAP :SISC i
BOILER
REMARKS
S9 0 0- 0 0 0 9 ELECTRICAL PERMIT
APPLICANT / City of El Segundo
__ S �n_�rgZ;ra�/ +• _______ � BUILD.ING SAFETY DEPARTMENT.
ADDRESS/SA/7S 22 S0 PBMAL Ni 4Nuo/ Bu mp No.
,$0-
aTY`co7TSDA ZIP Z d $2/ti,In PHONE Tract Block f PSW Lot f 1'✓u�
NAME �(� LLif V (, 1 cerdy that 1 have read this apple abmn and state that fhs above mlomWter is corre2i
1 agree to comply with all city and county ordinances and stele Iawe relefhq to building
3 ADDRESS PHONE construction,and hereby autho m roWr ntatiy of this city to enter upon the above
O CITY STATE/ZIP
- mention ro for four pu a
rpose
c
NAME
' Sq. re of Applicant or Agent Date
= ADDRESS PHONE
i CITY STATEfZIP PC No No of Pfarta O Read
ID
W NAME N.E.0 Date -Comm hous.
ADDRESS PHONE L SERVICENUMBER EACH FE
O
aZir CITY STATEfZIP Serve
NAME (,t///-.SON EL46C7V/C Service over ON volts 60.0o - -
MAILING ADDRESS Additional Meters 5.00
Panel Board
CITY TELEPHONE SWITCHBOARDS (Other than service sectlOns)
O
STATE ZIP CITY LIC NO b 7f`3 - First-
a
OI Mraby ammt under Perwly a peduy Net I end horMe sprinters
and
Proess of Chaphe 9
Additional Sections 30.00
V (Wenrew,rorq w1m Saucgowr 7000)a Dissident 3 a pia Business end Professions Cote andOffer WO Von Sections 60.00
Lice Claaa lG r r� Uc No 7 6 r- 9 9 Additional Sections 55.00
Dam r /0//r�i J r7�T Coma Srgnalurp OUTLETS - --
WORKER'S COMPENSATION DEC ARATION Switch Light, Receptacle .50
Light Fixtures .50
hereuy affirm under partly of penury one se ills following,:r. bons ' [/'
_I saw wen end nmutuvt•nrtlwate OI Canaenl ro sair!s a for workers' 1\ Appliance Domestic 4.00
2 wmPemaoon,as Pr for by Section 3700 of me Labs Cope for me performance
Appliance Commercial 8.00
O of woe for wNm nth permrl is round
M: news and well malnmm warterY mmpensaaon m.umnce,as rep.-,ad by Section
h 70Uoi the rcode ties rmanwo1 mework fervid ch Nis POWER EQUIPMENT HP OR KVA
peso permu n issued
2 My war Sense and polry num a UP TO 5HP 6 50.1-100 HP 33001
aCarrier Patio I, r °YZS>'r a f 9 3
(Thu eeeaen rtaetl nth be were d the Farms a for one hundred dollars($100)n was 5.1 to 20HP 10.00 Oiler 100HP 50.00 -
O _I Lwrtly Nat In me pasamance of me work for which ins permit IS l uU d I Shelf not 20.1 to 50HP 11
15.00
%1 employ any parson in any m s up ao a become Subteen Some women'can"".--.
y Lewes is Cablor and ayri a thct it I anowd bacome rumen to me workers'mmpeMapon Temporary Power Pole 20.0o
11 prmn imm m Section 3700 of ma Labor Code,t shan forthwith ropy with Nose 20.00
Wz Permanent Powe
Provebna _/ p
O Dale /N/� 1/ I Slgndmrs Fire Warning- mmunicalions merpBncy, ntrol Systems, Smoke
3 WARNING:FeYurs ro secure workers'cwmpenaato eraoe r.umewlul are atoll Detectors 8
Subject an employer W cmmrul penaftlers and rnrn f sup to one nur re en mouaanp QUANTITY
dollars($10 .000),in adp to me that of compensation,damanes as Frovwed for in _
Section 3706 of the Label Cpee,mlweal and enam,',lee. Control Equipment for above systoms �j Bt0 Q
1 Mrsby onrrm under Penalty a Sense,Mal I am enema,tiara rib Come.Leans.Law - QUANTITY - -
iw the bpowlng mason(Sec 7031 5 Busmess art Proleuens Code) An y or eoumy Investigation Fee 10000
which requies a permit to construct,alter,improves,demomn,m repan Soren W.Prior
to as mop ra,wag requires tier applicant Ior such parm0lo lib o.l smwment mat he
or sM a Iroenaep pWweot to M pmviaena d tM Convenors L, Law(Chap 9 -
(commanewe me Section 7000)of Dhbron 3 o1 me Buama.a professions Cade)or
Mat he or art it attempt"ratio.and ins burs Ior me al ad elempboo any vrolebon
of Section 7031.5 by any applicant fora"emit subpdt a epplu:a i fo a end plenary of
not move Nan Me ftunmep'or
(R00j)j
W ( )I.as owner a me pmpony or my employees wogs.ea men Sob compensation will -�-1
p do 1M woe,.rip me saucturo Is net rn m onered br sine(Sec 7oe4 Business and PERMIT FEE (Sub Total) St0 U
Profession.Cope) Tha connactas Oro Law Goa.nth apply fo an owner.1 a p opnM ems/
9 who bald.or improves tMreon,entl o roes sucn won mmsea or mrough has or her own REMARKS FIRM Check Fee.45z?A �
93
employees,pmvwed Nat such rm vem?his ore not imendidl or offered for sale If.ff�
W nmrmer,me ou Laing or eepi ant r.tom with one year of completion,me central Plan Rat Fall
2 builder will ibye tier old f proving that M or She did nor Mild m improve for Ins
3 purpose a sae)
O OLas owner Poparry,am eadusrvay connacmq with Imansed conuactora to laeuence Fee 818.00
card nun ab (Samara 7PIW ausrMm min Prolesmons Code ins nnanors /��e
Lceme doll he rip
ro an owner of pronem wM bunco a1 menna. Zoeon,and Issue Date TOTAL FEE
who Prop;for Such proper with a mmrana(s)license pursuant to N Convenors
nx Law) READ CO DITIONS BELOW
j I are eSampl under See_B A PC for Mrs real The Work authorized by 1S9uance of this permit IS eubleet to'fall the rules
and
lations
Dale owner Segund end thset
laws of thetate forth in the nfufoes and of California in regard to of the ory of EI
regard to such work,and
_ ell amendments thereto.
CONSTRUCTION LENDING ENCY This permit becomes nun and wild if work Is not commenced wttnm one
I item Were undo hundred eighty(180)days from date of issuance.or if work is m apended m
uW by a woult a which IS tnw.o a c a IS. 21 bndmp walla rw any time during certabuetlon for the lisrlte Period of lime,or If any work is done
2 rM pasormerrs a m.wort fa wren ram permit u r pap(sec 30g7 cN D7 in violation of the City Ordinance or State Iowa goveming same
tY Lenders Name
� VAUOATION "°
Lsrklerl.Atio etta
Distribution GREEN a BLUE (Dept. YELLOW (Applicant dos FORM E 103 Rev 1195
INSPECTION RECORD
APPROVALS DATE INSPECTOR'S SIGNATURE NOTES-
TEMP POWER POLE
UNDERGROUND
ROUGH
WALLS
CEILING
SERVICE
UTILITY NOTIFIED l
FINAL
REMARKS
ELECTRICAL PERMIT
APPLICANT -- Building Safety Division
L$ LEC;r' Community,Ecorwmk,a Development Services Dept
ADDRESS Q 3 0S �G 350 Main St.,El SegunCo,CA 90245
CJ (.PDIL FV/� 24-HR Inspection Request Line(310)322-7069
CITVJA/EES .
a, ` 21P PHONE
NAME H L7 Cn H -�Az� Treat
O L Block i Pope Ai- BUBfAna Novo
2 ADDRESS �30� ryIC CVAv, `tip E
CITY STATERIP / 1 certify aw I d Ihb?d114
nd am no the above 0tml11aM Is COIN.
�(- S87et.titsV ��D lapfasm- an ClladlnanCM end efW a rMBtlllgm
NAME aIm aenmbvea of this city bo arch upon theQ for IOMa
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cc CITY STATEIZIP .cot
W NAME P.C.No No ofPbrw Redid
? ADDRESS PHONE (�
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rxur CITY STATElZIP 1r10Yt
NAME 6LzC-6z4C Co r wC . %RWCE NUMBER EACH FEES
MAILING ADDRESSe3a5 IMCir . .� servicesizeService am wo votte _ -
r to J
yrs CITYW.v—m^,0!� s PJ2 TEMHpp"E&`1J-7ygyAdditional Meters
STATE CA ZIP 0L�& CI C.NO `S 04Y
0 ftnel Board
x I Ilweb7 on mar prmay of pwheY am I eon ubnsed undo aovlsima d Cbeptsr e
SWITCHBOARDS(other than Service sectiorm)
V (carrwtsndre Mw section 7000)a DMsk n 3 of dN fAna,Maa and Prassabns Coos grat section 35.60,
�� —I'�" Lx Na 3 69 O
Oats �� Conn SWalure Over 6DO Volt Sections 60.00
Additional Sections 55,00,
WORKER'S COMPENSATION DEKkOTIIIN l
I breby axem war p•rneby a awwy arts a von followmp a.dasiarw v t OUTLETS
_I bav era won msinwa•brmksts a rorra•m a aall.lnsun ro coo Switch Receptacle .50
x mnro•n•oam,as p tl to by by sewon 37M of ors Lebdr Cons ror wa penwmero• Light Fixtures .50
Q 'q la.wbrt to w!do nbpuranmuaa
►`. �1(anew ra we nrbnNn wwbrs'eompnubon om,ance.as nab~by sewn 8rltaI(Domestic) d.DD
R ar tabor Cob.b are prbrmarlb a Ots wort ror wIWJr Ws p•nwr a bawd
txb to cwow Prg= %KC i4y058oa Appliance Comma 8.00
ONs motion rtsed ror bs brnpatsa a tlw wmm a Nr am nundrad bur•(ftON w rses POWER EQUIPMENT HP OR KVA
_I way muaw.p.rmmmam.wonr mr wlticn Wspemnbbawd lartsa net UP T05HP 6.50 50.1-100 HP 33.00
empty arty poison a dry mares so es a borne arrgew w or raasn• rvsibr
y Lea)a Cetllmda,are apes ties n I slrouM bomme aubp dts water 00"* aeon 5.1 to 20HP 10.00 Over 100HP 50.00
Q prMsim a sect 700 of"Labor Code,I•ben Ion mP col w
p1O1,b 0J 20.1 to 50HP 115001
cow sranaw T Power Pole -
3 WARNING.:Far s• re wallas'wrapms corer is I.ra shM
subject an entoom w wbnbnt prrann sod cN v do huna•d wawa Permanent Power Pole 1 20.00
dolma(stfa,000),In edal an w uts coat a own n demaps as prbwaad lw a Fire Warning, munfcetbrle, Emerpricy, Control systems, smoke
sem 3ma of a.I Coxk amass aod amrney's Ines 5LAx-1ryL-
cornp� em
I Mob)siBm wow WWI y a prpay don I an eaemp tram dts conva vs Irene•LawQUANTITY -for 0ts tbcpwira reawn(sec.7031 5 eusinsa era Prdesnwa Coda).Any oft w wumy ControlEquipment iW above Bona
wax npuves a pwmn ts wuoun.simr,Improve,aamovan,or repo ay aovcats,ptsr
Io m Iaallallaa,abo w0uh•0r•appebnl b errrT pemd b aM a synod Wbdnenl tiW MOUANTITY
w sits ts awned lh a a dr•porbbns a we Cmbawora uesna LM(Clop 9 -
(o mandna 0ts section 7000)a Divism 3 a n srmvtsaa and Prbfnabra Code)or a10 tits baaa tw vts abpa namptsn, n —01 Seelwr 7m1.5 by coy ePol ror a pwrrar aubl a Wapadonamilis )))Wyr prbperry wmy won
do ale work and tits•bualrre b oat w oMrN Iw a Sec 7 111.aIC
Pmtsaablo Cade).Tits Cmveaaa Lew doss apply to M Donor w a proparry
orb brrllb a anpwea d,anm, wa au nariaea a vvovpn rue a rrw own
employes,povk•d don slim enprovarbn rot a onwed la Bab-0. PERMIT FEE (sub Total) —7. SO
InoweYw,vts brleallp s'enpovnnrd o wam y d om,ar dwrw.
Nddw wa hWW0ft WOen a ba site aunpron tar vts REMARKS Plan(Tsgt Fes �}
3 pumose a soak)
es o ion a ow, .eon esdusawy wlbaNrrp wa1 ncenaa emtraaon ts
wuw I tits oviect 70"Bu k sys ma Prbbaawn Cab Tb Cwtsesws Wen Rot.Fee • (
Lkane law does apply in wit owner a ploPenY sib brae a unpwee moiem,and
wllDwnaaa •bdn pp(eCb warawnb•atw(a)lCen•WraWmav,v cw r!
oboes bauarlos Fee alb.tp
( ) I ';,': �B a Pc f-.N--am ( Date TOTAL FEE 2 3.SEL
Der Owrr REM CONDITIONS BELOW _.
CONSTRUCTIQN LENDING AGENCY The�auawnzth by aWouenooDrum°so s a pmmit b aulrNct ft a0 the odes
e.,-I,gr1,�jLa„, anti ra0wmind eon fain ft tits take aticae pm■i n 9wd to or oh ay m a
Ulm,
I bra0y aam wndsr Owtslq 01 an•r•its ram anab•0•rw7 sw aeaatlo,tins ate lawn m the Sbm m Cmifrms m raprd m 11nCr1 rmrlL ono
2 atsperforrnaro aatsaekr A e0(See3fA7 CNc) all mrMnfbnMltB tflalr0.
Tab prone bseomm n1d1 and vdd H oak b not tanrrraload s1Nla am
LesOwa Nan• tarifbe0 ei�1y(190)11syB boon dons of bairanos,a s work b fNOpOrrdOd m
anytime durkp Ixuatrtrc11r1 Asr 1M��mmiws perbd of tlms,or It any work is dam
Lmdois In of alit City OMloanoa or laws gam lh acme.
Dlef&AM GREEN a BLUE (DWL) YELLOW (Mpr+d) sib FORM E•103 My 1105 YAMT= 0 03 (G (.,y-D
..�r.M a^;"-u: ., C,� � �"�1. 1. � .'.1 :"'� 'i ,. c: i.HC:r � .w:� Y�," ':'¢t t ...yia.;w•Y w, �� � �fir,i-{^,
INSPECTION RECORD
APPROVALS DATE INSPECTOR'S SIGNATURE NOTES.
TEMP,POWER POLE
UNDERGROUND _
ROUGH
WALLS
CEILING
SERVICE
UTILITY NOTIFIED
FINAL
REMARKS