r-· . . ~-. ----­CITY OF GARDEN GRC•VE

~~~OWNI:II

~· C-Lect M::a,.,hi.ne Products NAMC OP' CON8TftUCTION L.IEHD.: .... ftANCH

PLOT PLAN PUBLIC WORKS&. DEVELOPMEN~~-,,,.. ADDRESS I•ERMIT NO.

_11600 Honarch St flcLD'l.<->n r:: j,,)\.l)t;,<_:!.,Jl

SHOW NORTH AR~OW, PROPERTY LINES AND ADJACENT STREETS.

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, •1 ~ufldlng lnsp./<¥2 Aueulor/"'3 Permlttll/•4 Fll~ I etirjllv thtlnformltlon h1reouls eorn~lete ~~d cortlibl. ay ----.... ·--·-----·~-----··--

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tNS.•EcnON R~COflo-.--_DATE INSPECTOR

_~-----------,~---------------- _________ ION I ~ 'thrttfte followlnf eontr.ctor"s Licllnlle No-----­Mel c..-.~•lntuHfor;;;eMCI otH.ct.

(PIIIIOTJ C:OIOTIIACTOII (•:.-:~~~::rz::z..OII Dlt.'r&

.u .... •ss TAX c•lt"'''PICAT8-iie~--- IBXPIR,ATIOfl DAT&

Inspection RtqUnts 638-6771

C•ner~l fnfe;rmaticm 638-6661

For Applil:ant tG Fm in

r.lr17f c7J 'hl ~~~ 0 ? t h) .:Ly ":) c " "/,f' .rn- 6 ._\ C>

uAJs r, ~-Zll'

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REPAIR 0 DEMOLISH 0

PRESENT BLDG. ADDRESS

RELOCATION

NO.,dF DWELLING

UNITS

I c.tlfy tftllt I 11m •MIPl from ·81ctlon ?031.5 of ttte Bulin• and l'r~ c.-, Dlwllitln a. -~ •• ~tore· L'-- Law,

• · _I I 1 =~_.!0J::"_fac'rr"' ~-'c_undwllOO:_ • a.:tion 7048 0 jM_OVING ----- --~-----·-----~~---,--------------------. . - .llftllloYee.....,. ... fw ...... ei!IY:..._..101:10 CONTRACTOR

.......

! . . . ' .:.. .. ... .... . *'~ <'

Inspection Request3 638-6771

General lniormation 531!·6f.61

For Applicant tc Fill in

State Compensat'on -pc. 2 . · - V? /71 lnturanca Polic•t No.k0/6.!) Ewpiration Date.&'...-. ·0 1 cartlfV tflatin-ma Ptrformanct ot~a work for which t!li; permit ••

iuued, I shall not amplov an'f per10n In anv manner so aa to become subject to tha Workar'l Cornpansatlon laws of Callfo•nia.

NOl-E: If, •ftar makin~ such c:attlficate, the applicant for the permit should become subject to the Worker's Compensation provisions of this coda, hm shall forthwith ct·mply with the provisions of Section 3700 or his parmit shull be deemed revoked.

}811 cartify tflat I halVe r .. d thlt application end IUta that the above in­formation It correct. I agrla to comply with all City ordinanccti and State laws relating to pending con~ctlon. I furthal agree to hold the City ~~den Grove ~ al)(l" j(arml ... from any llabilitV 1ori~

frumW777

•u'.-JN-Iiii TAX CKRTU'ICA'rll NQ, 'EXPinATION OATE

I cart>fv. that 1. am exempt from Sactlon ·7031 .5 of the Bu•inass and Prof-ional ·coda, Division 3, ChaPter 9, Conuactoro' License Law, under tfla fc>llowing Section: Owner: ::..Ctlon 7044 0 Minor work und•r $100: Section 7048 0 Emplo·i'• ,...,..klnt for w•D" only: Section 7053 0 Other:_,_. ----------~-~--.. ~.~- "~"·~·-~·--

(•RJI!I!T) ~,_~"'RTT-~~~&"8 ·TAtag~T~t~..fJ.f .. .,~=~fi.:J~;~ CP.Tii

"ilf:·:IN!iHJ;T!ON -60-ETO OA f'AI\.tli'!£ TO MAKE:

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I f - - ~ , - . -:__!_-. 9_11 iJ ~~~ y -i o s_t9.4Jo-.;:_?:._ ---·· , .ADir'\I"''"U'3N • aiD..,.a RSMODI!L A.,ll. OAOU1" (t.!'t Ulf!'.'Ct..!~ (<#<" ur,:~to;: N1tW bUILDING Oft rti:~UJ'TtftG fHHt Dl,.t.' JOC.CUP/d''I!O: ~ f'~' I':V P~.!..l'"<fJ'..1 A.ND

SQ. PT.

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I '1'/ 1£. Clld_,!Nt.n:r/OA.K0/11/f-WORKER'S COMPE~SATION REQUIREMENTS

~~~e~:ro~~tlr::~.£/ '/ ,J!L_ E><plretlon Date t.j-1- rc Q I certify thet ifi the plltformen.:a of tha work for which-'t"h-ci-'s-p-n-rm--:1-t io

i•ued, I shell I'Ot .,.,ploy •nv per110n In any manner w as to bMomc subiOICt to the Worker't CQmpanMtlon l•ws of C.allfornla.

NOTE: If, efter making •v<h tertlf'cate, tt>O applicant for tr" permit s.hould become s<Jbjoct to the V.forkerws Componset:ion ;v~sio1 .s of this cud&. he shall forthwith comply with the provisions o1 Section ,..

~3700 or hit parr11h sh~!! bts ~l!J.emlrd revo.k.&d. ll5- I cwtifv that I haver~ lhiiiJI)J>Ii<>nior • .and $t8tO that tho ebovo ir,.

formation 11 corr...:t. I •II"'"" to comply with all City ordinances and State lavv11. r•let1n; to pandlnu construction. I 1urthsr ObTfOIJ to hold the City of Gard•n Grove frtv ~nd hDrmlo~ from onv Uabilitv 01 is· lng out of ln(u~o·,.~od)lv.A-mlll8 resulting from work parf

7ormod

ral0111ant.~th~.Jl~/~ /O//h }] DA"fit ·-

•ut:::~Nas• TAX.- ca"TIFIICATC N~u;-- kXPU\!IA'1'10N DATE

I certify that I em exempt from Sec:tlon 7031.5 of the BusinCM and Prof-ione! Code. Division 3, Chn>t..- 9, Contraett'n' :..;.,,.,.., L"'-"· under the followint) Section: Ownw: section 7044 0 MinP< work under !'1100: $9ction 7048 0 I;J:nplQVee working for w•IJM only: S«tion 7053.0

OtllM": --···'"··"·~ ..

iPtlln:T) il. OP«th -r OWNE" CsK;.~~Tj:N~~~·l':e.:r;';!"'•n DA-;-ii.

Bf- CHARGED FOR RE-11\ISPE~~O WORK, OR FAILURE TO MAI><E

a :\:..OUO"'!'I·~·n

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• .. CITY OFGAR[)EN GROVE . ELECTRICAL PERMIT hlSt>c~~ion .r~uqucsts <j{;;;rill lnf<Jn;;;;;t'lun . I ~ .~, ·' Public Works & Development 63IHill1 ( 638-G(>Ul) Jj. ;2 i

' _ INSPE~!l_?N RE~~R~---L--~----~---·-----------~ES_ _______ ____ __ ~~pplicnnt to f:ill1

f~"~.-~-· --· ·" .. 'j

saNGL-~ PHASE S!HWICE Sl.".!!--rTUn T:1 oH 1 IF' NoT l-ISTED eEt.ow ~·o T:A FEE ' 0 ""'""' . -·----~~~--~---"""·-~~""··~~·,:; 1 r., SI:E CODE .. . I "" . I

AMP" VOLTS RIG. CONIJUIT --·- .. - -------··· I . ----- r, Gn1·aou. Aesld. (M} sq. ft. l.oT '' 0 • tJLK NO. TRAcT No., Cl,nc'i'Hic t•Lnn-..1t'f' r·Jo. u

l-· -- ,:;PR0-~~-~-:· .. 1----- ~~~~---- 1 ;~~~~~~a;-- ;.~·~~~~~M~~-:'·-~~~-~~"--~~··_o - -~-- --1-----1

-- -- 21 gags 1 li It 'n ~ ti<_i~_,;\ ~ 1

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I Sofvlce 1\11otor1 1 hrea Phnso I ·-o··;-, _...,.- ' ~~ ~- .~e-.;:-._ ':..;...,..i. ,•!!,,•. ', .. ~ > .. li .. h

,·-: ~ .. - .......... -------- ------ ---------- Add'l:-M;;-;-;,:T~;.;;;~.;.~-- --- -------- I------ WNIZR l 'ft14) il I

Underground I _______________ __J_ ____ , -- - · ,.., ·L t , ·h · ' ij ____ Tern.£'.1'>!'!.-:~_Pow~r_l"()~----- ---------!· ___ -~:..f!,c·_ dac lne Products 1 S37-0Ll()() ,1

P ' O•JNER 5 A.C.OFH::SS ( 11-y -

Coodui! I .. [ !:.o.~~-~ Power,_:~~~:_____ . - f J .-- __ _ ~-\uhPnnels14> 7611 p· 1 · .... - ., · '" ~ ------------- .. -. __________________________ .... - ---;;----- -----------------------... I . ar< Ave._, Ga.tden (,J-0\'e 92fAl_

~~~~~~_!_5_~ q> ____ -~~ : .:) ~=~ ~cw ~un_ozN_~• _oR IE;~•~>TING LIUILD!hr. IOCl.Uf·l~"lcv ,· u1;r: <:..·J 'llliLLlii·K· Ar-itJ-I 1 DDPiON- "-~·'-" rl...:.MOOI:.L ARE:A I GHO• 1 on NUMil£:!1 o 1, UNIT' R

ou~~·----------- ___ -----1 I sQ n , ~pprox, s<> ,..., 1 " ~

~~~~-M;;;~:ou-ar-tz:;t-;;~-- -- ----- --1 -----F~--- · - ·VAi::rE>ATiorr : ·· . i :'> §f.1E9ol· ~~ ~~Fi i ', _:u:_,·~, ··. i)~~ ;:j;;;;;;;:-::N-;;~-o-:e;:-16_5_o_w___ --:------------ f I:::.~:-;;".: .· 1

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-------·~------·-~-~--~----,----·---------- ~_;;~··.l·r:·. ·~-- uu ~ ~~~~---··-- ---· --··· ~ ---- ------- _ -···- _ c• .. 1EC~~< .·l:l~~--e~.-~-:. OC• ~~~~- -~ ___ . ~-~- J ____ . I jsTATF.: -LIC. No. & T\'f'E

~~~~_e.~~------' ---1---· --------- i

'----'------'---'---4-1 =:.::::.:.~:.:.,,":.;:·,:;,~~-~'2.~~-';'_'_:-:ven ----- -----· -- - · -.. L ... .,-,;-·..; .... ·· -?HoN'iZ ______ -- ··:

_o_l•p_o_.,_'--·-·------·---~·--· _ _ Park Ave., Garden GroJe 537-0t.Jclo 1------------1-----'------~-----"..;.--j ~~~~~~tt~rr~~~f-;~afc;~n~~~: ~~c. ~-~~;r·~~--;~~-:--;--;;~-~~--,-~~~- ·;,~,-~ -;;·;~-c-~t~;H1 ~~-,-\-;-~ta~~~· ~~,~;-~- ;;-:·-· cll.Jovr

lnfofiY!atlon 1!. corr_ect. I agree to :::ornply to dll C1ty Ordmc,nce:s /11"1(1 St;;tt' Jaws rel,1tlng to bUIIdin() constwctlun. I c.ert1fv Ul,\t 111 tl"tc perfotrn;mct; ·1 1 the .above work I shull not ~n,pluy .1ny p(~r<:.on 111 vJol .. ttlon of ttlo Labur Code of C;Jiifornia rolatiru; tu Worktn;tll''• Cornr.P.n~atlon lnsur,ince 1 further agree to hold the C1ty of G.:JTdCn Grov(J lr(l(! ~·HHJ t1armles<.. from MIY ltabiht~ arising out of tnJUf'l or bodily ciMn;•jqc rH~llltlnlJ ron1 worl porforrnod n!lcv.lnt to this permit.

' - - -- _!'lo~ o~~~_!_o:_~oh·-=--=-:-·~~37 Ql __ -±---~~~~?shl .. -~· i 011~~-~c:~~~ ...?.".:."' _______ -· !Jj??__ _ _____ _3 __ " 2 .... _=:'· --.

·~------~------- Ove~~!:I~O each __ ..,::) .... _ ___ --·-- /_S . :~·:::

II ~~:~ ~::c0~u -------j--'l" ___ ----- l· ......

l-----'--+1----·---- ------- . .______ ----~ J__ --- . l ~!!___. Sinn I l

.. ~,~ ~·-------t"-~, --~---- ~~f~~=~=-~t

~ r::=... .< I I Pt~~-hgck

IDENTIFICATION CODE !Permit

---·~---~r~.=r.-=-,-~~~r~~~-~~-.... -~~~~~~;~~[~.~~u-~=~;~~Jj_~-J~7/¥~--J. INSPECTOR

'-------·-·----- 9-;!) ~ -;-; r·

CONTR/\CTOf~S SIGN lif:l ()vV

I certify that I am.<! liccn~ed rontractor .ttl<! 1!1,11 rny 11u~n·,!' ,., rn 1ull frJrl r-and effect. ic.AP,

\AJ.C. ~ ------------ DATE!:-~---------

, HY-----·-·------·-----------cot~TnAC::Tcn "'UT!l{"'>fl!lf 11 1\(>{!F-IT

OWI\IEf~ HUILUf:~ ~Jic .• N l1£ t PW I certify that I am exempt lrorn ll~e j.Huvi!III.HlS ol C~t"t. ?, D1v. J, t; ,11rU t•

Code {Contractor'!. Licenso Law) because (clwck one):

01 "I am the owner of the above property .1nd will personally rwrfnrrn tf1(• ~ve work. I certi1y that In the performance of the worl~ for wtlH;tl 1111~ pCrn)if is issued, I shall 11ot cmpTO\' Jny person in any m.:HIIl"r ~o .~s t(J

become subject to the workmen'::. compcns.atlon '"w-:. of tnc 5ti1tf' ("ll California.

~am the owner of tttc e~bovc property and I w111 contrilct to l1avl! .111 .,, ~bovo work pcrforrncd by lic.cnscd c'nntractors.

E;}\i'i,

If wotk is not started within 120 dt.t\'S 1rom t1at~>·nf I'.SIJ/! or 11 di>Mnlnntnl for m~re than 120 days, this perrnll will b'l 11'.111 o1nCI volcl . . . I "Af'"EE MI\Y ar. cHA'i~oTCr1·e:-tNsr·Ec-i"R'>N--5\jc·--·1i"i" NEGLIGENCE, INCOMI'LETE. WORK, OR FAILUrH.: ru Mill<[

.CORRECTIONS. _ .• __ --· __ ........... ---------,~.--_..r 1' Willi~*-'!!~~.

D~:H)Ot0~1·7t1

CITY OF GARDEN GROVE .. • Public W~ks & Dovefopmtnt

INSPECTION RECORD

"'-'

ELECTRICAL PERMIT FEES

··· · .. ln~tlection Requests •.. "638-6171

Gunliral Information G3D-6661

, _ PAR~ A '!_ __ ':-_jJ-_~ Y-?Pc;t (i_ .. 7 !vii --·-----+----SL.b PantJis :3 <Jl NEW autLOtNG oR 1 r.J'( tf.Tt~~G uutl.DH'H• Jcc:u""'.~Iu!•r 0r- ~1111\J:.••r

I Woring- Hougn I / '\ Outl~ts Ji/ i.ZG' · -;;,j? ~ •oonoo"- •••• i "':A"J:f:t:'"c•_" ,. 010,,.._ w "uM_"_"" '"

I ) ~IKfures _(05_ .ZS / (f -~~ ~-• sQ. FT. l ~,l]l)_1'i£~1' ___ ____ __ __ i.f H.clter Fixtures More, Ouortz, etc. VAL.ICATlON ::::l ·rc:.;:::.;•_

' -- .... ·'' ·-·'

-l Heetar'-NotOvar 1650W -·----- ____ ISS:·H=E

Washer C:HEC'l< ·---- --

(:__,_, (i(i Fixtures-a. Trim

·~. 1. ·~. ·~:.:=J .. OCt

l _ 1 \ :::e~~-t•r Heaters ·- . --=---- ~c;n•c;~ ~/{AcToR lsTAi''E~Ic:rio:& TYPE

"' Oishwash•r t;.U

"'-, P~~;::At:c Ra~ge orHOPva"K· W i ;~R;;s )> tJI{ K- A \1 ~---~~-~:-~-~]~~;_~;-~ ~~~ " ower _pparatua .•• , • • or

1\ K.V.A. Motors, Tr~nsformers, etc. WO. RKER'S COMPENSATION REQUIREMENTS

State CompensiJtion Not Over 1 each Insurance Policy No. ____ t;,xplrntlrm Date ____ . _

I ~ c•rtlfy that in the perforrnance of tho work for wt>lch this pormlt io

Over 1, Not Over 10 each __ -----r-----· ie~ued, t 1hall not e'l'lploy any pon~on In uny mannar so os to tmcurnfJ ./ Over 10, Not Over 30 each ubjwct to the Worker's Componsutlon lnws of Callfornio.

1---··--- I - / -··-·-r--- NOTE: If, afte, making such certlficotu, tho opplic,1nt for tho porrnit lndv. Circuits !!houlo become subject to tho Workor'!i Cwnponsnt1on p;-ov,~wnt.> T" C k · _._ __ --- of this code, he shall forthwith comply wilh tho provision' of S"otlnn

1 __________ .. . ome loc . 3700 or his permit shall no cluornod rovoi<Orl. ' f Sign --~ .~----· · r-··- ~I cortify that I hove road 1hlt npnllcnt_ion und r~~ut_?. thut tbc obovt) in ~----··-· ···~~-·--- --·-·-t-·-- formotlon Is r.orre~t. I nurno to ,;ornpJy vvltf1 n1l l..lty o,u,oo111.ua u11d Sign Hookup State laws rul~ting to pending construction. I furthor agreo to huid

I- I \ - the CiW of Garden Gro•e free ond lllmnl&oo from ~ny liablli\J' r.ri•· Uf lng f'1Ut of injury or bodily damogo rosuitlng loom work porfor'71Dd

er - 1--- reiiO\Iant to this pormlt.

Motors

"- BUSINESS ·rAX CERiTFiC-ATETIIIF(J'RM.AfiON I certify that th• followlroiJ Contractor's Llcen•• No---------------and Classification _______ , I• in foJII form• and effect. ·'-

fJNAL. ~ s=~s-:~~3~~) ___ =--f- ~ ITEM CODE FEES

UliJity ~~ofifoed Plan R•tentlon Fee ___ ---- ------......_ 8U.INP.'5!1 TAX Cl!:.ft'riPICATI! NO. l':XI'IJIA">'IOrl tH\Tr.

-------~;-~====~~=~~~-~~-------~P~~~n~C~h~e~c~k~-----~--~~=~~-~---~J--~ ~~~~ili•l~~~~~~nh~ion7001.&~t~Bu~MmMd L____ IDENTIFICATION CODE Permit P lonal Code, Division 3, Chaptor 9, Clllltractors' Licanto LoV\. r----- I nder t e following ~ion:

I I lssuanca Owntr: oction 7044 Minor work undor ffi1 00: suction 7040 U _ _ ee working I egeo o)nly: Sec !Ion 70&3 hl

t-::.----.., ---- -- -- --- TOTAL FEES ot:·i,... - Other:.,_ • --·-·--~ _L _ __,....,._.-~:-·&"1 Uft.llltH• IIMfT NO, Sra.N P'tENMIT NO, \/MtfY, H·~T. A Jilt V ;!J:,~~~ -,... .J ..,_._ • • ..

(:O~O. JOE,MfT No, AUTHI')"IZ&D rJ't' (~ftiNT) ,. .. O~I'I:!Jt"t'\' UWN q (!U!lNA'ft,IIU:;j "ROJ'P.ff~rv OWNf,rf;.__~-bi~1-r-: ~ 1--_;.,. t----:-.-::,."::NO::g:""u=olt;;----,.:===:c.~U~Ii..l1j~~-r.--- D ATC Off Ill UTf-l on 17.t:D ~U U NT

If wotlc ltf tiOt ftaf't~ Wlt.,in 1-20d•v• from datD of'""" or if fC;·J A FfE MAY BE CHARGE'f.lHif.!i-'fiT.TNsWffci'iclr:r-601:'"""1-crT ub#~l4cm- fot mOtfl than 120 dlll'f•, th'- Pllt'mlt will be null •nd , • ..., ,C:S NEGLIGENCE, INCOMPLETE WOf'll(, on Ff.\ILUHI.S TO M/-\l<lc 'fold. · · 'jt!C~. COBB!iCT!ONS. ·---· ---- ·---

1# t Off - IJ!')•I)\' ,fl•ti~'J(j

f"E-ifM'T APPi.-iCANT 510oofAT.Unti o~.Tt.~-.... Service

(!l:,':t'i~J¥J.:gl,~~~Tl~~~fJ~;;--(PIUNT} CONTRACTOR o~>.'rl: