Poursabahian, Siavosh - 2018-2019 FPPC Form 700STATEMENT OF ECONOMIC INTERESTSREV, „q
CALIFORNIA FORm7OO
POLITICALFAIR COVER PAGE CITY CLERK�OFFICE
Please type or print in ink. A PUBLIC DOCUMENT
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NAME OF FILER (LAST) (FIRST) (MIDDLE)
Poursabahian
1. Office, Agency, or Court
Siavosh
Agency Name (Do not use acronyms)
City of El Segundo
Division, Board, Department, District, if applicable Your Position
Planning and Building Safety Department Building Safety Manager
► If fling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑x City of El Segundo
3. Type of Statement (check at least one box)
❑ Annual: The period covered is January 1, 2018, through
December 31, 2018.
.or -
The period covered is
December 31, 2018.
0 Assuming Office: Date assumed 12 , 09 .
❑ Candidate: Date of Election
Position
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left
(Check one circle.)
, through O The period covered is January 1, 2018, through the date of
-or- leaving office,
2019 O The period covered is I through
the date of leaving office. Q
and office sought, if different than Part 1:� sty
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
i 7' Schedule A-1 - Investments - schedule attached
❑ Schedule A-2 - Investments - schedule attached
n Schedule B - Real Property - schedule attached
-Or- ❑ None - No reportable interests on any schedule
❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
35Q Hw h Sd- _LAB EL Seb"" o CA a _9 O Z. 4 S_
DAYTIME TELEPHONE NUMBER tMAIL AUUKCJJ D ry
( 310 �J Z�`2333� - = 5 Pa�0 V54.A.r .� E`S�RV►Kdc • 4Y�
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed
12/10/2019
(month, day, year)
Signature
the originally signed paper statement with your riling official)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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