- 1921 MARIPOSA AVE E APPLICANT PLUMBING9undo PERMIT
Ciiy of El t -
ADDRESS 7
v n BUILDING SAFETY DEPARTMENT
ir CITY HON .Cn Building / 1
!�/ / d
NAME rem 1 /Page Lot/Parcel
W I eenlfy that I have read this application and state that the above Information Is correct.
3 ADDRESS PHONE 1 agree to comply with all city and county ordinances and acids levee relating to building
CITY STATE/ZIP ` construction,and hereby authorize representatives of this city to enter upon the above
menu -d to[inspection purposes
'V NAME 4 _ � �
w
ADDRESS PHONE gneture of Applicant or Agent Data
Q CITY STATE/ZIP
W NAME PC No No of Plans
ADDRESS PHONE /
v Date MM Indus
rZs. CITY STATEIZIP
NAME 1 49Q PC Ed Quantity Fees
MAIUs p ./ Each Plumbing Fixture
CITY
o A: � Sewer
u STAT$ // ZI CITY ICs,-fJDj
C Cs� fJJJ
cI hereby arm under penalty of PwWn'mat I sme or e fider provisions of Chepler c Water Dispensing Equipment
ri (commencing whh 7d)0)of Division 3 of me Business own PolossmiloCalose.and
my downisin fu Water Pressure Regulator
Iucenae Chas Lic No q 9
Date � echo- Spnature pD'(eble Water System
WORKER'S COMPENSATION DECLARATION
I hereby alrm urger perolry W penury wo of dw Ialbwrrp dederamro as$ em
_I have and win meadow a Wrf k"011.9aSent la aellJnayre for wOlke@
lowlands. pmvwed wlands.as for m r by Sebri 3700 a the
Lr Code.Ior the
O_ Jg me work for whiw min permit b issued. Water Heater
haw eM ww malnrew work.@'awnW^saew ma@nce.as rpmree by
h3700 of in.Iaabr Code.for pis pwlormenca of the wank far whlan that Permit I.evolve Water Heater Vent
W f�J� °f vaaYa
d rCuayTr inn yzrU r,Number.
�. (The anon road rot be ampleue H eN perms u lw aro thiudOrad done@(5100)«less Swimming Pool
Ca I ow*Metal die perlimance of m pus perm e work for which it It Issued.I shell rat Spa
Ca _amp"arty person w arty,mauve'eo as ad Demme subject mew workers'campeeatbn
y laws of California.and do"that 41 should beconw in bled to ads workers'diem m rid.
t= prw@wru d Ss 371q of pie Labor Coda,I shot[feMwim coin wool pose
ilic
Pro eons �
p'y Solar Systems Collector
cc Date 2 d� slgri l,C�'V to— 1 Solar Storage Tank
3 WARNING:FWlurs to secure ovarian'mmpennow coverage is unlawful,and shall
wbfem an ampbyer to criminal paroalss rind=it loves vp to one mundred W h sarM
dollars($100.000).In atlrbon m the.1 ot compensation,di magma as pronged Ior M Back Flow Device
Secton 37M of the Labor Code,interest war enomay'a lees
I thereby anum under primly or penury mat I am..of mom Ma Connector,License law Lawn Sprinklers
for me following reason(Sec.7031 5 Bustruas and Pm 7:ne Casa) Any
wry my
whch requires a pe.1 w WnaW,%aft e,rmwaw,damersn,0r rvparc airy a Ford,prior
m ip issuanm,elm ratrymos me appllmnt l0r such permit b Xle a signed temanr met the Vacuum Breakers
or sere rs beamed pu.,to me prevainns of me' had [ors lxena w(Ch°p 9
(commencing me Section 7000)of DNblon 3 of Me;:mass arM P eaww a Code)or -
Mal he or aM 13 exempt meraom and dw basis IIX ma else rmpuon Any=am
of l tuna Ton t i by any d don.for a pemvt wgecu eve iunt to°awl oerolry of _
nor, a tine ins hundred alma@(f500))) P FEE (Sub Total)
W ( )I,ea owner of olio praparry w my am Iin n ss men sole mmpensstbn will
r, do me WOm,a d meZ
not a ww red Ior see(Sac 70W Business are 7
�s Proteserons Code) es Lice does not apply to an owner or a property REMA S O / — Plan Check Fee
Loop
or unprov and who work mmaet or mrougn nos w her own
empbyass,pmvbaprov anti r not intended or offered Ior seb IL Plan Rat FeeWthowavm ma buiwirt is w mobp-
32builder wall nave Vrovme alai a.w she dierotburntorimwowtwdwIesuanCB FOB S7800
v purpose of cola)( )I,u ownerofdwm esduanay-ntracunp wim limnaed mntreciors toconstruct the prM Business and PWIanchis Code The Contra nets [me Date O TOTAL FEE
Liunae Lmv, - not apply to an omw of pram ty who Owwa pr immovas maroon,end REAP CONDITIONS BELOW
veto mntre suctt Projects wall a contractors)license pursuant to the Contractors The work atrthOdietl b issuance O}cols subject fo all the relea
Larense ) Y permit Is su
( ) f exempt vented Sec_9 a PC for alb reason and regulations set forth in the ordinances and amendments of the City of El
Segundo,and the laws of the State of California el regard fo such work,and
Date Owmr all Monomania hereto
This permit becomes null and veld if work is not commenced within one
CONSTRUCTION LENDING AGENCY hundred eighty(180)days from date of issuance,or if Work is suspended at
WI herby efmm under parlay a Fees"�qd�uedmm Is in owlairuction tewting agency for any time during construction for Me same period of time,or if any work Is done
2 me pstlwmanm a ma Wank tw / '� b lea (Sec 3097 CN.C) I
In violation of the City Ordinance or State laws governing same.
L°rgera Name_ �L
VALIDATfON
Landers Address
Dowbeon PINK (Dept) YELLOW (Applicant) dos FORM P-108 Rev 1195
INSPECTION SRECOR® '
APPROVALS
DATE INSPECTOR'S SIGNATURE DATE INSPECTOR'S SIGNATURE
SHOWER PAN \ NOT WATER HEATER
SEPTIC TANK PLUMBING FIXTURES
SEWER GAS TEST
UNDER FLOOR WORK UTILITY CO NOTIFIED
ROUGH PLUMBING
GAS PIPING
GAS VENT A FINAL
REMARKS