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I cerUif that t have read tnls applicltiOn and! st•t• that tht above Information Js correct. I ••rM to comply to 1tf City OrdinilnCIS ,anc:l State taws relatlnq to buildlnt construction. I certify ltl.al in the performance of the .abor.re.work.l. shMI. nat.ampJoy . ..ny".pea·wn In .viotaUon-.of the Labor Code of California relating to Workman•s Compensation 1nsura11ce. I further agree to hold the City of Gnoen Grove frN .Jnd harmless from any liability arising out of injury or bodilY d1m191 resulting from work perforrr:ed ret•vant to this permit.
CONTRACTORS SIGN BELOW I certify thot I •m • llcon .. d contrlctor 1nd that my license Is In full force
L --· -- I 1 ·- I ~~~f;•ct. 111;. -I
"o"TWACTO" sv Au .... o.............. ..... I·(SQ;·~T-~uu s_To"t_Es.___ ·. tUHtTS · 1 0\YI'IER-BUILDER SIGN BELOW · ..... :...L--····-•
I certify that 1 •rn •x•mpt from the prov11ions of Ch. 9, Div. 3, e and P •• ·-·-~ ... •- ~-.._ ----~---' __ .. L._ --- • • ••
Coda (Contractor's Ll .. n .. Ltw}IMCauso (c!Nck one}: 0 .. ,. lm the Own•r ·c,, -,h. lbOv. proptirt-Y and wut PttSOnaiiY ·perfOrm ih* lbov• work. I certify that In the performance of tht work lor which lhls J)lr;mU Is. IHued, L shafl noLemploy_ any-penon in-any .. manner so. as to
1 - - - 1 "' • "' 1 '- 1 Mc:omt s~bJect to tttt workiM~'• comp•msatjon laV~ts oJ tnt _State .ol California. 0 I •m th• owner of the above pro;:Htfty and I will contt.ct to have all of the fboYe work performed by Ucenled con~i<ICtors.
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lute Cc!ompenMt~on (' - ...JJ 4 1..,,.,.,. l'ollcy NotrrS" Niabk.\ .,AOinttton oawvr~ -( 0 1 cartlfy that In the porlormance of till 'WOO'k for which tilll pormlt It F I
IIIUICI, I lhall not MAPIOV any.,.,_. In lftY m11nnor.., .. to btlcomo ~ WOtiK~- B"iiiD IUbjKt to tho Workor'o Conlpetatl.>n 1ewt of c.tlfornla. TO~ .... ·:~~~,~~ NOT:E: If, after making auch conlllcr••· tho apptlc..,t for tho permit ' . . ·. , •: [-', · · · · , .. , •hould become oubjtct to tho Worker'& Compenootlon provlalons Jl ~w-to~_.LL.,;·,..., · ~ ·cn.D..S of thlt coda, ho Ill all forth with cOtnply with tho provlolono of s~ctlon 3700 or hll permit thollt.,e dMmiCI rwoi<ICI.
0 I clnlfy that I hall a roed dill -'lcetiOfl and - tl>at till eb0\11 In• formation It corroct. I ~~. .... to comply wltll 1111 Cltv ordll18fiC• and Sutl l.wo relotlnt to p-Ing~ I funher..,.. to hold tho Cltv of Oardln Gtove frM- llarml-. fnm any llebllltV 111• ::.:.:,i!=ry or ::_odlly ....._I'IIUitlnt from -k l>erformld I (SQ. FT.\ lEV!'- I IT~" liS ___ 1 UHITI. ~
~~a.,r: - ---- ,?-to~ 'i o -- · - · · · · ·- · · ~ .AT. AUIINQI TAX CER1 IFICATE INfORMATION
1 certifY thot the followtne Contractor'• 1.'-'M No.~-:------
~~~qbNd: ~~~Mfect.
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•! lulldlnt IMP./<112 Altlllorl•3 Ptrmlttt1,.4 Fll• 1 c:ertify th• lnformonion hereon 11 eompie1tllllld cor-•·
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FINAL
UTiliTY CO. NOTIFIED
(.-,._aNTI C:CINT .. ACTOif ts:;.~~~=:1/i::":::~, .. . ..,.II£ :MU1UNaas 'tAX Cli""'1'-t"I•ATK NO.. --... ,_.litA'PI~ OAT•;
I certify· 'that 1-- .. 41mr:>t·froin Section 7031 ,I$ of the !Ius'"- •nd Prcf"'lon•l (;.;de, Dlvlaton 3, Ch.Pttf 9, Cc.mractort' l.lottnM Law, under tile following ~ton: owr ... : Sfi!:Wjn 7044 D ·llo!lnor work undttr liDO: S.Ctlon 7048 0 Employ .. working for wilfel onlv: ~tlon 70153 0
0"1-'-~---------~. •··· ·- -"··-,,-..·,·---·--~··~·---· (..W•,..T) "'"o~ ... -tY a • .._. i.,.::~Aite.'\f::":.Ja'.if"" --;;:;:a-
~~TIHSPF:~~t~iON'-··r~r:--oR I'AILl!totr 'T'O MI\KE
CITY OF GARDE'N GROVE 't'ubticCWorks. -&.: CAJflt!)pment.
' ! .,._ •· _· '--'
INSPECTION RECORD
PLUMBING. PERMIT -,
FEES Ft.r A;IP(ieant to Fill ;.,
N·P.ROVAL~ . . . OAH -r---_-IN_SI'_t""c-T'o-. R'-'----r-T-Y·"'"·p·.E--•. o-_F __ -F ___ .-~-'tu-~'I<.~OROO :Net FT He:> FD>ru.·ss '/ //' /' r~;.._ . . ... ·_· · .. 'is .. >SOill'illir.a ~ _ _.f/J _trl,. .tid ·· ~;t<r?I(MI hollctl ·(::F !_ ~'P.t')_ 'J~<?_ (/~<;t5XJO ~ _ , 'f -{'5 (&· :..:J_~ ~-~':!-~- . _ .. _ _, L<>T .. o. .," ........ 'rri;, Nil. r -' ... t+tf, _ . ,Q,A ('~ Ptumbing f!h~~~:..-.~ ··"· - . - . h .::.~ . . :: ·• · tf' . · ·-,·;< < __ .- . -. ~-~
1-- _ ~ ' LovnH::.•v \Wash Basonl :;;.- E::; "f) . . ·· · ~ . " I .. -.-- ·_ .A; ,. /!in A;-., . K;t~h~~ tl;;;k . r- ow""'/ . l ,;Q -f_~ j"RoMe
Eugtt Plumbmg~ ~ ~,... QU. (;f(.."'! · ~-~~~E~ --~-~ l=Jf)C(}f () n'(;;;y.e&~TJe;~ . • J.; . • · yt L. ilu!l<ltv tub or Tray · · · · · ---'---- c.w'"''" s AoPn.t,, ii -~~--~~~'":::... ::l~i'!'Y I "'" ropm; !-·--~··· -~- - _ .
. ~-- _ · .· ·._ · WcH~r Heuter kdi::t-!lcn ·_ I ..:5 ;y./ l , .. · Fluor Smk· I · ~.· -·-"···-- --~====,.,
~,_a~ .. Var.ot . ·~--_. .. "'£W.I!:IUIL~1NC oR .IE~tSTIN;-* Mtut..tnl_,~· v~liUi'L01 ,..a Ar« ·---·----~-,;-------+----------l...F-1~<1-()( ()rain AtJbfTION .un:.:.a """M'OOCI,. A'17~A OM HIJMW£rf Of' UNIT:!
;:- Oi$h Washer · -;~., · SQ; "· S(~L vrt ..
WC< f Dr'nkong Fountain __ _,,~ _ VALIDA"l'luN ~-~--'-----''--------11
l M;Jon Drain and · · Uronal - . ·--~~ >tacuum Line; I Gas System - Outlets --~ r---
1 , I u -~F '"'_lch_ngSewer(f-irst100it.l. -t--· ~~w· urN.,,~']='"'"~;.~..;.-.. 76··-.ISTAH'u. " ___ ·No.&TYI'"' . ~ 1 Water Heater · · - · 1 • : -1-----c:---r . auild~ng sewer 'Add'' ~.oo ft.) • £,. ""-"'.. _ ;';)-?~ {!.3(
I IW:kw,;~h . ~~: tea. add I dra.n) • - 'fl)::J rar 'Q· . uw1 ' ! . · Raonwater Drain - AOP""55 tf} A , / . g ~'T/ ll~"oNo:S-~-).-
·. t w_ater laternl f' 'I '~ingPo~l Poping ?550 r;;;lttlla.vMC"l ~.s/;;J ,(/~ 6tf'2!.. · · Sand Traps/Receptors - ·
~-. ,..------- -. 1 f Au 1om<otic W~shing Machine ' WORKER'S CQII,tPENiA'f;ON REQUIREMENTS/ :· t · Surto Compensatlo" /.,ffll!f/'N/4 " · /../~--~&J
·- _"'"'"""·~: ..... _, ____ .,;__ ___ . \\'~.ncr Softeners ln"'r•nc• ~oJicY,f'O.~~-~~-"~"P.h'atlor:- D•te (-7' , . .. .. . , . . · · . . · _ 0 I C'Oftify til.:!t on Uta P*fcrm1nca Of 11M WOrk foi' whiCh 1hiH>ermlda
I + P.,,._,_n~ ;-~·""""~·--•~·~-"~·--~·"-"~ [Water Lateral *UbjiOCt to t~* Worker's Companutlon law. of Ctllfornia.
}--~- j 7 . · - - NOTE: It, oftor maklnr. ouch ·oortlllcat•. tho '"I'Piitant for the permit I · . , Backflow Protect1ve Devw.es. · shOul~. b~omt subjttct to the Worker's Compens:ation provitionJ.
~ A.. -1: w· t p· . '" 100ft ) . of·~ cod~. ho shallfo,thwlth comply with tho provision. of !Yection ' I J P- J Cr IJ.}ln'J 1t:!u. • ·~ ,., , • .
...... _--------.·-.··[it; __ , .. ; -/""'- - ·--~--l;·;.-;;- Spron~~s-:Fn:-0~~~~ -,--·--• ~~~~~ ~h~~rh;~:~=~bt"nr._·:;p~r.~:i~nk:~d StOTt lh&t the above in•
~~w ' c . --· !formation Is corract. I "llf" to comply with all City Ot'dineMG"' and
; - Lawo Spronklers !other) .- ! f~Witate laws_ relatin~g~ to pond!nv conatruction. 1 ~ .. urth., 1111••• to hold. r---------.- . . I ; • City <>I G&rd• Grcwo frM anc! harml- from anv liability orl•-j · · fi ~: outt i! ~jiur.v U~am.tO'f\res~ttli'l!!' from work PwformKf + j _c . ' , ·u· « ·· ..Jc -4 :5:Hrro ~ --f t -L.i Pa"MfT .. f'P C~HT ..-jf"JiTu~ DAY.
V BUSINESS ·rAX Ct: IC _ FORMATION Lu l~ . ---- :---1_- . I cotr_ lif. v tl1!'t t~o following Co~~~~{~ .. No. I ~"' j. 1'1\..., ~ A _, ~ · :==t and Clii.,ffoea_toon-~. -~-~II 111 full fore• and •f:!~: .. 'r~~· lf\.L ~-~--'¥! -Z..l .... ~'f/ I~ · --=·~-...,-----~-r-enn.c-=""'l=~"'--co;;'E~"'~-=r~=~-;;e'Ei·-~= ''"'"'' CONT ... CTO.. ,.,G ... ~un! ,.,.T •• i::.g" ---,:;-;."Tc:·--. UfH_JTY CO. ;r ·-r Pbn RetentiOn Foe ~~._.._.- , . OJ' ...,I.J,.,.n •zeb AQKHT
~ f,;(~T!!=IE!) ~ ---. tH1'5JNl':lU 'TAX CfinTW_IC:A'n~ !'.JO. .. =-·'fiK·~-Trot~ OATI!;
1---~ .. - PI~., Check . I I cortify that I em •xempt from Section 7031.5 of the Bu•'n"" and
~-. ·~ ___ _!f?_~~!!F!CATWt..! CODE ~'' ____ _q~J.~.:=:=~--:ZQ_,_[l;;t;[ ~~~r:r'~~c"1~u~~~·g ~~~~~~~ 3, Chapter 9, CLntractoro' licensl! LBw,
I T ] I Issuance __&'L_ j V:;;'rf;';,( ,- Ownor: S&c1'.,n_7044 0 Miroor work und•r $_100: SOO<:tiOtl 7045 0 1 "--'-- Employee worklf1g for w~o"• only: E~ctlon 7053 [J
-~~------· -- --- ~--~- -· ~, .. 1 'J"""A' --;fS ~~ {)C' Otll•r· • ---~~~-~ - ~- ----- -~~-_,.. .. .._____ Vf 6 t"'l:~ ....,.. ' 1
• ·: .... ,,_ • ....., .• -. .... ~~-~ .... --•r •-: p_·_:"! I' •'r' "II •.) l I! c Tr;H Jlt. fo'ZrftAIJ' UU.,
1 , ~~--~-----'"""'~~----A·;;:;;;,~,z .nu-t . {PwJHTJ PRo,...;-;;, oWr«-.:~~t~ T4i;-~:;..-:;~ ... d~v-;·;::;;;;;; ~---u~;v;·~~--~-=--~-=-~i:AT«J~-r· _,.,.~twi'Ui~----r;A~ ... .,.__._ Oll't. AU"tf"'OJIIU«:O A-.UtH'l'
-.~ .. at;.·.; .. :r~ r.7. ~"- ____ t;, "l'J ~ ·=~- 1: .. ,.~:~-:..~--~~--.-_--;---·1 . M-~-::::-r~--w.-:---l~i-~i.l;.Ht~-~r~-~rc:J·~--··r~-t' IN.,H:;·;Jui\~ i:;-iJi::-'·-=r,~--·:··~- ,: .. ~1 /.'"": ~~:1:.;.-~-, ~~· 1 ::1 ;n_ -;:;:= ~<:-·~-~ .. -· .·::'..--~· ·~~~~~.-~·- 1_"5~~-~ i.l~ ~ I l d:"'1 -·- :>1 ~J t!'_ - · NF.(~i..1GE"NCf::. !NCOMH r.;·n~ w(•Pt<.. (;il Fi'dt.t ~~4.- t-f~ -JAH.F ··- '- rr.a.~ I "J.l .. ~(,. ,,,_j_,, .:, _- •'-. ?::1., •···· .. ;J •·~·I! ~,n._ ~ ~f!l jc..,. il/) ~ORRECTH1N5. i ,: ? I.J -· -----~- -------..,.·-·- • ---~·-··~~··-~-· . -·--"
-- _ _____.._ _______ ------- -'--~ .. ~-·---..... -.-----..-~ .. _.!,_ _ _.--.__~____._~~-·--- .....,_, __ ..... --......_....._. ---··.-- ......... ~.._...... ...... _~------ -- _. ___ -
HEATING, VEIITUniG, REFRIGERAJIDN--&-Mt-COND~·PERMil···
lllll*tion R......., .638-6711
For
Gentr., Information 63HII1
to Fill in
. Furnai:etc>&lni-!_::!OO~J.T.u::::_::_-=:=L.: I r " -., r ,·n -----a.-••n- lJuil<11)gh,.,7 z·tJ. Mora thin 100M & inr.l. 500M B.T.U. - I -- - : LOT NO. 8LK NO. TIIA<f" NO'fttt'!MJ§
I ~n System to & incl. 500M B.T.U.I I I I ~ ~o~npre•sor ~~ ~ i~cl:.~~,~~~ .. - ·· 141)3 E. Borchai'd Santa Ana 1953;;;6956 , WORI<ER'SCOMHN-IATIOH AiOUIRiiMiiNTS
Steto C:ompeniOitlor<JC-20-358-1 00884 ~ 1 ,..,:. lor. lnlllr•nc•Pollcv No. ~l:~epTratlon Date~~ 0 I certify tl!at In th• ,_,.,,_ o(lfM work. for wfllch .~~-. .. -mit Ia llaUod, I lhab /lot emplCf •nll persoN In •nv man._ 10 H to IMocome subject to the Worker'• Compun .. tiO."' llows of Ctll~ornia. NOT.£: _If, af~er m~.k.lng 10eh c•r11flc•t_e, b"i; ::~!!l!p!:f1t for .. ~.~. permit sflould becom• subject to th~ Worker's Compen .. tlon provisions of this ~oda, he shall forthwith comply with thil provlalons of Section 3700 or Ilia permit shall bit d8mod revoklld. 0 I certify ·tht I h .. • ,_ thlt OIPI>flaetlon elld ttatll thet the IIbov• In-formation t. cnrr""'· I _ .. to comply with oil City ordlnancM 1nd
conotri!JI'IIon. I further IQI'It to hold oAc!Mrml.,. from env~llebilltv arla
'""ldng from work performed
3/17/80
DATil
riUSIN•sg 1' '-X c•IIIITfJI'Ic;AYa fti.J~-~ aXPI"ATION DATE '1 certlf~· lhlt 1 am ex-' from Sotr:tltJn 7031.!S of the Busln ... and 1.. ···-·· • •• ·-~ • ·~·· ---- r Perm,t ~. } 1 1 ¥~QO I PrQf .. lonai·Codl, OIYIGion-3i C!1ap-~9; C:ontriiCtora• Llc•n" L•w,
r I • -·- • .p ---+~ ~!..;·-- _ under the following ~tlon: ~ C'wnw: Section 7(14..' 0 Minor work und., t:! 00: S.Ctlon 7048 0 ~EmPiovw working fnf w .... only: Sr.c:tlon .7063 !:1 . Other: -·-------
~ .. , ... ____ ···----·--···---L··----------,-1 If workls.not Jt1rtod within 120 dava from mn· ollaeue or <1 ~ lOt' more th•n 120 diYI, this permit will be I
L~ .... ~~-· I. INSrj::rTr"u)
8
p,l!!"""''l"'·';' . . . . ~ . CITf OF GARDEN GROVE
.··Public Works & Development ., . I~SPECTION RE~ORD
ELECTRICAL. PERMIT _FEES
Inspection Requ~ttt 838-1771
Gtnerel lnforiMtion 638-6661
For Applicant to Fill in ADD" lESS stNGLt: PHASE sERvtce s1ze DTio -061-1 . 1 ~':!loT LlsTio n:Low No. EA. FEE
:~~~R~~~HAS:~:~VICE~IZ:~!~;;~ o'n;;r=·~~~N~~:~~~~~~-l & R·3 l sq. ft. _!]_I{~~ - _0t"S'!/~o~l2.__A_,;e I t . · . ,... Garage •. Ae~d. CM) sq. ft.. ...... .t.OT MO. •kK NO~~~-:,oEKi.&~TiriC .,&RNii' NO, •r-
---- -.AMPS· VOLTS. .flJ,,,,CONDUI!'S~ter,SinglePhau:·· .. , ... ._.
!. •- ~. _ OVS.L .DATE INSPECTOR _ ~~.~~e,;~~O!Pha.. ·-!--· ~c:iW'Ni'li''----- ------.- -j-·-·-Jl;J 7 5 A ' Lindt d Ad<l'l. M~tor, Thnw Fha"' . "/ -""'
~r--rgreu~~-- ~ _ ~mE.~rttrvPuwerPole - '<{.&J.'#,!t,fl;!P-_jll/o.v~ fJ99?$3$ ~ . \ Pole, Power. Light. etc.
01 unt caTv J Condutt ..,....,.. · - -------- .
t Wtting . R' gh -- ------ ~~~:~;;;-:--------- 1···"·-·:-----f"·· --· -- ~~ .g'!u!:!~-.,~4~i~i0-•LO.N--q_:.Oc'E'Uiti~o~cv I - ~ --- JU Outlets :r~ I r.Ji ~- "'"¢:of$ ....... ~ •••• ••••••• •••• • ••••
\ Fi~tures ·- c ":Zc •"" /..>-.. ~6 SQ. "·j 10
' "· f --z.._ tiNter --~ ~~ ~ --"'--~ Ll A I iN - --¥-·---'-..!..---~LL.J~!J.L<J(JL.,=-'/
i Fixtures, Mere. Quartz, etc. v .... ·10·
101
~-".-.------+--- Hoater-Not0ver1650-W -- '" -·- --r---"'"'''"·-1---- J{j (!)c) Fo><tures a. Trim J .. ·-· --·-· --- -·-- .. · / . { ( / N & ,-c ::·::· --·- .... ---1- ?L..t-f'i79- ·--~~t-JddL
; Mot·or· .•... . / ~-------------~ _ ·.·-1·---·-f----f-----------f-- EL.E.CTIUCIU., CCfNTIIACTOII! ITAT.:UC.NO.atTYP'il - Hot Water Heaters . ~
. . ·/ Dishwashe;- --- ~l-=-- - .0$ f e!/.,~rJ€1(! ~. ;jof €•1eJ : Dom~stic Range or Oven I "Do••us ------~-·- --CITY' ~tHoN•
. • • ~. . \ ~~::::~paratus-H.P., K.W. or r5o '7 fUAJ#4 s r..~·..;:· :...::.=4)="""'---L-------
\
K.V.A. Motnrs. Transformers. etc.
-----!---+---- L jNot Over~ j Over 1,Nc!~~_!~eac~---
Over 10. Not Over 30 ea~h
-L I '7 15""'-L -='-~-1~0 J:LL~ ()0,
1----1---·1 I I --f,M.,.~hJ-.,._ ____ --if---------t.:.:Tirne Clock
Ufer ,::~~H-;;~-~~~~=-==-==f=· --·=}3=---~--§ ---------- --L -- -
I
I
---t--
WORKER'S COMP!NJATIOH IU!OIJIREMENTS Su~ Com~ntatlon .II:!.Nr•nc• Polley No. - . - E><plratlon Dot•----J§l. l'clt'tlfy tl!lt't In tha plt'form•nc• otm. work for which this P"f'mlt Is
l•uotd, I thall not •mploy any o.,IOn In any m•nn., 10 41 to bocome ~ubjoct to the Worker's Compo,..tlon laws of Celifornla.
NOTE: If, After maldng.such Urtlflcatlo, the applicant for the permit should becoma subjoct to tllo Worker's Compensation provisions of this coda, he shall forthwith comply with the provisions of Section 3700 or his perrnlt shall be dMmed ravokotd.
0 I' c~rtifv that I hav• rNd thlo apptJcatlon ond nate tha: the above Information Is correct. I ag<M to comply with ell CitY ord lnancn end State lawo r•l•tlng to Pending construction. I furth., oc;ret to ho!d th• Cltv of Garden Grove fr" .nd h.,ml- from >nY liabilitY ariolng out of Injury orb lly dt-ae r...,ltlng from work performed rei an to p I. • ~·i3!i·/'j
DATIE
f------------ -1 • I RMATION 1 certify that the following Contr~~<;tor's lcanM No.--------and Claulflcatlon I~ 11'1 full Ioree and affect.
--=<
fP' .. J~'I'~ CONTMACTOJt (Mb~r:J~::!.i::TA":~r!~", • I:JATIE
-lZ-~0 6/~'-..Q - aUII'fan ""' ea•Tt•leAUt no, OJ<riNATlON nATO: f------....:::...J-..1-f--;--_;:...._...J._,,t.:.......liJ"-..L fC.::, ___ ~P~Ia~n~~--·--- ----· ___ I certify that I am exempt frorn S.Ctlon 7031.5 of the Ei"•ln .. • end
IDF.NTI FICA. TION CO Petmit Prof•slonal ~odo, Division 3, Chi>Pter ~. Contractoro' Llconso :...,..,
l ~------·1- y--~ ,:-.~----- ----- -- ~:,~h~c~~;~";'7':J:Jo10"' Min~ w-.rk undor f.100: Section 7048 0
ik;;;;;·,;;~ ~- .. · ... ,-. _ ..._[. . . . J __ _ .. 1
:. j __ :::.c:.:.......=~-=.._..._- TOTAL FEES : ~~:~~V .. wmking fo. r wqeo only~~f~:":~~~-~~--~~-.. -. " .. 0~ t:fGH PCifMIT NO, V&NT• HEAT. AIR
0 jCC.HO. fiii!KMI'r HO~
I Of ,I C·/l ,- ; (foi'IINT) ,. .. OPttRTY OWNRIIt (•tG.IIIA'tc.M~o;;.'!): .M!OPR .. TT OW1'1111Jft DA.'r .. I Ullt7 otiAUTMO'At~· AOKHT
1------'"-·-- ---~c•-'-•·-•-· _ _j_______ -------·--·-- ••·' ,_._, ___ _
ITEM CODE FI:ES Plan Retention Fee
lfworklor.ottutrt4'Jwlthin120doy•fromd~ttoofl-1torlf A FEE MAY BE. CHARGI'O F'.O"l RE-INSP!::CiiON DU~ TO -MIOIOI!d fo< mO<o ~llon 120 doyo, this permit will bo nu!l •nd NEGLIGENCE, INCCMPLETE WOR;>, OR FAILURE TO MAKE n,.._ · S::ORRECJIQNS, ·---
~~-~f(")p
CtTY OF GA.RDEI'll GROVE Public W""f'8i OMilopment · r
LANO
ELECti~ILfEIMtl .fEES
I: A: I"EE
lnspmion Aequem Ol-e771·.
Gtlwll Information UMII1
F.or Applicant to Fill in
WORKER'S COMI'I!NIATION RI!QUIIII!MI!NTS
~~=~~~~:~n~t';;~. eR7?.2-2&?E,.plratlon oat.~-~-~ 0 ·1 certify ttl at In tlla pertotmanca ahha·~ 'fOf' whlclt "ttl-:-:11-perm_::'"'t""t""Jt
l .. ued, I thall "ot amplov any pareon In any man...,. ao .. to bacomo subjact to the Worklf'a Com-tlon lawt of C.llfot"nla.
NOTE: .If, aftar making such certiflceto, the -..PIIcant. for the parmit ohould becoma subjact to the Workar'e Compan&~tlon provisions
~ this coda, ha """. II forthwith comply with tho proviolons of Section
700 or hla permit shall ba dHmod revoked. certify that f have rlod this application and auota that tha above in·
formation lo ccmect. I agr11 to comply with all CitY ordinanc• and Stlta lawa relating to panding eonnruction. I lurtt>er llltll to hold tha Ci~y o Gll'dln Grove''" lind harml- fr.:>m any lilbilitY aris·
out injury or bodily d~rg~~~e rllulting from work performed '" ihis periJIII'I» _ w-- /..:>-~ 7'1
• U.IN·~· TAX C ... TIP"ICAT& NO. &"P'I"ATION DATil
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I certify that I om exempt from Stc:tlon 7031.5 of the Businefa and Prof ... ional COdiO, Divioion 3, C"aptar 9, Cont'lctors' LlcenM· Law, undll' tha following Saction: Ownar: Section 70« 0 MinCH' work under 1100: Section 71MB 0 Employ .. workiniJ for-.- lll'lv: ..., ... 70tsa 0
....
B
tt _.. r. not ftMIId whhln 120 day& from dato of ltaue or If I \ >:!'l· 1; ~n~.S ,r, 7 q NEGLIGEI'ICE, INCOMPLETE Y,0,.-1<, OR FAII...UIIt TO- MAKE J ~ I :_111•1111 too- ~~~«~ 111an 120 d1y1, this parrnit will ba null •r><1 1 ~ . -~,~~:._:':._jl.,;c~o~R;i;B:r:c;r;•o~N;S~.:;;. ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;jjjjj;iiiiiiiiiiiiOOOiiiiiiiiiiiiiiiiiii~-~-~~~.~~~-~.. j J. IN5PECTOI< · · , ·-
CITY OF GARDEff GROVE WORKER'S COMPENSATION REQUIREMENTS
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State Cotnpensation Insurance Policy NoA(jL/1'/ J · Expiration Datei.Jt tJ)~b;l Q I certify that in the perforwoce of the work for which this pem1t 1s .
issued, I shall not employ any person .in any manner so as to become sub-ject to the Worker's Compensation laws of California. If after IIMI~1ng such certificate the applicant for the permit should become subject to the Worker's Coq.ensation provisions of this coder I shall forthw1~h comply with the provisions of Section 3700 or permit shall be dee~Qd revoked.
I certify .thilt I have read this application and state that the ulJove ·infonna• tfon .is correct. I agree to comply with all City ordinances and State laws relating to pending construction. I furtller agree to hold the City of Garden Grove fr-ee and harmless from any liability arising out of i~jury or. bodi ~ge resulting from work performed relevant to th1s perm1t.
' a~ 19/f?
BUSINESS TAX CERTIFICATE INFORK~TION
tftjsiness Tax Certificate No. Expiration bate
l certify that I am exempt from Section 7031.5 of the Business and Professional Code, Division 3, Chapter 9, Contractors' L1cense Law,· under the following Section:
Owner: Section 7044 D Minor work under $100: Section 7048 D Employee working for wages only: Section 7053 D Other:
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(Print) PropP.rty Owner ( S1 gnature) Property OWner . (or Authorized Agent)
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L.ti-tcoLN Ptz:~·:·P'!<:r.:~t"'( C.c:>i'1Ro-HY t., Oc:l' 7'6 I IVP. 5 H~~ OMU(
~--------------------------~------~~--~~-c~~~------~------~ DIMEN.ION PLOT PLAN COM .. LETELY SHOWING ALL STftUCTURIEil ON THE LOT AND rHEIII u•E.
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CITY OF GARDEN GROVE ~·· . .-Works & Development auau.a PBIIIIT
INSPECTION RECORD
AI'I'RDVAL DATl1 INSPECTOR
Stan Compensatlon.y-6 ,.._.. 7 .-, c:-c; ,_,, .. nee Polley No. u .i/1(~ J El<pll'lltlon Da~-9- ·/:V,. 0 I certify that in the performance of the work for which this permit 11 ;11ued, I lhall not am ploy •nv per10n In anv manner 10 • to bacoma lllb]act to ttl• Worker's Compensation laws of California.
NOTE: If, aftor ma~lng sucll cttrtlflcate, tha applicant for tha permit ohould becotnt subject to the Worker's Compensation provision• of this code, ht oil all fortllwlth comply with \hot provlolona of Ssctlon 3700 or his perml!shall be dHmed revoked. I ~4rtlfv that I h811a r.ed this application and nata thltt ttl• ebova In· formation Is co,.,ect. I •Ill'• to comply witt! all CitY ordlnancn and k'•• rlllatlng to paneling construction. I further "~~'" 'lO hold
•·~· -• Garden Gr011a fraa and herml- from anv llabllltV ari• ~Z4,~odlly dam- IMultllta from work berformed
.I.!.IHK•8 TAX c•ftTI,ICA1'. "0• .KPJMA110N DATE I cwtlfy 111at I em exempt from Benton 7031.6 of the Busln- and l'rof.-lonal Coda, Division 3, ChiJ'IIr ~. Contrl!l'tora• Llcant41 Law,
I~Wf~Htion ~ 838.fS771
Oenerll lllformetion 83MM1
For AppUc:.nt to Fill in
-~-~-· ·~ .. ---··~-. ---------~-~-under tha following s.ctlon:
---1... ' 1 Owner: Slllltlon 7044 0 Minor work under t.tOO: Section 7048 0 ··--- EmploYM worklntfor w..- !N)Iy: lectlon ·70113 l:J · ·· ·. · . ~CONTRACTOR om.: • ~ ., (P"t,.'l') PltO ... "TT OWNaR OAT.
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•1 i3uildl,1g lntp.l«l .a.-or/"'3 ,..rmlttN/•4 F::~ I e1rtlfy thtt lnlotrnatlon t.er.on il complettllnd corr.ct.
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;, - -.· -.-CITY OF GAP.DEN GROVF, ' ·· Public Works & Developmeltt ELECTRICAL PERMIT l'.tspection Reque111
838·11171 a.n.,; Information
8:JMII1 INSPEC;TION RECOaD FEES For Appll~ttt to Fill In
J~NGLE PHA.SE SERVICE SIZE -uuo-- DOH ~~ . II'" NOT LISTeD BELOW ADDIIIEsaTff~-:_; -7'/:;"i.-;,~~S(, - /'/ C,J!Wk~ -?f.rt . ' SEE CODE A j { I ... ,.I"S voLT::. RIG. coNDIJI:r ~ .. -- · utt IJ.~ot(J.re c,U aoa c:!a -':'HAF.E PHASE SERVICE SIZE 0 3Wiro 0 4 Wire "LfliGL.IOH Rtli~~~~ & R·3 ) sq. ft. ' .! _____ .::_______ _ • ... l----. · I.'ILK NDo TRAC'!' HID KLitCTJIU: P&llrMtT NO.
AMPS _ VOLTS .2l!.G· CONDUIT ro 5 5 1 0 A AI'PftOVAL ~·-···· . D~ INSP_ECTOR
---. ~ ·:zUl. ~ Uildef~t~ .. d~--·. '1_ tl-79 (jj~-- ---- .,'!;;!;;, .. ~(...y ffi~e_ Co ·-Cifi 1
""""' - ·--~~{. ? .. '::f!.:;..+.~.&~:L:!-f'V'.!I!.f-AODITION .. A"« A fUU.fODIEL ANti: A Jid_4JIIOU" OR MIMC;.>'.JI Of' UNITS
Fi A.J-h ~.I;.,;-;:---:-. tiQ. I'T. H."· ' I xtures ,t..-¥~~k!. j --~·--- • Cb. J..._.:_ _ __: ___ t--...,.....;e::::.t:==!.:;:;~-,_--_:~F!:i~~~~ures, M·~~ ',etc. I ( 0 ,_,-.>tt "''"., r 0{1' ?S ot'' h1. ~ • d i
Morox~ - ... stAnt uc. No~ • ,.vn
ower Apparnus-H.P., K.W. or .V.A. Motors, Tr•ndcrmers, etc. WORKER'S COMPENSATION REQUIREMilNTS
Stllte Compenletlon ''c. lnouranca l'ollcv No .. ________ Ellpir.tlon 1>•••----~.,.. r D I certlfl• thlt In tho l)erform~nee of the work for whk:lt thlt permit·•·
!Mued, I 1111111 not employ •nv P«tOft In any mllflner 10 N to become subject t<:l the Worker't ComtHI,..tlOfo l.w. of C.!lfornl•.
NOTE: If, nftor m•klng lll<ch certlfic:ot. , tL11 eppUc•r.t for the permit ohould tecome oubl•· c to thl iNorker't Compen~etlon provisions of thlf. cc.do, ho oholl fo: 'hwlth comply w!th •h• provlolo.,. of Section t-'----=-....l.:.::!!!IC:ft,r/1,1.~,-l;;.=~~;:-!f-------....:-f.:~::::.~~~:__-------+---+- 0 ~~~~~~~~..';~'~.!!:~:!!t,':t1,":;;.';l'.!:rc:'.::"::C, lute that the flboveln•
Ufer
· formotlon It conecc. I IIII'H to complv with e:J C!tV ordlnoncM end . Sta•• lowe. r•l•tlng to oordlng (::Onstructlon. I furthlll' ••• 10 hold : till ctw of Gordin Grove frM tnd htrml- from •nv liability aris-
Ing o f :n)ut v or l?fdll'l a.m- rNUitlng frotn work plll'formld
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- ,.,.., t oth" ~~ I~ /zr ~~-.l--..:.:.lo!l.,...=-------~-----·-----'---+--·-+--+-----+--4 P'.NMI'I" AP .. Lic,;;uT ..... ATU,_. !/!tifiT& 1------- ~ffiFICATEINFOft~T oij J--------+-~~~~--~--f---:::::::----_, ____________ -J !:'g~W~:l'o~•followl~a ccn~fr.'t.; ~':;"...:':tJ'"'ec_t. _____ _ IIINAL
--ITEM FEES 111JiliNTI COHTIIIACTO" C•taHATU"~;I CONTRAf "HH eATa
l------------1f---------1----'· -·L 019: AUTHC •••o A .... .-aUWINSWW TAX c•fiYIP'IC:ATit ff!i»o --:"~j··~ " _i - Plan Check -. ,.,.. · ·;- -t 'J.."),-"] G ~¢!:=1 I c-trtlfV that I ""' t1.1empt from taction. 7031.5 of thl Bu•ln.,J and
Pr~f-lonel Cc><w Olvl.·lon 3, CI'IIIPIIII' I, Contrac:toro' Llcenll L1w, ur><Hr the fotiOIN• .; .: etlon: '· ~~~ e.- Owner: Slctlon '/(.44 0 Minor work undlr llOO: !'ec:tlon • :48 D Emplov .. working for W•lift onlv: Slcdon 70153 0 Oti>w:: ___________________________________________ ___
~DENTIFICATipN CODE 1 _ j:Permit
... :!..-· ' \. .,.,... -·. . ••• ---_,.. -· 4
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~.--=" ... ......._:- ~~ -··~·-·--.··~ ••• L _ _:_ ./' ·- .--·-···--·-----. ___ :_ r; -···· .. 1 .... ..--........ iNii:-"' ---rotNi::0<E·A;:;-;;;,;---. CDJ.;,.o .. 8:111JI<II'I" "'0• ___ _;_,_______ ------...... ,. not tterttcl wl1hln 120 davo from d•t• of laue ar If.
ICIOfMd for mo..e mon 120 deyl, thlo plll'mlt will i>5' iiUII tnd: r ..L:::"..~ I ; ~~k-- r~ - .
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TOTAL FEES ~--·, ~ il1~ ~""'"'~•o ar
...... uu: I!_UTH~O~··::.:· ~--- ¥;;.-;.-A FEE MAY BE CHARGED FOR Rf:·INSPf:CTtO-.- DUE TO
II· 1.-1. NEGLIGENCE, INCOMPLETE WORK, OR FAII.UI'IE TO MAKE • - , COB!]ECTIQNS1 __ _____ __.._.,....., . .. ......... ..
-,;;1,.,.) ,.ROPflltTY owN•" 1•Jtt:i"i::T~~,~ PA1'11.
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HEAniG, -REFR.ERATIDN -~--AIR l: .. D. PERM~T
lmpection R....llf4771
:Fountain way~
C)lMf'lll lnforrnat\cln ea&M1
to fill in
·t;. . 1 ___ 1 ___ __j Absorption System to & Incl. 1 MM B.T.U. 1 1 1 I ' I ... 1 certjfy_t_~•l.l h_aY~ .. r~•a. ltl/s aPPIIcl!l~n- a~d • ~~~U~at Jhe . above_ r, . .,.,..,......,. -. · -. ,-. ~.-.. - -- ... -~-- ~ . Information is c.orrec.t. I •9r1• lo comply to 111 CUy OHiinances .and State f.liWS '"lilting to buildln9 con.strUC:li'ln, I certifY that tn the pertorm•nce of the above work I 5h< not •rru)IO)o JOY person In vlolltlon of the Labor
·· fu~1~-.?~g;~1.1f~~~l;,.({~~:th1fv ~rct~cl~~~iJvf~'r.~g-~~~~m1~~~~~~eiln~ · I Boiler Ol' Compreuor over 50 ~p. I I I 1--1 tilblllty ulsif19 out of. ln!Y~'Y or bodily- d1m1ge ,..sutting_ from work . - · -t-----+-- . performed reltvant to th1s permit. _.. .. . . ......... _ ~CNTR.'\;:TQRSSfGN.BEJ..OW. .. _. ----------I cer~lfy that I am a ficenHd contractor and thlt my license is :n full forc:e and ettect. W.C.. ~XI'.
-{y&,;;t.:·iliMe~iN(,. av~~~~-,a...t.~~~. coNT•uc:To~t luTHf~tz'!y:;o;N/ / C:Z:n· ' . - .. . ... OWNEA..:;I!UIJ..DER lliGN B~~ . 1 I certify that I am exempt frnm the provisions of t:h. 9, Olv. 3, B anc' P Code (Contractor's Lh:anse L.JW) bec~use (chec:k one):
£lo~~-a::,~~~~o~~~yo:~~: ~~bfif: ~~~o~~·~~:·:rul;r.~~~:%:'':t~~~ t'::l~ . ~~~~c15s~5~J~~~· :o~~~! ~~,:~:~~( <;agl,J'e-,;~~~!'A" ,:~~ ~t~~:r ~?a~s ~~ Cellfo•nl•.----- - ··-- · - · · • .. ---------· ----- ... - · .. -- .... - • --0 I ~m the owner of the lbCJve Pi'Optrty 'md I will conu~t ~o have all of tns aboue work pertotmed by tlctnstd contractors.
--- · ----- ·--··- · · - ·-·----- · cxp;·· W.C. ,; DATI: -------0 I am the- owner of tn• abov• pr':lperty 1nd will employ persons to perform--tnt ~bova __ work wHh WAgeS .as. ttuw s.oJe ~:ompcns.uon._ l wHL furnish Insurance for my •mploytes as required by the Labor Code of Cal,fotnia.
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Dl.oO ... ·t~7&
OAT•
•vWtNII>~S TAX C.R',.ttriG.A.~K N~~ ~-p·~Al'fOii ~4TC
1 """'tv· that f ..,. aempt from Nc:tl01l.70:n;• of tiM a--. end ProfiMion.l c..-,. DiY!Ifan 3, C'-"' I, Crlntr.ewrt' Lie.._ Lew, undenh...._MI!I~I<>n: . .. · · OWnar: S.CtiOft ~ [] . Mtllor -k ulldlot tJOO; Mctlon 7048 0 llmptov•wOII<Intl f.,. w..-.llllllv: -..:""" 70&U:J · .-.
DATI!
•l.ltlffiLI• TAX CENTifl'fCA'o·· NQ. 8:XPI,..ATION r;"I''IT£
I C:ortify that 1 om .,..mPt frorri s.tilori 7031.6 of lh• Buoin•• ond Prof-iontl CO<I9, Oiv!.Jion 3, Chept.,. 9, Cc:.ntractor.' Licon .. Low, unclor the following Sactlc:.n: OWnor: Section 7044 0 Minor work underllOO: Section 7~ 0 Employ .. wOfklng for.., .... l'<!nlv: ~d.,,. 70153 0 _ Other:.___ ___ ~---~-------, __ "'·"·---~,,:_, ---------
'~•u~~~t'?) .,.,.o.-c~~~:Fv o•Hsll l•tsC:':::Jo.,~T~~~":e~,.«M ---a;A~
-.$.-='l\.'&f
Main Drain and •Vacuum · Lines
r WatJir Heater
ii~kwash
LWater L<~teral
State Companaetlon
I:J":'!::.Ct~1~0~~~~ 1~':;,-.-. p-.-,-,~.,-,m-a-nt_e_o_f t-h:-:::~:; .e~l~h:-,ti"•I:-,-~-,m-..,.lt,-;-is ls1uod, I shall not employ any p.,son In any rr.anner so •• to boco;ne subj""t to the Worker'& Compan .. tion lawt of C.llfornio.
NOTE: If, tftor mtking such ~•nlftcate, the . .applic•nt for th• p•rmi" 'hould bP.:ome !.UbJJ'ICt tt;'· th• Worker's Compfllnsatlon provi~ions
nwh:h comply wlth the provisions o1 Section rovokod. ltldn
(i:u.mre~~ --Ti"ii;;il~~-~r.~~:":i-~J~" --r;;:Te--
•~JiiiNIO..S TAK ecN'rlfliC:A'OE:.,flfJ, EXPUtATION 1:'1'\T£
I i:ortify lhat 1 am oxompt from Stction 7031.5 t>f the ausinftJ and PtofeMioneJ ·coae, Oiv.!aion 3, Ch•:.lt*l' ·g, Contractor•"' Licans• Law, under the following S""tlc.n: Owner: Stetion 7044 fJ MinD" work un<lor t:!OO: Stetlon 7048 0 employ" working for w•oo• t~nly: Stctll)l'\ 7053 lJ Other::.-·-~-------·--~.-..
._(f'HI~l') ,,..O,IUt't~ OWH:Itll (tUd;;;-~.-.-.-;;;;;-.·;,;;;--;-;-;;;; -=-<H"t;;;.-:t-tt__...__.,. olll A'U'J'"OIII't,1;:·r, AGW."'T
" r. Eli-~-a;;:-c..-4.t\fii,;t~f·o·R-----m:~iNsrtr t.: r7ifiN--iJvL · f(,ILf.~ l"~UJMPLE'H! WOkK, {jR J.- A!L~t~H ~ () !v"/'I..K~ Qt-j$,
CiTY OIF G.~WWEI\l GROVE F'uih!i~ Wmlts & Development mrLffi~u~u©&1u~ !ID~ml~c~O'IT lnspa.;tfion Rc!postr.
638-6771 Gero8V<;l Gnformatiofl
633-o~~6~
fi~JSPECTION RECORD FEES ?or Ar;:;1:licam l!o ii'i!l in rslN(\'L--:::t-:,:c,,-,-:-A-::S-:Ec-G::-:-e-::R-:-Vcci-::C-::E:c:-;::S;-::IZEt:::'Jli"G"TJOH i ~~~~~~~STEO BELOW NO EA. 1---F-E;=lEl ~A;;OR,£s; -·=··-a-=·- ~~= 4t ~-~ L.-----< '\MPS VO_L TS A19~ CON~·U~ .. ~ r. --..----I "'=7Ji,-.Y..f..._.? '?'. 7 ·. .... I , jTHflC:EPHASESERVICF.SIZE[.}Jw"c LJ4wm, ,_,,h; .,-,oH,Rc,,dontooi{R •=R·3),q.ft, I )i.._y....J ~- '1'-'r/Ji.I~/;$/{JrJ0./2 _ _A'[t//t:. .
I ! Gomgo, Fl05ld. (M} ~q. ft. n LO'r NO. DL~'t NO. TAACT rw.r t:r-'-'c~c·n-~~c: s::r~::,n:nt7 ~-.iO. ~I AMPS VOLTS -~j ...... , · · 11 i . _ I Sorvicc Meter, Singlo Phor>e f l'
I i '\?PROVAL l DATI: • INSI'ECTOA Scrvoco Motor, Throo Phooo B' ,j);~ A,;- no "l~---- . ____ (;_f0~!..-_:JL1'-f.'r-\\ r- ----- - ---- ------------- ~'--"''-- ---11. ..j 0\"JNCA v 'I P(-':;>r:.:::l :c;i "1 f• ~
L\Jndm;rcund ---i-----.. ~=:~o~:::r~~v:::cp:~oo --~--~-----~1---=LL.,.L::UC. CC/,L_l'5_"C(J/~_ -----·ji l j jl OWl"! En'~ AIDDRC:s;, V CITY I CC!WU<t --- ---- ---f-- "'"? -. IVJ /) , L __ __j ____ __ _ ___ ---------_I • L.IJ I tl'~/ft::;.C.Jav t-/.Jf. Irt l , ""' Sub-Purotr; :1 cb .t!"... ;::;;:f ·~ ,,_ -- ---- -- -----~- - ~ ' .,.._..,..,{,._.,
I · OU ' ;;t ..J ...- j I £-;, --;,;- · ~~- /. ( . A:>OITI(o~ A~f" nrMotH 1 r;nr -"' · r-,r;-ouP ------ .... ;.y . ~ Outlets ~'--· Lf o;,(..(:; C:~~ j 1 1
r !!)" I' ' = ' -~ ''T '·"- ~T I Q.A l~~~-a-te_'___ ~-~~~c-=- l:::~:~;,:,a~v:,~,a~:~;~ f?~~- L?~ ---~_e..._J_ iJvALfDAliON j --- ~·~1 ·~-- \
~ FJ:-:tur~s·tiz Tnm ------- - -- ~-- --- ---+------ ]' I M-otors • - ~~'--- -- ---- - - ~- --~- ~ ----------~j~-- 1] ELECTRICAL GONTi<A_c_·_ri.)'if -~TE uc. NO. !'.:TYPE r-- .~--- ~-----~~~~~·"'""----- J _I_~ ---:i-~~Ol/ ~(7f6_!f~tC.f.rttC_~- .?2'-172'-/ C~t~ ! II --r- C'omo;tlcRongoorOvon -----·t =t1~~ADO,R.C5S ' ' . co-rv. 'PH~:" .. ~ 1 =r ____ ,n- L .. n. St !lU LlJ. {.JJf!rtt,j)J_f}t_ );1 !S5 7-C//_CQ_ -~-~-------- __ r , I I 1 Wuf'l!CEWS co:v:PEr-JGC;'TI0:\1 REI:!UHAIEP~i:ONTS ~ i ---- ~--- T-~---::::::.; --- I Sv:oto Compom:Nion ( I J ~ .?--~~5() '(tO, lnouroncoPollcyNo, ______ .. ____ LnfJirotionDoto ____ _ r=------ I ee-l ~---- ~--- . I . ., .. - -? .......,_, I 0 ~ certify thi2t in tho p.oriarmt~fiLo nJ thD work fo~ \tJhich thia permit i:; .1
~ IJ ~.o ~- --~ (......, __j •cr;ocd, I ~>holl not employ onv ~fton In onv monncr co oJ to bocomo Ovor 10. Not OvC'l" JO anch ~ subject to tho WoriWI'!i Coky-hsotion lcwa of Cnlifornia. P r- I ' r-------- . . -~ --~ ! NOTE: If, uftor making r,uch, /;Jnlficnto, tho .:~~licont 1or IIHi ncm11t I -.........._ 1 !ndv_ ClrCUilS 1 I shoul~torno subJCCt ''l,,;l-1!1 VJorkor·~ Corr.DO'lS')tio., provi~1on~ ' ·., 1 J1-:-r----C-~-----------~- . ._ i ofth-~ctdo,ho;f•>llforthJif!hcornply·.v•ththoprov,": 1Hii.01So:tlo'l r·--- __ ~- --·· .. 1 ----··-------~,----·- --t- -,. lmO IO(' t _ ~ --- ____ ---- ··- -· -f ___ i ~/'.S}J79b o_c./ li!l1110fr/\it !;hoJ\ ~(' tJc-;urn::>d r.JVOkCfi. 1 I \ ! S1qn t / [f_j f cy::rt} <1 tt-fc,;t lj/lOVO.fc~dli·h\::. L:fJr.JIIc.<Jtlq:n und ~toto thwt tho otovo m 1 . 1 __/ i ~--- --· --~-~- ---------- --~- -- -~ I f.t;rfl]Ot~.f J.~ _r~rrc;;--i/i fr,rc_r:, t~> C:()rnf)iy v-Jith Pll City ordinnncc~ end 1-------------i----( __ --t-----· -----· . J Stgn Hookup s._f:;_to t~yty rt1~tii)B • .:~Q. por.~:ng r,on:z.iructlon. I furt~1;;r c~ro. ~ ~o ,•,o_I.J I -" 1 ----r------- J I i}jJ C!~f pi ,;m:l~H C)Jov~ tre;:J Gn;'f hnrmlf'..-::1 Vr~Jm 1bnv ltnb•lny url&-1 Uf--.r ) ; 1- _.{?~9.CVftP1 i!j'p/y~/&.}f-Jof.WY .d. om.G";J~ rC!:.1f,1tino 'lrQ_rrJ wort~. performed [ - +- I --·--- ------------- ------ j [(Cln'l,_yf~O·,Jiidr_;(;7)'l. I /1 / ,.-~ ;----------- ---- ---+------ _ _j_ ______ ===t--- 1 "\ i \"!/"' ( I I/ ///-Z..fr?__2_ ! ~, ., ( ! L 1 I ~ i><fnif,:;-;-:i;j; :cz•"'3"'!E~:._-=:z ----cA\-c --·' "-''"-·' ------ - ~--- 1 susiNE"S TAJ: cGynHclWE lrJ••,mrJ'HIOrJ ~_,_.,""·-·-~---~-~= I 1
- r----;;;~----~ --+----1 I ccr!_i.fy t_~_ot t?o tS,71;;w!n!_t..~~/~rtlclor/J~iccn)/No.~__r:,__'j_};__:.__'i" ___ ~ :J ~'iJJ r""'";/ - r, I r .r"';\ !:! I ' \ n or!U \,..T~:lfl~~ym;m_.t_r-~~~~~~~ m 7~11 ;orcyr;;no of'icct. u .. '.':·;;'"_ .I~ -. n,.-7t.Y \/'L i'-~=-=- - ~,-~--~"""·=------- ------ I e :-Utl::tL-~ -1/ 'I/( f u ,v~, -r, ----~ ----~HJ-~" "".::2__/--T'----- J ITEM CODE ==f fEES ---1, len"•Tl ca.nn;.¢,o,r -1(,,,,A_"~"',c,,(!j";J,';;.~-;;;;;--· -o-.A,;:--',, l :'\ ~ ""~--;~t7It/? /- /' ~ "'-~--; '~0Pldn_R_c_t~~on F--- ------- ---~--""]! 7 ~~ -. t, 3 \.) " ~r~ AtHHO H ... o//\c-.4rJT j --?j- J;:'?c 'JL 1t; 1Jn,1'1'''tl }·-""'\ /- f·~/ /--...._ ~ 1L .r::;'i - ~~ - '~"" ~------ _r ___ 1 __ J....L_ ___ _ - y- £._ _,r_./'-(1 / \)""-~~ "/ ------- ~= __ _:;::-.L~dl• --:lUDir4 G!lTI'oltCG:RTIFICJ\Tr.rlf~, '-"t•lillo.T10~10A/[' ~- -----=---"-=-=-~~~ "" ~==---= _ ~~~-0-l')n Check ' ~-:;:....)r--;:.-"-' .-fi I certify th<.H I om o;cornpt 1rom Section 7031.5 of tt1n Gu!;lno-:::s nnc1 ~DEi1.ll~ FD CP1 TiON COD2 !Pnrrnit . ··.--;;Jf('"-:"5) 2 -:;\{ Pr'Jfc:;s:onnl Ccc~o., ~ivis,~o~ J, t;hra1tt,- 9, C.ontr-.[Jctors' Lic<:r.:;o L<Jw. -r ------ --·r ---- ------r--- ~- ____. -------· :.I~ ~· undor thE- foi!OV'Jint. ..-Cct.un. I I I llo<uancu ,, rf CP !i Ownor: soction 7044 D ;J,nn~ worll """'''" ~;100: Section "/llu8 r l
, "~ '" :,.; ~-,::,.,.: .. ~ .. : .;;,, .... : ~ ~; .. ; .. F =;;:;:=-J ... :~~~17tt~":~f ~:·:~~~~~~~;~;~~~ .. :;.;:;;.:~;;~~:~~·:·.:"'"· ,,, . ,, ''' rn'r:~':'=_:':_':":.~:,;, :ocrmit -:,ill b'> nu-Uc~:~J " r;( 0 Jl;<c~~~~ ~{f,(.5~/}l:; ~~~~~~~~l:~::::;~;-~'~ '~:Hf,: ~~i<-~t~~~~U:;L '2._r:_:~~
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CITY Of GARDEN GROVE Public Works & Development
BUII.Dii1G PERMiT Inspection Requ.,ts 638-6771
Gttner .. lnfow-rna'.ian 638-6661
P.c. #" lt.JSI>ECTION RECORD _!or Appli~nt to Fill in
I OCCU r- ' Hl J OCC FIRE ADDRESS PANC~- :Z, _T_VPE!.f..J-./i LOA'o -- SPRINK. APPROVAL DATE iNSPECTOR . _ Of '/}-''
!Ius;:;;-:::::> I c• ·"' LO>T GOGHT .... 7.A«i- "'"''"~"' o. oa ZONf( Lt.O FOUNOA'1'10N & LOCATION L~T~ULK ~frr .:: ,_, fCWMI_f-. ;.
FIRE ..., Eo;1'•oj. - /31-C:>s-l-0/ -.11 I I e-p ~A ZONE.~ SotUGck.u owN Eft ------ J. T1tl-:H'"o-:-· --~ PLANNING ;{J_ J :2 .-,/ ACTION {I t(t(} / G ~- /10 FLAN5
, D
~~~~~~~~-- ---- ==.;~= ~q=-~2)-- ------REMARKS: v __ --ciiY ____ _
ZIP
--- ----
SMOKE DETECTOR Y~tiO. ---TcrA'T"i:: uc, No, & ·npc --- --------- PARKING -- l
G.G.SANT.£.-~ fo.C.SANT,OISj_~ "jtiii< I'HmAL ~/\PING ----- +-=- VALiill•'iocu'{-7-::t¥~ c;p.;;:7,_i~'----~- -- . -~-FEE REQ'D:____l_ l"EE REQ'o. ,~ " 1 0/0cuf:" . = ,~ fr•!?t:~~1- 1 f:
1 REQ·o PROVIDED /) 12 r LoU~ J...p.cR'ru~.: A1P /4..~.- i::>, ~2: '?~2
1 PAACI:l. MAP 8;·- --p--· • - .-,.-RIW o~:;.~A-:;:;-;;;-- -------- --1----- LANe usE FINAL ' /'?RPZO~~&~f Co J. ~ 0 ~·:1 I
i ., I· / .. c;--~- co,.T.nfcwn ~\"'f. t:.•. c:JU I FEES AND BONDS FINAL .. LE ,.,.._tj)· "C??- r:t..u=o~ · ,r,. ·*"·? c.2
r---------- ------~~-- -------- u-luTv RELEAS~ -----J - ' /7( ?I M7'/t:-l'fi::L /!?ldiJ'J - · -·
1
,- REV. C.JDi:.: . AMOUNT 1
~ MA'ia.ING ADD.ftii!J!J CITY" ZIP' -~~ ~. ± - IDENTIFICATION CODE ST. SCND t---·
'·'lATE~:~~- -= --=- --~=- --- I I l "TIZL. ~o. 1 STATE uc. r<o.
~R ASSMT. FEE !ACRG.l ~ I WORKER'SCOMPEN5ATION RSQUIREMENTS ~A_ f.;fj 41 {,§ !-:::-:;------------- -------'k--h- StotoComponl!!ltlon oi<f J""l) ('-- .... L !PRESENT I PROPOSE:D
Wt>.TER ASSMT. FEE {FT.l I Insurance Polley No. "'1 expiration Oato • .fo'V'-1: I BLDG. USE BLDG. USE f----- -------- ---- ----- - - ---+-- ---- 0 I certify that in tho perform once of the work for whocil tills pnrmlt Is PARI'WA y TREE FEE t \ iss•md, I shell not omploy any pon;on in any manner so ea to bocomo DESCRtBE WORK
' _ _ j subject to tho Worker's Compan•otlon loW$ of Calllorni;: TD.BE DONE 1 1---------- -- - - --· -- -- - - "\ - -- NOTE: If I aft or mnk lng cuch corc.:lflcDto, tho applicant for tho permit . . . - •
PARI< C1 1-lEC. FEE {DIST I \ r.hould bocomo oubjoct to tho Worl<or'o Cornponoatlon prov<olonr. r.-1':··,r.1•'t£.<"'1_,...1L 'Up• _r.:l"/f,'"1m-; ---- ==l \\' _j o1 thic codo, hooholl forthwith complywlththoprovlslonaofSoctlon J.~VI r- ~~-- ~ &JL_JJI_ li_~----~ .. ----~------DRAIN 'SS""r FE"' { 1ST 1 , '%700 or hi~ permit aholl bodoomod rovoltad. 1. -~'1 ,.,, · ~ D · , I certify thot I ha•1o rend this oppllcotlon and ctoto thot tho obovo In· NEW 0 ADD'N 0 ALTER. i7l RO:PAI R 0 DEMO '-ISH 0
----------- - -------r'~ formation I• oorrcct. I ogroo to comply wltlloll CitY ordlnancC3 and .I'\ '..l ~toto lowe rolatlng to pondlng conotruct!on. I fuother ogroo to hold 1
_ ___ tho City uf Gmdon Grovo frM and ilnrrnloll! from any lloblll1:y arl&- FLOOR AREA . N.D •. OF. . JNO. OF DWELLING -- ing out of Injury or bo<lll'/ damoaa rc:ultlng from work performed
5 F /lo' STORI~" /
IPLAN rlETENTION FEE rc:lavonttoth-loparrnlt. ~- T.L::-.. - ... --- ____ , ___ ':::'~~ UNITS I r-------~--------- '/7.--.. , c::::vJ/, ~,..,_,_,..,.._, /(!-- ;J- "7'l:___ If work io not otart~d within 120 <lf>VI lrorn <!•to of itsuo or if !aLDG. PLAN CHECK "C 2-C l j 2 ·7 2 vnRMI PPLic ~:miNA'V'tuu& OATI! abandoned tot moro lhon 120 dnyu, thiA pormJt will bn null .:md L . ·.) 1 BUSINESS TAX CERTiFICATI:: !NFORIIQATION void.
!sLoG---PER-MIT. FE--E----- -~ "'~' ~~T r. I certify thot. tho following Contractor's Llcensi. No.~-~ .-,A,_.,F:-:E:cE::-:M:-::.-:A-:Y:-:B:-:E::-:C::-.bARGED-F.OA~AE--INSPECTION OUE-Tc;--
~. O"Cfio u on!!,_Cio::.•~otlon ........- lolniullforcocndoff<>et. _ NEGLIGI:NCE,INCOMPLETEWOAK,ORFAILURETOMAI<E
- . t?.l?eU"f Uh#- 1CfY<c'»1:<J.~w,ll .LiLJ::..?..Cf_ coRRECTIONS. C£ (.-~-- ) ,-, (FniNY) CONTRACTOR {flroNlTunal C:ONT~ TOR- DATil -------------· -----------
------------~ ___ .;>_:::>_') { v 0" AUTHO~IZP.P AQ NT RELOCATION r ~j,C_G,l)h'~Hl-t·-J-_~ :·-------·l--------, --- r.•t'lJtrHZDfl VAX CCnTIP"ICATC NO. CX.IPUIA.TIOJ'I O~'Jf!t 1 . ';_ ~, TO}AL i c?- r, 7 ' curtlfy thot I om exefi'lpt from SCJC11on. 7031.5 .of tho Bu~lne" end PRES EN~ BLDG, ; ; ',-~1 ;, {: · f'.:ES .· ,J 7 (...) .;;_ ?rofo,~lonnl C!>do, Dlvl,lo~ 3, Ch1pnr fi, -::ontrllctora' t.lc•nu. Lnw, ADORES_ , , . ,,_,, :_,r I under th!J folfowlng Section. ---~-------·- ----------f·"·--.:_ _______ ,_<---~--~-~--- ---- - Own•r: S~>ctlon 7044 0 Minor -.ork un<lGr ~00: Sot;:tle>n 7048 0 f."OVING
l f'.':..IT~W'I~ZLU o·t - Pfi.'J"C Employco "!'~king faa~~~ only: Soctlon 7CO.S L.i cONTRACTOR
/) Other: /,;;.~= r'i.'(.'-'~1!):-..2 ~--------- ----~---! .Y-; -1 It) -1-7 Cj I - !L .......___ A- ? 77 . · /:;JY • / (PrnN~·• PRQPORTY owNsn t:JIG~ATu~~:cl ,.Fil:oP.-nTv owNcn DATI!t ADDRESs L;~---~:~-:.:-:_~~·;=:c;;('--~~---- ___ , __ ~ owA<JTHon;:za?AG&rtT _ --... --~~..v-;,
·t~'l t'wlttinn ln~p./ !;';.:2 ,1\r.:rn::~ntn/q.<:J. P>Jtmht!::o/~.~~~ hl1~ ~ .onrtily tilt' <nform.ltln.l ileiiiOil ito (;umplntn nnd c0crrcct. nv
i": '~ en·~; .Qf! J3Ai:;~DEI\i GROVE
Public WOrk~ & Deve!~~ment
iNSPECTION RECORD
PLUMBING PERMIT lnspectiQll RequeJts . 638·6771
0.Mflil Information t/38-6661
r_· ·-~,;-l'l_O_V_;A.;,_·-L-S-f - •• -T--E---...---_-,-N __ S_P_E_C_,.T-O_R, _ _,_TY ___ PE_O_~_F_I_X_T_U_R_E_,O-R-,T-E-r-- ADOR~.-_¥ .. ·_:.- n - - '
! -, 1 ..,. - ' 3 ·1 '(S "iJfi Water Closet (tOilet) . ~ ·"' 7 :;J- il~f:~-rJ • ,_,n1 ~~f{ung. ,._, h. jlJ{J ------ ~-1 ~· I} '\· Bnth Tub . t.o'l' rw.--·--.,,_;1( rl'O.-,.-tlKF.rilrf~--:ru~:-----:---
r~:~:.d P'umbin: 1j --- --- Sho~r -c:---=~~--~-. :~ ----- - ----=r-; 13' I • 1- ~-,- • 0 l ( ~ . ! I ~ A c A "" t.
L-~- __ ___:___ ,:_.....; __ -------. _________ , Lavatorv !Wash Bas~nl • ·_..y /' .,....-, , ___ .... L f.P..;) 1 ·
i. Fl~'~:ni~~~~:nb:: ___ t~-=IH_" 0JL.: - P .!Vr.-j -----·--' ~~:~~~----·---t
t------~ -! ~'' \~~~: __ , ___ ~----~--- -1 =------- -1 _:-; -f""'"" ··:)"'""'"'""":-~1··;;;;1-- rr>t>JM<c~e•u"oTU ~
'Se.~·r 1 j c-:;:--:----·-··· --'-- r.~--~--1,___ flo • ~ Drinl-<rng Fountmn vAt."i.liA't'!oN ,.....,.......___-- - ~~----
r~-~:--in-!1roi~-on_d __ l --------- . Urinal r----- ----~-~~-= o ...
~::::~~-~- __ -· ----- ___ Ga~ S~'stem- Outoets --,- 1-:--o-_l __ ------~- ____ J /1
L~~:J~~ r-:c.":~-+--- -t----- ~~::::_:::::J:::~::;J~, --rt ~ dJ~!.:"g.osh j Building Sewl!r (ea. add' I drain) -~ ---, ___ .. _ l" ____ ------~----- _
! L Rainwuter Drain -1 ADtHB!US f C!l~}J rk·:JNC ~U.PJ,... •-------------- ------------· ---------. ----------------- -t---1 -- /2 /jJ I II // _t _,,.., k .,.. ! L jSwimmingPooiPiping
1 ~ · ~ F!CJ rv_ ,.,f,.-h ./ ~~ /nrl ~ -.-vPV
•>:Jtcr LatryrJI 1 ---- ----------~f.--- .· ~~fLLLfiJ!:.~~J:k CA ._'h-
,- --- ·------·--- ·t· --1 -----~~::~:~~~s~i::~- - ---; _- WOR~ER'SC~PEiP!o ~~if~E-NT?<S-- ----
. ~ ----- - · --- -----,-~ StM$ Complilno..<loo ,i_!l? {fa~ .6 · IL> I'J}; •-~---- -- ! t =ft_~!~~-~?_f~~~s ____________ --- -- : ln•ur•nc•?ollev No.t:a::..!ID E><plratl<m Date "/(./77...-'
I B.:!ckwash _ T.-=0 1 0! ctr~ifv 1hntlnthepwrformanr;eof:..h•wrukfarwh1ch thitpv.-mlt i~ I --------- ---- _ , .... '--"'- •Mu.ld,llh•~fnotarn~li)ynnyp.-sonfnnnvmf1n~er~o•s;tobacomo
•• Vater Lateral l DUbJ~.tt to 1r1c Work.er't Comf)etntation lav.ts oi Californlo. ---------t--A-y-_+ ____ ----- --·--- -~--------;----- -- - ~ · ~·- ~~~-- 4- --" NOTE: Jf, aftor m.:~king such eertificate the applicant for the pormit
. ~~ ,(Y;:;, , _Back flow Pro~ect.ve Dev1~ _ ___ __ l____ __ _oho"l_d become •ubjuct to tho Wcrkm's Compen.atton provisions I f • --" I Water p1p1ng (ea. 100 IU : oft!»& codo, h" '"'"II forthwith comply with thoproviolons?IS~ctlon , ---------,--~--+--------1-------- ___ · _,_ ;l.'i'tfil or hi~ pormlt shall uodoomod rovoked. ·
!(\ I _j~- Lawn Sprinlders (S.F.D. Only} I . t:::r'l certify that l hii!Vcr""d tlli&appllcationand state that fho <1bnvc lr<-~ ~ J I - - ··-f---- ·-· formotlon b correct. t cote~ to lt"cmply with oil C'tY tlrd;m~r.c•t:llmd
l\J - ; - - -- -- - ~Lawn Spr•nlderc: (other) t ! Gtnto lnwl rolntlniJ t::> ptmdin.g C(Jfl:;.tructlon. I further ~IJTCO tu hold ~ , /j I ~· - - ----- . - - · --- -_ . -. -- ~~a, ity of Gordon G.(o o free ""d llarm!o" f"om onv llcbllltv orlo-1 ln,'lt t uf h'!jury o bo lly <l~!ll.IIQO nnultlnij ~rom WOl'k perfurmcd
~----- -------L------- ---------- ---- --------------~-- r, '" n t t I•P•r :_....-~1};.//\,ln.- /.1-"'..?4 .fJ'J
~-~ ~~ I I + ~= ~=~=-==::: : -: r= ===t-=- - " e:c,,.,.,~ v ~{.::.JL -~ fil'-l~.L ~--- C),!J t!JI Lc~-------=-------r-~---------~-~-l-----=:1 ~·~ __ {~-~---[~ 1 '!:7 ITEM ~ coor= ___ ·---··- -~-~~~ .. -·--· J (PRlt-~YJ <;:orn"AAC:'tOtr -----~(-;!~:1~·;~-u~;;--; ::;b~i~:;-!0CO. j I Plan Retention Fee i ' · - - .. -- ------- ------.
OATil
I :_~_:~-~"~------L- - Plvn C_h_c_c_k----~---T-IDENTJ!'!C/I,TION CODE Permit ---------. -----------:- ------T. j ---I .lslu;,;;;.---
-;c;;ic':';-;;c-·,,;;:,~,};;-:;:=~-c;=-;:,."-· ~:;Tiii;;~~~;~;-;;{;-~ .. ~-;-:=·.:~--==:t-L__----------~~~~~~~-~~~~---~-0-T-AL fEES ; j AVIUOI"H:':CD UV
j f : . .1\f•H) Uf;c:·-~~ £----~~---tJU~LO!r{:iG• ~OATf:.-
•---;-~"• ~c~;~.:-~-~---~·;_~f.~~-;;-~~~~r t·? j I f'\ F. c;r_.~
coy,, tn"-~""':'''~~~~-=,lcrd _j ____ ·---~-~-L-~1fljiL_ Q· ~~ ~_0
CVUINI:tH1 TAX C::f;!:l'l'I"IP"tcATii"F'if.,7"............... c.:;:::PIRA'l'IOrl OA7C
~~-;;;;;;:-.-,;-;vm;-m;;;- -~;,~~i~'~ji[:?;i;'i~i~~~~~-;:,:;;- ·~-;;;:;;~-~~ ~ ~-MAY~·ur:-c-.:TARGE;J~iit:~~i:flf~_,..Ti:h~;1Ln:-ro I f~E{5~~~~£f-.!t.;C~ ,,~~._.,{lT\.'lJ'! Fl[' •N,~f'f-~. r)f.{ f r .. ILI!P<.: Y() .'itl~E fl
~:::-:.::~~~::~;~:....:~==:~~.:~~~j
I C!Jrttfy that I arn cxemp1 1ror.l Suction ?031.G of ti1<o BuninC!J c.nd Professional Co~e, Divi&Iol"' 3, Clloptsr 9, Controctors' Lkansa L::.w. under the followlno S<~ctlon: Ownar:.Soctlon 7044 0 .'llln~r work undor $100: Section 7'l48 D Emploveo wnrkis,g fo:r \t"illQ~ .. q,:,y: so:.:t?:Jon 7053 0 Other: ______ --~--·-·~· .. -----~·-~-~---~-----
I
CIJY 0~ GABDEN GROVE Public W~rks &Development:
~EATING, VENTILATING, REFIUGalATUlN ·& AIR COND. PERMIT
lnspecti~>n P.eql!!etti 638-67n
#60F
Generr.d Information 630.6661
liiiSPECTION RECORD
r~~
1
DATE ~1-.;..=..I_N_'O_!'E_C_T_O_R·-.. c---·---~-~-P-E--0-F_F_IX_T_U_R~_OR~:~--~~ SA-1·. $~FEE
I'''··········--.. .. r-urnaceto&incl. 100M O.T.U. r--J- =~J r 'URNACE . . I ____ :::.~::;;:::I:::.~~~o:a~~J~----· --r--r---t-.t-· I FURNACE VENTS f---·-----··-··-----·--
~ . . . Installation or Rolo~~~!_~--~__!_.~_u_cp. Heater 1 I ·- ~---· -·~-·" - I i . . ln~t.111atlon or Relocntlon of Wofl Heotor
GAS PIPING _ ~ ~ ___ _;.,._______ ____ tnstullation or RoiO<.."'tlon of Unit Heater
~, - ___ ::.=:-... -- IJ t'"" /) /~~~ ll"lstallation of ApplioncG'J Vent Onlv
UCTS _,! . ") ... ,;:;-} ....[..,.~I ------ y.__~.:__'. .. ~'::""--- -----+----- Repair. Alteration orAddi
s 1r~GLE DUCT · ~ Heating or Cooling svstom
~AN Vf..:NT Incidental Gas Piping ---·-----··--- - -- ---- -- ·-- - -- -- ---------------r----
Ei1C.. Aango Hood Incl. Duct and Fnn $ KITCHEN HOOD ---- · ---·
-~- _______ I_ _ --------- Eoch Vont Fan Connected ~~~Si_~!JI~ Duct _
AiR t·fANOLING r Eoch_ Vontiln~ing Sy~t?m .not <J P<lrt of il ur.Jti' Heat1ng or A1r Condlttonmg SV!Itorn
FEES For Applicant to Fill in ADDFl'F.$5
----l[~:nw CUILDING 01< [I><IGTIOf> ~UII !IIIII> ADDoTION. ~ AUCA ~Ci:MOOCL AnHn
---- - !)Q.I'"T, OO."T. ~
--- --- VA.lDA~--- --
__ • __ £__
Tenant Improvmr•unt.
. +--1----+-----11
7472 Oran~ewoo_~.'- ~ldg. ~'1hlfr4.-;e-t-l.. LOTNQ, DLKNO. Tf!AC<I<Ol--- " r-.-.~·-.1_._ ~-~-~
-·- rON2< OWNI:!R
Shendn Williams ------------ C&'J'V tn•JN~R'"iJADDRI<!fJ!:)
7472 Orungel·JOod ~ Gurden Grove
EVAPORATIVE COOLER
eoa"Li:'fi on COMPRESSOR
-------------~ .. _ ----·- _ ~!_!h.ooccri"-'"'"d::..::b"y-'P-'o:.:.r:.cmccl.:..t -------__ _
I. Boil~r or Compressor to"' incl. 5 Hp. l1 5 QQ ~G CONTRA~······'---. :J:'i"A1'l:: uc. N.O. l?.i TYPi!
---- . - --------- Ah'iorptron Systom to & 1ncl. 100M B.T.U. j _ _ r----Boolor or Cor.1pressor to llr incl. 15 Hp. . -t-- t----- Far West Air Cond. I c. 312478 c-20
·j-----· -- ADORttGS __________ .. ______ ~ITY PHONE
________ Absorption System to & incl. 500M B.T.U.
OECORATIVE APPLIANCE
Boiler or Compressor to llr. Incl. 30 Hp. 1403 East Borchnrd' Santa An 953-695JS f-"--- - 1--
----------- Absorption !)ystom to~ tncl. 1MM B.T.U. --- "''"~......_ ------
Boiler or <.omprosoor to & incl. 50 Hp. ., c WORKEfl~CCOM2P0ENi<LA6T810NlR0E0QU818R4EMENTS3 2 5 80 ~- - ~toto ompansntion - - - 3E - - -
,------r-. --------- ____ ·--~----- Ab$orption Systom to & incl. 2MM B.T.U. Insurance Policy No. ____ • ....,"' ____ Expiration Oatu-,---..,-,-
1--· 0 I conlfy thot ln the porformonce of the work for which this permit Is Boi.-ar or Compressor over 50 Hp.
r=· t------- _ --t---- _ --~-;; EvaE?!a_t":_e c':'.IJ~".'_- ------\--+ t / ~~ Handli~~-ll_n~t-~o& i~ 2M C.F -~
___ _ _ __ Air Handling Unit to ~~~-~_:__~'.__OM ~-~~-M. ____ j___ __ --+--
---+--
... __ 1 ~ ~andling Unit over 10M C.F.M. _____ _L __ _
-- i ----------- . ' ---------~~----l -- ~~~n~:~~
f. NOTIFIED I ~Pian 13~e"t'o_n Feu __ __ ___ _ ___ ~-Jr--l~--- . Plan Check
I"-· ____ HDEr:l._T_iF_!CA'!IOI\l CODE _ _ Por~•t --- ------ ----.;Jd)..a ___ - --n I 00
[ ·. I. .1. . ... . J ~--- -~-~~u~o~c~----- --· - - --5~js:______ b! UU
---
Issued, I shell not employ ony per~n In any mannet" so as to become subJect to tho Worf:ar'o Componsntlon Iowa of ~llfornla.
NOTE: If, altor making auch cortlficnto, tho oppllcont for tho permit should bccomo subject to tho Workor'n Compensatitm provision!O of this codo, ho tholl forthwith comply with tho provisions of Section I 3700 or his permit tholl be doomed revoKed.
0 I certify that I havo r""d thlo llPPI!totion Md """'~hat tho obovo In· formntlo Is correct. I ogreo to comply with all CitY ordlnonc"' ond Stoto lo· ;,n rolotlnu to pondlnp ;aon ttuction. I fut thor oaroo to hold tho of Gordon Gr vo.;;fco o ,d hP;rmlos;, from onv l!obllitY or ln.-In ut of lnJurv or b ~trv dn ~•oco u1~ultlno from work porformc.d
a~t01 I per ~--? /
.. · ~ 3-10-80 P'fH1MI"r l l,; C GINATUHI! DATU
/ BUSII11ESS TAX CE 'TtFICATE li\IFORMATIOr~ I certify that t~e following Contrector'o Llcenro No.·--------ond Cl&ooiflcotlon lr In full force er.d el!e.:t.
(PRINT, CONTHACTOA CD1c::4:3~::gA.~g~··~~tfJf'" 01\Til
DUtJIN:O.:tJtl TI\X CllATJIPICATI::!. NO. 'ISXPIRATICN 01\T.::
I certify that I am exempt fr"'" Section 7031.5 of tho Busln<m ond Pt'Of~sJone; Code, Division 3, Choptur 9, Contrar.torn' Ucom;o Low, undor the following SectiGn: Owner: Soction 7044 0 Minor work under :1>.1 Oil: $8ctlon 704D 0 Employee worklno tor wag® onlv> Section 7053 0
Othdr'--·-----·-··-· --.. ---- --"~-~ ~~-. ----! uu~~lli;f,ii'-r··w,., [ q.cc-vniC"PWM;:yH--;;;:----- TOTAL FEES $ 171 00 ! AU'I'HOH\l.t:.D U 'r --..- (Pnlr.J'fj PnCH'I:l:rlTY OWrH:n (!H~fU\TUhG) P!1C:~I:nTV out--.H::n 0.:\'i'E:
_______ j__ -·- --------- ·-· ·-c,;;<;:; uoc ---·- --r~--- ou~NG -~;·f;:/8'6 ~EciC.~E~~~ ~~~O~~~J\9£::~~;;m;;.;;.;:~~r,r~·N;gu~~-~i .. If -.::1n:rl~ !'1 not ~n:,.,ncd wi'f.hin 120 <Joys from dato of 1;::-.uo or i :1 r:~-~:~dow;!J fo::- moto lh<J'i1 120 th:::ya, thi::; permit v•JiJI bo i r.:.;H c1.:·:J 'J-Oid. .L.----·-----...J.L... ___ ?'ff_-ii-fiV-[._----'-'-"" I CORRECTIONS. _,_,_ ;;, I
OS.O.OQJ~'!-4:1
.. , Cl"tv OF GARDEN GROVE _.ptlbtic'Works & Oev91opmeut BUDLD.G FERMIT Inspection RlqUtilts
638-E771 General lnfOI'mttif)('\
638-6661
P .. C .• lNSPECTtON RECORD For Applicant to Fill in
loceu ]?~---- occ I'IRE ... ------~ ~ PANcv J2(1(._ TYPE LoAo SPRoNK. APPROVAL DATE INSPEC.OR _ 1!.1 n•~i-,.._ --- -- /. '/'-!A J ~~£ . Fr...'NT LEi'T RjGHT REAR_ FOUNDATION&I.OCATION .LO' flo, ~ ~~~W~Q • .:,. -
FIRE EavPro). ./J //A '\ J~ J '-~ ~~ I ~·~lOlA ZONE Sotbock• ... ? l l v CONCRETE FLOOR owNil:il .. :: _ _ '0J ,. f ~> .. ~'d • REINFORCING , • •
PLANNING 7fT/ni'A' (}( RooF SHTO ~h.uroL.J.t P. ~ . SS-.:J.~(d ACTION ...--.... 1 Fl:.z>.'!IJS" I ----· MAWNftS'i:uu;~s ca v -,-,-P--
C '·All D:~A-rE (;ROUGH FRAME j':J,/'7< 1J'O j~ ,. ~"Wo~~~ia-' J.-'\ c., V i ~-TION, ENERGY ~ ,..,. 215'L-L'!1!~rm.--JB__IdL:iJL..------~-~---'" -- // T 1
· - ~ ZF 07 DRYWALL 'J/'•J'7,1'~ t::/a1 """'"L>.RCH - . REMARKS: {I' !'-----'-- ~ - 0 ENGR. -&r- !1-Ai:i'..t.') ()/(C) /'10M i PLAS. DRowN C:T. ~ ......_ rt.~AJUNG A0Ri?!lrr ~... .. t;ITv ~-~~zvp---,
~ --SOUND INSULATION f--------- 55 GU. ;)..
~ . . ::~~::::~::TOR • ·---- :V~A:L·I.D~Ao~-oo····,.··"~~~-~---lSTAyguc.r:~.~~~~•~-----~~~ ~~ I
DATO ONOTOAL o
Q FEE REQ'O. _l_ 1-nr.>L •••...., ~.... 1 -.,-... •• .•• ~GG SAN (I.C,SANT.OIS.I ,__ ..... \ I.. .. ... -.- ._
. REQ'O PROVIDED I' • ~~ "Qi&l \A'Af.l. 'J. .. UJ!- Z,O I PARCEL MA.P ' -
f'!IW OEDIC~TION LAND USE FINAL 1 ( ..,. 1 ~ t•.L y CONTRACTOR --o Fees Al\lo soNos FINAL .,._.61 -n IG~V "A ,.., f.::P.EI':l?J
------ ~REV coo~ AM-OUN.y:-- U1JILITY RELEASE l-f ':&--~ ~J'- ~ 1.1.1 c:c.N.•rT , u. MAILING ADDRE'"J.S CITY Z~P
;_ --f-·---- ----~~ ID r IFICATION CODE "' -. ST. BONO
I-- -------1-- 'J [ l l I i76't/ Ell li.HI!LL. &It! TlliiJHri. WATER BOND /- EL.. NO. I STAT£ LJC. NO.
WATER ~SSMT. FEE (ACRG.) *- WORKER'S COMPENSATION REQUIREMENTS t:iA-C/-A-~ - s~., Compensatlo.1 I PRESF.:NT I PROPOSI';:O
WATER ASSMT. FEE (FT.) ' I ranee Polley No. Expiration Oatil _ BLDG. USE BLDG. USE --f-----1---- -' -- I certify that In the performance of tho work for which this permit Is ::z:::t{ /)'
PARKWAY TREE i'EE luuod, I shall not employ ~ny person In any manner so as to become ~-ESCRIDI': WORK '!""' -~f<_:l.__ .CJ!r:l.IJ.t 6< 4->S subject to the Worker'o Compensation laws of California. TO BE DONE ~
I V --- NOTE: If, after making such certificoto, tho applicant for tho pormit JJ ,.,.-r; !PARK & REC. FEE (QIST. l should become oubjoct to tho Work•r's Comp&matlon provision• '·, ~ D Jtt_ tA/tJ J.-.1; 0 N /V!FM L ;;.I(; f)$ ~--------- _ _ _ ____ --:7· -+--- .. _____ ·+-· _______ of thl$ codo, ho shall forthwith comply with tho provl~lons of Section ~ .. 1 ('C' ' 700 or hlo porml' !iholl ba doomed rovckod. I DRt.IN AJJMl' ·FEE (DtSl'. I ~<ortllv thot 1 havo rond thlo application end ototc that tho obove In- NEW 0 ADD'N [J AL TEr:t. J~ REPAIR 0 DEMOLISH 0
/
~ h)Fmotlon Is correct. I Bj;jjree to comply with~~~ City ordinances and f:iiJo Stato laws ralatln9 to pending connrucdon. I fuvthor aqrqg to hold --- · ~ == ths Citv of Gordon Grove friH! and hormiGIS from or.u liobh.•tY arlo- FLOOR A~EICJ• O. OF INO. OF DWELLING ... · - .. f/ 1 lng out of Injury or bodily d•mage resultln~ {rom work i>erformed (SQ FT' STORIES U"'ITS
PLAN RE"rt:;NTION FEE I r:.lwanttothlapo.-mlt. _ · '·'- _. --- " ------./~ ~ ..2- -2 j, ~ If work ;s nor ntsrtad within 120 days from dote of lswo or if
I BLDG. PLAN CHECK I .~ J "\ J r;.-i v PsuMt;v£~5iTif ... e DATe: nbandonod for morG thun 120 dnyt, thfl pormit will bo null and ~--- _____ I ,~b) fCJI-i £) / BUSINESS ~X CERTIFICATE INii'OFlMATION void.
; I certify that ttoe following Contraetor'o Licenll8 No. A FEE MAY BE CHARGED FOR RE-INSPECTION OUE TO BLDG. o>F.P.MIT FEE 2-2& o<.o· t-30 and Clanificalio io ;n full force and effect. NEGLIGENCE, INCOMPLETE WORK, OR FAILURE TO MAKE
CORRECTIONS. ISSUANCE l "5'b.t::.. I- (J7J (PRINT) CONTRACTOR hiGNATUfU%1 CONTRACTOR -----;;-1\-:;:;-- --·-···-.-- --1=-~~.:.c:oo~--- _ W f.ll OR AUTHOitt .. t:> AwENT RELOCATION . 'l}AL~JATIO~J dff.J 1 1 I at,UUNtttn:: 'TAX CI!UlTJPI~AT~ r-10. !!:XPJRATION IOATD
f . ·~ I TOil'.!.. , I conlfy thut I Gill •~•m•'t from S<>ctlon 7031.5 of the Buslnen ond ~RESENT ~LOG.
f* I r-7 0'1\ FEES I <p.,Q /7 Prolcnlonal Code, DMtJon 3, Chapter 9, Contrecto11'1' Llcsnoo Low, ADDRESS
1 Q U l/-f undor~~efollowlnQSe_Eior>: ----------~---· ____ -----------1--i cc-c~.,.,.,.-· -i- ~ · ., ------- _ Owner: Sse~lon /044 U Minor work und~r $..100: Section 7048 0 MOVING
LAVTHomZP:0 ~v OATr: Employee working for W898'i '"'lily: S.Ctfon 7053 0 CONTRACTOR
~' • Oth•r: _ bO:I<faJ-.41-f:/?f!U . , ---------------.._.. - ) ,.,., _.., 1-t:?'J • ~.,.,.. Zii ~I i'<{m·~"'~-.... < ..... : 2.-?L->:&J I ~ ~- P. ~ /:;JV {PMIATJP1toF.IUtTV OW .~SlUt i.tGJ.ffl.'tmtal rilt:~~i",-,. '.f~_.,;· ~. "'T•P,OORESS ~ 0 .. IUI\'1t0ilttZ:1!Q At•,..'•• ----'-----------------------------"" ~~,;:;~..it~?.::T{Jr~. ·-- ~ .. ----.. - ... o•ofi97•-,..
=---~- ·----~---
.r------~--------------·-------------------------~~----------,,r
!
[, . ..--·"-
[
l
---~--~=J
Bv ...
CITY OF GARDEN GROVE Public Works & Development
INSPECTION RECORD
. ELECTRICAL· PERMIT FEES
EA.
ln5pection Rcque:it$ 638·6771
VOLTS ~CONDUIT Service Meter Single Pha«J Garoga, Roold. IM) sq. tt. I I I • .. ,,.,-..l~'·'~'·'l~·.-·•
DA;;---r INSPECTOR ~orvlo• 11.1Atu: ThrAA Ph•.., JjP. I,.....,N<-'r<> ·-- I au~ .. ~ I
State Compensation
tJ'~r~:i'2~f~0~~ca~~~h-.-p-o-rrormiO~'i-af_t_h;:;r;:~t:~~ ~h~8h-t-:-h-is_p_e_r-m"'i·-. -,, issued, I shall not employ any Pi\TIOn in anv manner so at; to becomo subje~t to the Worker's Cornpltn!atfon tawt of C111ifornia.
NOrE: If, after making su~h IC(lrtlflca1e, the applicunt for the permit shou'd become subject to tho Work£"r's Compensation provisions of this coda, he thall forthwith comply with thop:-ovislonsofSection 3700 or his pormlt shall bo dc!lmnd rovoked.
0 I certify that t have road thl" application und Gtate that tho obovo in·
Sign Hookup ' Stato lows rolotlng to pondlna conntruction. I turthor auroo to hold I I +~ -----+~---1 ~motion is correct. I agree to comply w·ith all City ordinances Dr'ld
----t--·--------- ---------t-·- . . . - tho City of Garda fO''B froo and harmav,., from .ony lloiJilltV orts· lng of Injury r bodily domogo rcz:vlt;no from work Porformod
re to JhiG , it. ' .A:_?i.JJ.Q_ BUSINE TAX CERTIF T INFORMfl<\~ E
I cortlfy that tho fOII~W~Ir;g Con ctor's c nso Nu. ,·!)c:;_j____ "-"d Cfanlfication~ • • In full .-a'!P effec;;.j ~ /./8 fk. ,,
t'<~~ ~\U_ ' ~ CPRJNT) CONTRA<. TOR (sg',t'!~~.:J~L ~-.TRAC:TO ~A 1:
OUtiJNI!~S TAX. CERTIF"Ie:ATE:: f~Q, I;XPIRATION OATE
f - ~, i ( ~ I' '~~ ~ R~an ~necK I ~- I :_ il I .::- .J- ~r~~~~:~~~~a~~;~ ~7:ir:;~~ f~~~h~~~~~~.7~~:,~;a;tto:~.o ~~!~~~ssl~~
LAN.D lJ5t!
undor the following S'='ctlon: Own~r: Soction 7044 D Minor work under ~00: Section 7048 D EmployeD v.Jorking for WH~Itn only: Section 7053 0
(PRINT) FROPt!:OTV OW':-I!::R y;;c,::~;;~~r;~~~-::;:;o.-c:RT"V C:.:T.i'Hl'j" ~ CR hUTJ-JC~~c.:t:IC.-:J AG!:l:NV
~---::>A1"C.
A---FE~--MAV BE CHARGED FOR ll!::-iNSPJ;:CTIOt< DUL~TO NEGLIGENCE, INCOMPLETE WOHK, OR "AlLURE TO MAKE .£0RBECTI!l!::!L
DS...;"::Jttl',11•711
Underground
Fixtures•& Trim
Service
FI~JAl
ELECTRICAL PERM!T FE
lnspaction Requests 638·6771
General lnfmmation 63S-9661
CITY OF GARDEN GROVE P\iblic Works & Development BUILDING PEiiMIT lr1:pectjon RIH!Uelts
(;38-6771 f'An!lral lnform•timo
638-6661
P.c.it - • INSPECTION ~ECORD f~f Applic;ant to Fill in I OCCU· OCC. FiRE rl r ADD Ill! GO - ,_ PANCY TYPE LOAD SPRINK. APPROVAL i DATE tNSPECTOR
IJSl!: . "" .t I'RONT LEFt RIGHT REAR -f 7.41/:Z ~b.~ [!c.NE/ /t FOUNDATION & LoCATION I n~~&:Klilv. ~r&~~14~U.~ ...... ,T "'"· : l'l RE .....- Eav Pro]. 1 J - J I . / _ . ~ONE sotbatks 'f\j //.. CONCRETE FLOOR _ ..::;?.L__=---f.C7--~
PLANNING (?-(~/--"" .--ACTION p{A~S ROOF SH rG A ,/Z. _,/ . ,/ ~£}, !j;qlp __ ~ ( f d)-"") REINFORCING 0 WNEft -----''----.....1.---.,.&,;._
f1ATE ROUGH FRAME < /5 /~1/ ;c~ "MXi " " o.ru~ ...._,"'-"'"""~~
l~~~.?c~'k~ BY INSULATION. ENERGY .., _, /-io:: _ .j¢1£L_-Afl~~-__j~}L;_N.Jii' • . ~··-·- ----"~"~=LATH OR DRYWALL --=-/ -;r ' .,., - 0 ARCH _ REMARV-5: ? r ~- Q · • - "
t:= PLAS. BROW~J c·r, ""~L~NGG~A-,v.lf:r_-v:u> •. !2/(d§M-aL1i.. -~· -~ ---· • D:flT"U'"?.s CIT'\' l:IP
-------····----SOUND INSULATION SMOKE DeTECTOR -- ~J;jt:li.l>(JJ~;l.J,CC: / AJL!JN.iL---!!/-2:f_IJJL __ _ ____ _ . - ~------~:NO. e.: TYPt! --t-PARKING I ~~:.G., .• sAN. T.o•s·) lo.c.sANi .. :.o.-ls.T l D.T.- l •NTr~~-ANoscAPING ~~/{;,~:5.~;:-.k--~-L~=------ ~~~~-----"~--·
l"_E~EQ'D. 1-'EE _rl_~Q'C.
~L~-~M-~~~p------------------~ FOICATION
_ FEES A~m~o=N=o""s=f==:_~=-=_=_=~==~-F-,N-A-L _
REV. COCE AMOUNT t-U_T_;I L:..I.;.T_Y_R_;:.E;:;L;:;E_;A:.;;.S;:;E ____ 4 :.._ __
CONTA~·------·--·-·------- ~
~~~. co~/ CITY "'p
'/'/.!(. ~--<?_AL_fz_~
I
ST. BONO
1
------- ==-~~.r ... / .- _ l'JENT!FICATION CODE •
WATER BOND y-~: L7_(,qj ,M; J';;J.JLdLAJ~- 'D.J ''" 9127/4 TfiL.-t.jO. I GTATE :.~e. No.
WATER J'.SSMT. FEE (ACRG.) WORKER'S COMP5NSATlON REQUIREMENTS f--------- ---- State Compungstlon 'I PRE:;ENT ; PROPOSE:.D [W-ATER ASSMT. FEE (FT.) lnauranco Policy No. E:<plratlon DDtO BLDG. USE I BLOG. use r--·------ 0 I cortlfy that In tho porformanco -:>f the work for which this pormlt Is ~ --------. 1 PARKWAY TREE FF.E lusuod. 1 shell not omplcv ony parson_ in ~ny manner ~o •• to becomo ~ESCRIOE WORK --r.:tJ.M~-Cr,•./..';); ((.- , K p~r oubjeet to b•o Work.,'o Compansatoon laws of Calofornoo. TO BE DONE ,.. · '' 1.. r----- NOTE: If, ofter making ouch ccrtlflcote, tho applicant for the permit WllJ...f- Ul-f •·1J>TIL J,~/(/1)$ I PARK & REC. FEE (DiST. l :houla bccomo oubjoct to tho \IIJorkor•a Cornponsotion prc;vlolonc 1 \--------------~ __ _ _ of thl!l codo, ho [ihnll forthwith comply with thn provh;lonn of Section _ _ ....... -~·----~~ __ _
..~700 or hi!J pormit nhm1 .10 dcamod rovokod. DRAIN ASSMT. FEE IDIST. 0 I certify thot I havo road thio application and otnto that tho obovo In- , NEW 0 ADD'N 0 AL TEfl. j(l REPAIR lJ OCMOLISH 0 formation lo correc.:. I 119reo to compl'i with ail City ordlnancos ond
i SttJte tows rolatlng to p!mdirg constructioi"J. I further agree to hold ·--------t _L_ thll City of Garden Grovo free and h~rmlou from any liability oris- FLOOR ~RJ;;:g.~ 1 NO. OF . NO, OF DWELLING
~ I lng out of Injury f'r bodilY d.,mpg;: resultiflg from work perlormod 7.:1 . I PLAN RETENTIO~· FEE 1 rel.,•nttoth~permlt. (SQ.FT.)J'...ie:__t-P¥ ~:_~-=- .~:-.arrs 1 g --------- · ~~ ~~L 1£:.. .J. w 9-i! ~is not started within 120 dO\''l from C;ite of l!;!iUO or iY PLP..N CHECK '? T\. "'/ fJ t-1 r w;>irtfol'fAJ"li.#:XfiT BIGHATURC ~ATC!. abandoned for more thnn 120 days, tht!J ~)t-~ nlU \.'\till b. 0 null llnd ----------- <::..... U ______ ";) __ • I BUSINESS TAX CERTIFICATE INFORMATION void.
L pr:. R~'·•HT ~~~ .,-, ~ / 1 . 1 1.---..., f certifY that tho following Contractor's. Llctlnl$ No·---------~ ' m "" 00 '"'"''" ;cOiifT,,>C<CiooN ;, 00-. "· - ·--. -- t.-\o J ""!:;)'()/'\ . e~uCiaS3Iflcotl~n lsinfullfocsanJeffa<:t. {-C...l NEGLIGENCE,INCOMPLETEWORK,ORFAILURE1vMI>.KE f.- l]},ep-7n,A' t"'J.."-'r;.-z--=·~ -:i::::f_:..a:::::_ CORRECTIONS.
~SSUANCE 0'0 (s>n~ON~;i (ll{lr;ATUNI!o eo,_, cTQR DA7rz ----------------.--· ------ -·~ OAAUTrlO l%5"'- .,... RELOf'ATION ! ;;l.l..Jt<;;("·~~· . TOTP,!.
1
1 /)I -h JJ I co~~~~·~;tTt.~·~~~,;;t7~r~~ Sr>ctlon 7()!)1.5 ~~·~~:·~~=~~~~;"'and • --/t 4z:.;~;;;:;, • 'J 0 FEES C:.,. j{ / ~~~~;"tli'~~b~~~~~·gg~~~~:, a, Chopter 9, Conlractorq' Llcen'o l.ftw, ____ ------ ----- ----·· ____ ··-------7·-. · L.. ; - 1 - .___:_____L.___ Ownar: Su~tlon 7044 0 Minor ..vorl: untiu ~01): S<octloo 7045 0 J Au·:••omzmJ ov a,.vn Employe:.~ wurking far wagaJ ontv: S.ctlcn 7053 0
l ~. . /} Aj- { ~ .... OR-c:_j 4~ ADDRESS ------\ T;[ , IUt OAT£ - -- . -----------------------~----------------~~~~~;~----------6---~--------------~~ L E;;:)~~.::~TCI~.
~----------
r '. 1·, l '
Ll.~ l: j
I l --·- ";, 1 ,-1 Ouddmq lc.·,p.( <? A"l"l',or/73 r•crrniUcJ(,7tl r.r-" ~ ~ ~./_,:;_(,:::,: ~ _f)'_tl'j'".:!.:r2-:;:'~~-·-·--- I ccrufy the in·Jrrn:Jtton h0n:nn 1::; c:cnmlr...'tn t~n.:J cmrr;c~. C~t ~·----~ ··~ .. ,,_ .. --~ ....... - '" o t,"':' !r/ LlHl i\f'P';"~GVY?"~uy ..........
~-;.•s .. ~-...~~~..,..--~~-~....,..,--....,.-... =~.,._____,_..~, ... ~-~-~-------·-----~------- --~---
·- :.:.._--.!~...-.;....:..~ • ...o:;;... -··~· _ ........... -.. _.- -· " 7:--:_~:-"'f.!~~"!.~~'!'&.,.~ ~~~-~7~·-':::.·2:i}C--:s, ::·-~ --- ~~-D2~~:Z~~~
CUTV OF GAlRDEi\1 GROVE PtJbiic Work~ tlJ Deve6opmen~
rsn r:::!\"111 ~- 9u· i.f/f1·~ n 111 rBr;r;r.IJn 'i7 ~l..blS~..;;J t.nJU~u-Jl!:, U QU~JuJJU U ln~poctica Ac~uozt:c
63G-G771 Gcncml ln1otmDtio:l
G3tJ-SG31
, INSPECTOO[IJ RECORD !FEtES For Applir;Dnt to Fiii ira ~NGL!o PHASE SEHVICE SIZE TJU(;Tro;::;-- ~f' NOT LISTED BELOW I'IO. c;:A. FE!': ~.;;;;css --·-=~=~~~"~=·~· il
, 1 •. J oEECOOE J ~-A 51 I, --~~-----·_.&.M~--~J?_L_!~ RI~Of'J~-~-:J-,--;--.----- .. i --- :;1_1 ~1..,. r ((_ ()Q J~ 7 _ "'- !l
1 r-n:::J,E[ PH AS~ S.ERV1C' E f.. I LE ( -) :1 \NirP. 1 J <1 V\ilre JUG . l..:-11 Ro ... ld.H1tsol (R-1 & R-3} -Q. t. (/ U • 't) ..... w ~-<:A...c~:..;o~-, '1
L01r" No. --oi.:-KNO.- ·TAA-i:T ~J-tl·~~--2il~0~:.-e-F~n~yiiTfK>:---!! .t-.MPS ___ VOLTS RIG.CONDU!T --~- f-- . fi
01ov~ DATE 1 INSPECTOR ·-- r : /. ,,,...-,;-,,~:~ -- ----" I -- - ----- --l- -- Add'l Meow Thr.,; Ph"oo I 0 ,-,,-N-E-·.Cl-·- -----0--- ~ L-,4-~-~ ~---v---.,.jP~:-{ity_f·-{_j.,_~-_;~~-J"'I'J U11L'-:!rground ------~ j ------~----- ----- - - -- - - I ----l ) \ J( -X . I ! _________ __l____ _ Tompo<nryPowcr?olc
1 ___________ _[ --~--:':~&o__r::._ __ ~~e<:~·/··-,t __ ('?__ I ··-· J
_L ~ I _JOWNt:~.:·s ADDRE"SS \i '"· CiTY ;!
l':ontu1t 1 -- "------ ------ -f-------------~r ~ L_ \ I I J~ I!:) rfi . -~ ---·-- ---.;c-·------ - -. ·r -- --. I "l..u I IV •Uv (? ''-• ,. _,-," . 0 n "l" "
I -;::'J / 6:~~ [' ~ SuhPtlnols3 { it 5 CfV - '\/"' ~- -~--- 1 ' ::-::__'1 ______ '.:,-.1 .. '-:~:.;.... .-!,.-.,....,.Ft~~ .J" L"J<rtnc R '" L; -~-' ;j>,'JI I "'---- ))/ . p ! -- .. ---· ,_ -' N' ,., UUHD,NC au c"'"'"~ ""'W"oo rccueM'O I uct.· N. '_'"""'.'"" A<<c'll :J
0 ~ g t~ ere /5 __ ...... (J'S.Ij (0--7~.--;:::} Outlot<; g ~~ o--{)~1\00irooH Alii A ~~Etllon~ I r-"1 r . '·IIOUI' 0'1 r~UM!~f_l7 <_;;·UP IT:; . -----· ---t~." tl;;~, - . - --_-_---i~- =f-~2 G 0 _____ _:_"" J - ·.o n f..str.-(\ i/ ·--t----- ---- j _______ !F~::ttu~-s.Morc.Ounrti',etc:~~ __ ---~----
1VALIDATION 01/j_G/?§o-·--------------dfjt)[;QJ 18
1 "--TJ 1 H~lator-1\Jot Ovor 1650 W -----~ I r:fn 7P~R 42 SO I :l"tJJ'"' .& r,,n S- ~- 6('...-f. _J:__ ___ ----b.0;;;~~------ =----- .. -1--~~-=-~--J-~----t=JI issN~E ~ G:: on I
~otors-----· ~ • ~ ---{~::::::.~~''"''• r-~ _:r_-:f-= .... '4~~=~::::'";::':".G~:,~:-:i\N::1 I--- -J-- iltomeolic Ran~ or Oven
1 I -r
1
ll'Aoonr:::.ss C!TV • PHONE 0->t :1 ~ I ---- ! -r---- ·- - -· -~>OS"'-----, =-=:I ___ j=L __ l_ ___ ,_ fiA4-5 1..&-'.~St-.H:... 6~1/'Q 1-:;1.&-3;13; f! L---·~- J I Powor P.pporotuo-H.P .. K.N. m j t 'I --11( V.A. 1\.~otoro. Transformecs. etc. . Vv.)RI{Hl'S co;v._.>'t:rJGt\oiON RICQUiriEMt::r~·Ts_ { 'I ~-~ _ ___ _ ___________ j____ _ ___ !Not0vor1o<:~ch '- E L6___p l!t;uronco.tolicyl\to.~----!:"- -~--ll-Ye~plrotlonOoto ____ 1
' l---------- -------- -~t~,- ·r -- S<oto Componootlon e.f "''11~ _ ~;: (). Q 8 ff 1 I I 1 0 , N tO 10 h -1 L~cor1i~ythntinthopod'orrnu·r·.;coo1tha,nor«1orwhkhthi:;pcrrniti!:i I 1 ' ~~ v~ ~-'--~~a_:_____ ___ __ __ it5ucd. I aholl not omploy rmv por!;on in ol'ly monnor uo o:; to bocornc J L 1 O..tcr 1 0, Not Over 30 c.:Jch I -t :_ubjcct to tho Workor'5 Cnmpon'irltion lowG of Cnli1ormo. ~--- -r----- -~ ------ -t I -- - -l N01E: If, o1tor rna!tln{J o:.ut.l} t;ertiflcnto, tho op~licont for ttrr: pc;mrt 1 i li~J' ~~r~=---~~---~ ______ 1 shoul_d bct;;orno 5llbJCCt fl.t thu 1/'-/c.r kcr'? Compon!:<H_ion pro\.-15rofls ! ! ! 1 T 1 rno~Ciock -----r-- ....,.[ of thrs co~o, ho ~h::.ll for!h·rmn comolywlth tt>o prOV151Ctrl.s of Snct1on ·! ·r·-- __ A -~ r - - I - ---+-- 8700 or hl5 porm.t 'ih<lfl ,{j •lrJrJITII;~J f'IVOkod II
, 111 1 I ft I corti~·y thot I IHNo rood thin npplication and !>tnto thot tho nhovo 1n 'I t t _ +- t form<HIOn Is correct 1 •1urn·, -:o r.ornply w1t'1 oil Citv ~rdr,.,:uH.u:; nntJ j
~- ___ _,_ :-,,on Hool' \H)
1 Stoto .ID·vs rolut~':f tor cnrltnG conntruction. I fur thor ao_rco_ ~.) ho_ld 11
--. -+ --r------ e-+--t~-- ~ho. Cttv of·G._er::J. on .Grovn 'Ire':: llnd hcrmlc::J frcm on.v •. llu_LHIItY Qrl!>· II. Ulcr I cn~}Y~of '"IU y 0 bDdiiV cJr;rncro rooultlno from W<p' kol'lrfcrrned I I . I -- - ------·---- -- -~- -- -- -<[>Ci" 5':'1 tp th'• ' lt. r.J, ~ . r:- --~ I -+-- -~ _::: _ __::_<;•M"ti';;~,i.';ii);,=•ic 411~-d~~. 11 l ... ,,v,cc t---------------- -+-- 1- I !JUSI~'<:SSTAXCCfUtr-uc.l',~r<mt<=oP.rJlATAQJ\l£{ 1 "I' .. -.~----;- _______ 1 _ ·--------- •---+ __ .(___ _ I certify thot th',{followlcor;.Con1pcior'o(fconoo No.-JJZ~"'In<Jy J-,-- 111
' ., · - C) II -==:=J: ___ L 1 "flJf Cloool11cotiGn ~..£--1"1. -,...{:jt~ fuJft'prco and ollc:;t. • l. ~
F~~:~,t~J =" __ ,;-;, _? ;-;~[-=f~~:_{]~~~~. <~~--f;:~ Re~:-;~~:~F~-- -, ·e:c;o·E 1___ Fe;! -~~ ;::;~~~.c~ -· <o~~~.~~:!J!~~gT::::~.:~" <y-:¥(7 i :·) I ( u .. ,.,., r/ ) ·/(!_ )-( ,' ' I !(. ! -~-------~---==- ~ OUfiiNL'.:Sf; TAJ::. CGf~TJFFCArc f/0. I:.KPIH/\TlO~.I DATE. !
_____.,_, ______ -·--'-~~-~ '-=-=:""o:-"""'--==-=--"""""=-----~ " cert1 y t at am c:tompt 1"0f">~ .;.JoCCt1on 7031 5 of tho Bu .• mcss ond \..r ·· - ' r. , \I ~-- f! Pl<:!n Check 1 l 1 ··f h 1 f " t' · .,· - I !DEr-~T!f!CAY!Of\1 CO:JE 'Pnrrrut :? "i · I Profcs~ionnl Cc.~o, f?ivie.ion 3, Ch.:mtcr 9, Contrnctors' UcOn5o L.:wv.
__ __. -~-r _ _____f:...---...o:-"- under tho followtng Soc non· I i 'lf;-;u 2 nc·; 1 5 =35 I OfJ 11 Owner: Section 7044 ~ _MhJ'Jr ·11orlt undor b~100: So..:tion 704!3 lJ I I ~------- ----~--_, _ __i_ ---- ..__ • ~ Emph.>y'CC \•vorking for wll:;-c::~ ':";nf;t· S-c-ct!on 7053 •
----~-- ------- · - - . j -i WT A L )- l:.:: S I t".~- )tl ~-~, ) Othor: !I ' ::_.::·.;·_:__~:~:IT""!-:!.,:; c•'• .,.,-r.e.•:r -"' J,~ r-tT ';:~;~;_,f:-•:.'o -, --~h;c·:,~~~~- -~::_u~,;:;:o;C~:;~~:;- .~ ~~==~~~j~ (?RoNT} eo<O>-;,-;;;, OW"C;;" ·~,c:;;-~~'.;'.;~~~.;;;~,"g'':,'<?c-;:T'"" ~-z- ~~
:.:-;;: -:;~:::r~:~j '."J1::;-11n i2i) -;~r :-.i~:':-7! t:--::!1 12~J d:::y:,
Vrc;lln c J';::J o-=' 1::~ . .10 cr of permit ~·..tiil bo nut! :ir..d
~- ( ) il I :~ .,._ li A FEE rv1A'-' or::: CH/,n~' [J~~ECTiON ___ ou£- ;c !i :~~--"'"?"/' \__ 4 ~t\rg6/l ~~g~~c~~~J~~ li'JCOW.: l._;:-~~:oiw;, OR Ff.liLURE TO r.~AKE:: II
! ._::--.:--:::;:o-.:;;:::: ... ~::;:-·~-::-=-·:;:::.:~~~~~,__~-_,-:;E__ -=-- ~~"~-.. ·J
CITY' OF GARDEN GROVE Public Works & Development BUILIJIIIG PERMIT losPtction R~
638-6n1 Gorleral lnfOI'ma'tion
638-6001 . P.C. # INSPECTION RECORD For Applicant to Fill in IOCCI.J· OCC. FIRE -
ADbo<ES~ PANCY TYPE I..OAO SPRINK. APPROVAL DATE INSPECTOR ,A/ 1 I usE j FRo"'NT 'LEFT-'Ri,o:;.HT REAR 7~ t:Jh £?~~~.,5 (1. I ZONE FOUNDATION & LOCATION 1'-" NQ. "LK NO. n..,., ---FIRE J;av Proj. -'· , · ZONE 1 Sotback• CONCRETE FI..OOR /1 p !5/-0 6/.: 0/ ,o , I, .• A ! REINFORCING
Ol IR £ • N - I
tPLANNIN3
I / "II"- . 1'!../',M A ,.1'\ ''L ACTION PLA~IS ROOF s., TG I !it.tf:}::f:::,~A.VV-~ _ _j/1/u i ______ , ___ _ - DATE RO>UGH FRAME c:•n :>P ~~~o't~Eo BY ~ULATiQN, ENERGY 74 bt:; oeAAICdi:_f1!.@~.6fcJ.r2 __ ._ · · ~=--= LATH OR DRYWALL 0 ARCH -
REMARKS: 0 ENGR. /=/£.{£' -r/Z/Vf:'t,_€7(< PLAS. OROWN CT. "'"'LIN<'• ADDRESS .. _ .... CITY ---·· .. .,,.--· : / ~ -- SOUND INSULATION I I
SMOKED ETECTOR KL----:-N-0. ! STATE l.IC.:', t·!O. 0: TYP:! PARKING
jPAAC~L~~----------;-----t-------~~----------------------~r--------------4----------------1
FvALroiii'iioii' -- _Q:l/.4L~~.Qi ==~=~,,J.~Q0h2~J! DOGPER 19.20 PUiHCI< 12. 72 NO PGi'1 7. 60
~!CATION -----~- FEES AND BO!IIDS --------i~~<+-::._,;c-+--:.-<;...---9"""=~--t
ISSt!CE 6. 00 ·--;.;r:-m~.:.,-::_'1" ::)~
_ PRCJI C&. Ltt~ C~TY --'IP
~;::::~,---------- !""'-'"'' ~~~~~~~~------L---------~~==~~=====--hf.f.~~~
I ~-;SSM-:;::-;;~~RG.) - WCRKER'S COMPJ:NSATION REOUIREME~)TS 5_!l93 b .... State Compen.,tlcn '· I-"J :• -'1. L f"l \11 r:.Ll.(/- 01 (/~~ PROPOSED W.._TEA ASSMT. FEE (FT ,) lnouronca Polley No • .ll!:!l...!~.cJL:...:Eii"pi'ratlon Dan. SLOG. USE 0 1 ccrtif,.,· that in the parform~n~ of the work for which t Is ermlt is PAAICWAY TREE FEE i"'ued, I shell not employ anv p8<$Cln in any mon,or so esto t:>ecomo
!------------------ --+-- NOTE: If, aftor mnklng such certificate. the applicant lor tho psrmlt ,
: ~ subject to th" Worker's Compensation law• of California.
_ _ +---~.~ ~~rc,~~~~1sep~;~~a~~~~~~h0~~~~~~~~o~~~.theprovislonsotSecticn a.'.~-~~-~ , I PARK a. AEC. FEE (DIST. ' should bocomo subject to tho Worker·· Compensation provisions ARE s,M~' . v CRAIN ASSMT. l'cE (DIST. ' , r/J I cortlfy that I havo read thl• opplicotion and ntato that tllo above !n· NEir 0 ADO'N 0 At. TER. REPAIR 0 DEMOLISH 0 -· ~~-~ ---! formation In correct. I agmo to compl\' with all City ordlnancas ond State lawa rola·dno to pandlng construction. I lurthar agraa to hold ·-~-----------.--------------; t~O CitY of Gord"n Grove frao 01nd harm!.,.. from any liability oris· FLOO;::: AREA j NO. OF NO. OF DWELLING
~lng <>ut of Injury or bodily damal!<' r8$Uitin;~ from work performed S F
1 ,. 1 IE~ _ nt othlspaJ}J'It. ~ #1~ ( Q. T. --~fJ.~. "--- UNitS ----- tz1 ~f 3 11 work is not start1!~ Wifhih 120 days from d:lto of issue or if
BLDG. _,LAN CHECit::: PllltMM1T APPucAfliTStfiHATL~ c e: abondoned for moro trH':Ih 120 d:ws, thin permit willl!o null and BUSINESS TAX CERTIF!CATE INFORMATION void. BLDG PERMIT FEE ---~'----G--+-'----'Il I certify thlltth&following COntractor's LicenM No. l-t....;_"'-:,-·E--~c:~-,A"'V-B"E=-C:=cH{;f!r3tD FOR RElNsPECliON DUE~ . t1 -z.__.o Jl'A<! l;losslflcati(UL_,_.<Lioi]l full lo'j}a~~~~~~~n. NEGI..IGENCE,INCCIN'lETE WORK,ORFAII.~Ii'lE TO MA:<E f1f),J'J!/I!f:C. lfiet'•lf()T /VIJ/4'¥'"' n 't;£&oV!If!ii'1Yiv'\ 'il..Lil CORRECTIONS. rssuANcE /~ t~mNTJ eoNTRAC:Tor. a:• A'tURE' coN"rftAC:TCin n-"~ Cl? . 3 . AUTHO..,rzr:o AGENT j ~ / ,"7, AE' OCATION I= " . '"- . . 2.00 z " $'1? ?J'i2 .. vt ... t..UAT!O~J ' I CUfi'Nd!IU! TAX CER1lU'IC: .. T8 NO. l!tXPI'i!ATr'Ori'OATE -----. " 10TAl I 4 r- "'J I certify that 1 am eumpt from SI!C'tion 7031.5 of the Business end j j •:Y (!J FEES :::> • Pmf<~OJI;:mal r ,:Jdo, Divi~•on 3, ChaDter 9, Controctars• Lican .. Law, { ' v") A :./ , I undor tho lcllawlng Section: --·-.r~·,/ 1 ___ _1._ __ ~:~! Own<rr~ S~ion 1'¥-;..; 0 Mlncr work undar $100: S&c'tlcn 7046 0 MOVING AUl'Horl,zc:o to~ oATE EmpJoyoa working for watn ontv:· S.C't!on 105.~ 0 lCC:'-!TRP .. CT0P ttb.t::/ ,1 O O;hor:__
f--. ------~·-. ra Lr 2./-o'6 ;ADDRr~~ L---{PR!fn) f"t'tO;~"tt;:tTV" cwH~R! ('3aa~-:~~-Mcf~~r1~:~~~J.~~NJS!'t OAR i ~~ _ J ~ ~ u·-.:~~ :~2"-~~~---z~l:. -- -------L--------------------~-z~·~ .. =-.,-~-.. -,-.-.. -.,~.
PLAII: AETEN iiON FEE
------t
---·
.. , !:iHOW f'.IORTH ARROW, PROPER TV J...U'\if.tG AND AOJACC!NT STfh!t!TS •
.;•.:1 BUilding Insp./ ~2 /\::::.:!.!ssorlti,J PorrnittGt'/:.!4 .r:!le I cnrtify d•P informtlti<.,n horeon i~ cmnplntc nnd corruct.
.. CITY OF GARDEN ..GRO\U:
,.: Public Wotks & D::;11elopq~ent
' HEATING, VENTILATING, ICEFRIGEP.ATIOtt& ·AIR COHO. ·PERMIT-
Inspection RIC!Qertl 638-6711
General lnform.tion 638-6661
- . • INSPECTION RECORD FEES For Applicant to Fill in r--7c-' , ACOR&tJS ;:::;:'1 J ~Pl'PIOVALS DATE INSPECTOR TYPE OF_!.~~TURE 0~~~--1-~ ~A:I--_SFE_~-- _ . '&[ t.;'Af',
7 ""fiiNA~e ·-- !:_~acetu&in_c_l:_!OC~_B_:!.:'-f:·.: _____ l--f---- ---·· 1 '(tf~ 0~:/Et.AnO "'::, C:,I!.IJ:/Ir .... ... . LOT NO. "'Lt< NO. 'l'ftACI rl NW 80. !--------- --·--- _ _, Moro than 1OOM & m;-1. 500M B.T.U. 1 . . .
__ ---·-·- Mor;,thansooM&inci~-1MM·e.T.u: -- ·f ··f ·•·& 8 ·3-A FUFU<ACE VENTS . . --- I ; ... "
~+_., .. ..._.;._ lnstnlln~•on_ or_ R~lo~~~~~~- ~f. $use_~_ eater ·--t--- OWNICH . "- . rHOHK GkS PtPING ~~- .. -
-·- Installation or Relocation of Wail Heater ~ 1 . __ lnstalla•ionorRctocationofUnltHcator fi1\ . f(lf:;: r()(. 811 ~11
~~-=·-~-·· ~---- .. OWHIEft 5 AflbH'Iifjs J;i"IV ~ Installation of Appliance Vont Only c; '--
1
t_· DUC~----.L~ ·:2-L-:...-;" r ---- Repa_ir, Altoroti_on or Addition to any 7!./liz.. t:::>ed !Jf,t;'£Wt>Ob :\ "~ (A .... - --·-··-- - tJ,-:DtmgorCaohngSystem ~- -- - -
SINGLE DUCT ___ --~- f--""":d~-~3-f---~- Nl!tW eu Lv1N1l on .1 tnunTING DUH.t:Hr~G occuP'A"cv• !rn.: Ojt' ~ 1\H:Q
FAN V£Ni , Incidental Gos Piping ; lS~~ O__Q__ ACI:ln'toN • Ahf:A nttr-a~oocn. IHHtA Gflou" OR~ 011 t.afftD
!-----------------· ... . - ---------·-r . ·-- .,.,OT. to.n-.
!~11'CHFtJ HOOD ------------------- VAL.IDATION ~h . ...1 ...
------------ Each Vent Fan Connoctod t~~~il~~-lc_?uct 1----- ~-j -~ 1 · .-1 ;-~ ~I E:.ach Rango hood Incl. Duct and Fnn i , , · -!.
AIFi HANDLING UNIT
f-:--:-:::::::-:::-:---------·-EVAPORATIVE COOlER
Each Ventlfating System not a Part of o ; .. -.,: ,_ ,. .-~.-Heating or Air Conditioning System .. •·--· Authorized by Permit ~--!---~:--, ~ .-:
1-.
Boiler or Comnrossor to & incl. 5 Hp, Hf!t,!INGCON'ikACT--cm--------.. !STATe uc. No. & TYPI!!:
BOiLER OR COMPRESSOR
<it'$ ~<£-S -AbsorptiOn Sysrom to & incl. 100M 8-,!~ j - '\ _/
];2;•"orComp•c51orto&inci.1SHp. - (/1~~--::_· .. ~~!J ~12'1~ (!.;-Z.O ------ --!----------- ---
1-----------·i----·- ----------'OE'CoRAT'!VE AP:>t,IAI\ICE
-·-- ADDR S!l _ CITY ,~HOH orption svstom to & incl. SOOM a.T.U. C:/)5:7(.. 1/u s,roA/ -~-- "').1"3
Boiler or Compre,.or to & incl. 30 Hp, AJ6; 4ol..'=" y~~!..'f}j,) ____ "l.[l-0 ( 1tlJ ~0~ r AbsorptiOr"t Svatem to & incl. 1MM B.T.U. I 1----=t---------j Boiler or Compressor to & incl. 50 Hp.
t-:- -------·- __________ Absorntion Svstom to & incl. 2MM B.T.U.
1 1 1
c J Bo1ler or Compressor over 50 Hp. ; - . . . -.
-------------1--
t I ""'"""' ........ .,c •• ,.,__ nc ~ ~m +--Air H.:nd:mg Unit to & incl. 2M C.F .M. t __ _J_ ~:=- ~ :: ;;~:i:::i:;;,:~~;: kl;f n~~"
l--·----------l-__ ___ ------- ___ ___ 1~PJ%4.:.L~td_!fo=?rr~k __ _
I ~AL~----.t~~--t_·:..,-_; .-zq~a-r~- .. mM ~ ~ f~ _ CODC ~ ~ . t= ,_,i_s _I j ~b~~~~~go. d:&L?--o/!o I_) V fL :~~~-~·~~~i~n Fee___ ______ ' !----~-=-- -· ·- - ·· • o.Lin ChvCr.
! mamf!CiTION CODE ~ ~---· ~.:~:~.=~:~~----=~--- ~- J • ~~ ----~; r · · ·- ----- -~ ----- [-- ·----~ 'TOTAL FEES Vj ,PO --· --- u,-,. I CLt!<:!'r'fflr,: PP.QMJT HO, ~--- ~--~ fllJ;i.Dit~G ,.,_,,._.,,,
~---LANO U'Gr:
WORKER'S COMPENSATION REQUI!'l5~ENTS Stoto Com;Hnsatlan,.,\1 q"'• :i/.1.-u>.. •I If. loauranca Polley No.?.-I'?IC. .,.,..., ~Expiration Oatil C>f 2..o I L"6 0 I cortify thot In the petformance ot the work for which this permit Is
iuugcl, I aholl not employ any poroor In any monner 10 •• to b~~eome ~ubject ,o the Worker's Camponutlon laws of Callfornlo.
NOTE' If, after moklns such cortlflcr.re, the OP1'1i~ant far tho permit should boccmo e.ubject to 1 .1n Worker·~ Compe11S111tlon provisions of this code, he shall forthwith comply with tho ~ravislons of Soctll)n '
0 f~C:~~~ ~tt~r::'~:~=~b,;;1."~~';,~c~~o0::~d tttlte ~ .. " thu above in· formt~tion Ia correct. I agree tQ eornpJy with all CitY ordinances end State Jawa relating to pending conttruction. I furttaw ~tgrae to t.oJd tho CitY of Garden Grove free anti horml<sJ fr<un onv 'loblllty orltlng out of Injury or bodily dbrllcgtt r~sultlnu !rem work performed
ro~t.._tb1sf~ ~""- . /4?.ef:. 11,/<:; 61 P£ IT AP .. LIC::ANT 'liiiUHATU'U' DA"''Il
BOSfr\fESSTAlCCERTIFICATE IN FOR~~~ !!/:. I certify that tha f~>llowlng Contr•ctOr'o LlconM No'1 and Claulf!t:atlon ~f!J~ondeffect. · kt SilO !.~!!./!._ ~ t I'-' J
( .. RINT) C:ONTRACTON ~H U;.r. I COHTRACTOt1" DAT& f s ~ f # ""'::t ,,P~ (THQ .. IZBU AOENT _ ;! u.-II'D I' ~ t..;J ;;;~ • .,...,.."' '1 - 1 -~~v MIUIUNt:S·o;~ TAX CltA'TIPICATK Nl), E:XPiftATION DA'tlt
I certify that I am exem~t from ~octlan 7031.5 of tha Buolneu ancl Professional Code; Olvlsion 3, CllAptor 9. Contr~ctGrs' License Law, under the foll<"wlno Section: Owner: Section 7044 0 Minor work under ~00: Ssctlon 7048 0 Employee working for wage1 only: S-.:tlcn i'063 0
Oth!lr: ·------------~~--------------(PRtr-JT) JFROPC:RTY OWi'lCIIt (c:Qt-i;o'f".UI!N:!~ P"'Ktt,.. .. TV OWU"f!R -----
On All'nlleJI!IZt!D- A~l!tN'JI'
7f ~bu:;donc-ci for moro '\hen 120 dey!:, thb permit will be NEGLtGENCE, 1NCOMPI...£TE- WORM, CR FAILURE TO MAK£ '!'no•kisnotot:;r1<::!within120doyofrornootcofis;ueor I A FE-E: MAY BE CHARGED F<J>< ~<<o·<NWt.t;IIUr< uut. TO
~~•H ~:m:1 'JJtd. CORRECTIONS. _
, _ r--J~;:;J_~..--~-;rlf?
_5;4D· I ~li'v
WORKER'S C(IMffiNfATION MI!OutfiiEMIENTI ~ CompenMtion · . .. , !!!~~Wane:• Polley N<> ··. ·. · hllll<ntcm 0..--,----,,.-,-l:l'l Qrtlfy tllat in tto. pMat-.t• of..,. Weill far ...,hill thil -mh lc . IMUIId, I ohall not empJO'f ...,V ll•non In any ""'"- tel at tO weomo · ,;--.bl~ to the Worke<r'• Cc>-tlon 1- of c.tlf«wnle. ·'; ~JOTE; If, ~~~.., mo~ln11 tueh HUifJ.,..ti>. the eppllcMs for m<t -mit
shoufd b.c.ilme eub;ect to thJ Worker'.l Compen,.tlon ptc'Jitiont of tills code, ha ah-.11 forthwith comply with the prcwl$ions of Sectic.n
· 3700 or hi1 ~rmit >h5IIIH d..,mlk! revoked. 0 1 c.,tlfy that J hwa r..., thltl IINIIIIC<ItlornNI orwta that til• llboJt in·
formation it ~orrect. J ..... 10 t:Of'nl>ly with all CitY ordlnanc .. and Stota laws rotla~lng to -'<lint c:On11r..,..tlcHt. I furt!Mr *t!<H to hold tho City of Garden Grewe fr• •nd h..-ml- from MV lloblllty arl•· lng out of InJury or bodily dtm- r-ltlng from work i>.,lorm•d •••tv ant to thll ~.,mit.
·~·· ~w.T
w; • .j?J&- rm.o~~ t:!;;.'k'. .V,tft:;Ss TAX CIC.rtTir'IC:ATI: 'IO,· i&"JriP.tfif"'TiOif t;~#'i;T£
I ~tlfy that I 1m eumpt frum s.etlon 7031.11 c.f m. Suoln- wnd l>tof-ionoi·Code, Dlvlsion·3, ChaptM Sl, COftttlictora' l.lc- law, Ut'W tha followlng!l«tiOn: ; 0¥.,.,.: Section 70_44 0. . Mli1or wo, !< uncMr $tOO:~. 7~ 0 E"IPiov ..... orklng •or w._o,lv: S.C:~tun 70&'3 0 . · ()dler '·----· _ ~---··~·-· _
(.,.kii'!.T) PfrOF.~'ftT't' onwtt·~ T.;;;;;-.r·~;;-)-;;-o"';;f.~ 6ft A:lJTHqfiJ:aW:D A.1EfifT
~ ._· €.E MAY8i--;::-.~Ai':Gir)-F~TN~E-CTi(yN- uui rO ott:GuG=:Nt.:E, lNI::OMi>L('\'.;: WOR_K, OR f'._ILVRI. "TO MAKE ".l'Hl(CTIO"'S.
WORKER'S CCJMPENSATION AfOUIREMENTS s- Compensation · .• -lfttlltance Policy N.:>.__; __ . __ ,._, _____ e,..,r, .. lon ci••------0 ·I certify that In ti'e porlormiiiYta oft.,. work for which thl' peo-mh io . issuod, I shall not employ 'II!V Pllfton In any m•nner ~ •• to become · · ; .. bJK~ ~o tha Y\lorkti•'• Compentarion lowo of Collfor~>io. :~JOTE: Jt. aft'lr ma~inij "lith c:•rtHic~~~t., the appllc.nt for th~ p8rmit
~hou:d bet.amo subjsct to 1h-J Y'Vgrker's Com:-J•n~~etlon prc·lilion! of thb coda, he sh~tJ 1ortt'tWfth t<iinply with the provisionJof Section ~700 or his pormit shall b• d""moo riVokll<l.
0 1 c"'tify titat I have r...O rhft iipolleation onct atota that tho abo•• in· formalion It correct. I liOtN to comply with all CitY ordinanc.,; end StatiJ laws rel&-:ing to p~tnalng construc..-tfon4 I furthw aon• to hold th• CitY of Garden Grcv11 frH and tau miMi from •nv liability arl&· lng out of inJury_ or bQdliy dontai!O rowlting from work performod raiOIVar.t to this ~mit.
---- ---~ !all _ __ . __ ~P~~Tir .. Lt ,..-tfJO"flUJIUt - OA'tlt
BUSINESS TA CEA I ICATE INF R ION --1 certify ~hn the_ foiiQwin" C<>llttaotor's llnnM No.:;l:::~.!l· G :1 Y oh<l Cie,.lficatlon It w 1 II lore~""" .tllfet. . .·<:.-.> .ldJ,l:J.";"/l(.!.~~.J.c......:a ~- .- 4-...:::J.:.-.S-!i.-_ r{~iifNTrCoNTRA.Cto~ {~IGHATU .. d HT'fACTOM: ..,. .... DATE
Ofl 4'JTHQ(U;t 0 A&,;.CH"t
e~:!I!"!!!.SS Til~ C!!.~YH"fC:~T~ ~0. :':XP".nl"o'l.~t;·;:.~ ~;:.-;";:;
I certi-fy that I om exempt frum S.Ctioli 7031.5 uf the Susin~tJI;. und P'rC!fcsional Coda, Oivbiun · 3, Chapttr.- 9 .. Corrnacr!Jitl'" ·J..ic.tlnt.e law, u.,.;., the foilowlng Se<.•ion: . O...n..-: Section 704-4 0 Mii•o• wo.~ llnd'>f t!OO: Soe•lo" 70416 0 Ei'Tlployee YrOrktug for w~ onf·t: Sec;;ton "10(3 [] · ·
r;;;-~T)1.r.-Q;,~-;-;:;o;,-Nt!ff"' 1;:;;~~-;;j';-;;;;;:~-;;---~;;-~~,. . Gl! ,t,ul"HOPH.l.t;~ A&~ .. r
·- ----- --·~- ~~.iA4:t tJ·-r-t:)i.t -~P.F·-:;;r;rt: c:·:r·i~~~r~- · u.~;'tT7J WO~K. OR fAil.J..J~f 'H) !'w:'?AKf;
,. ; . , ..
ill' ~ \.: •ctTY OF GARDE!\J GROVE Publh Works-&· Development
""
HEATiitG, VENnLA liNG, I~FR~E!ATitlN·& ·AIR COND. PERMIT
Inspection Requesu 63~711
13G
Gentr" lnforrmtion 638.f5661
INSPECTION RECORD FEES For t\pr.-licant to Fill ia ACDRi!:S.S NO.I EA. $FEE f Afii'ROVA!..S DATE INSPECTOR TY"E OF FIXTURE OR ITEM
~:::-:-:. . . ... - Furna<:;~;;-;-,;~-;:-;ooM;T~u:-- 7456 Orange\'JOOd J. FtJnf.jAce M~~~-~-h;;; 1-00M -&~i-~50-oM~T.U-.--· DLK No, 'rRAcT<,.O<o>:jr-----.--..,,.r=-,_•h"'"""'IT,..,W•vn-,-.-
[:t~:;=itr.iA:tv-~N-TS r:n~~-WO~&_i_n_cr_:_1~' S.T:U. . I '.,. ••n , Installation or Ffclocation o~ Susp. Heater · ~HONI!'% · ·-
~~~-- }:-<. ,... li f)! . ~~~~, Relcc<Jtion Of~~~--·---GJ\:, PI.PING K: '~-: lAt .. ,II, ~ . . - t.'' B t c ·!.- ...
I. __ _(._(2_~<::.._ 1 ________ 1,~~ Rclocatoon of Unn Heater 1-;;,~ """'"~;, ~{,k"'"0~ns ... ruct:ton
. - ~__.,.- // ~....-); /1 ./ lr~stnllatior. of Appliance Ver. ... Onlv DUCTS _) / (.~ lr .--< vt- - ----------~----- ___ £> __ ~......:_::-_:-:: __ --- Acoo.".AitorauonorAdditiontoa~v 17691 Mitchell 1\ve. Irvine
549-41:i5 Rn--
SrNGLE DUCT Hcotmgor coohn-a svstem ;;:aw·~UiL.D;N-o-o-~--rxmo-,_"-,.-u;LowG . t-AN VENT -·-~ ~ i" - ADDI'l"'IOt• • ARI!A RIZUQDce:4. AlfUA
----·-·- -· -· ---- i ... ~ -~--- 1 --~- 5:£. ---·- CQ. PT. OQ. PT. · ·-··-·-- j i 1 Each Rongo Hood Incl. Duct and Fan fi KITCHEN HOOD J ·-- ·----- vA~o,.-- v4;rt'$"'/" ,o ,
t ~ Eat:h Vent Fon Connected to a Sir.glo Duct --- '-
... . ... ----- - ---· HTGPER 2" 0 • AIA "hANDLING I I Each Voptilnting svstom _not L: f'nrt of a • q., 0 UNIT I I Heating_or Air Conditoonono Svnorn Imp rover®.U.fCE 6. 00 ~--- ~ ... ---- ------ ---t ---- -- ~-e-~_bv Pcrmft }Jh,!•·-t·AO nn 'EVAPORATIVE I ~ Com~HtJ.~S:or to & mel. 5 H_o_.__ !>TATt.! l.IC. NO.6! TYP1I-"' - ...
tCOO.LE R ___ •. _ .. ---t ___ .. . --·-. -~orptoon System to & oncl. 100M B.T.U.
t101LER OR I ! Boiler or Cornprosc;or :o & ll'lCI 15 Hp, 1 COMPR~SSOR 1 --
~--- ------~~---- ___ ,_ _ _ 1:\bscrpt,o·l Systcrn to & .ncl 500M B.T.U.
c~OR~T!VE r_ ... ~·~·-..... >"-"• .. Soi!er or_~OOT\p.essor tO~_in<l. 30~--+---+--+----+----t Borchard Santa f LIA.~CE ,t-· , ------- ----·-----------'--------1 --------C2---___ L]' ___ ______ Absor tton System tC' & mel. 1!-,1M B.T.U.
. . . ·'' "-- ./J ll g .f.)~J" ..mli'fer o ,Compressor to & one I 50 Hp. -j---
L--- ----- ? #£'' ----- -~~).'./_:'__., Abs.orpto1n.g;;,~&~i. 2MM B.T.Ui·
"""i' (! \J Boilr.?- or{Comprcssor over 50 H~. _
-----;f'£
1~----.f /+--~!.----···-- ~ e}?~ratJvr:.E~.:'.~---------
.. __L_, .,J\·· •. ! ..... AirH.!indlingUnitto& ind._ :Z_M_._C_.F_._M_. __ t--+-
1 .. -:--= /:...---~- ~)tr- ----- . •. jpji_:_,~:;~: ~~;; :~"~-~~: ~o_~~--F~- ~--
, J \_ (II'_/ [~/'l_r: \ ·~. ?l'OTH . --- - . t 'l __ .. ____ /-- "I\' vr.: - . -.. ,I\ . .-~--- __:,;;- E H ,, . ' ' I I I ,<''
~::::_:-f -l~ .v~t;~i'_ ... +-~,....ee-"'::""::__ __ -J~""'~-:-.-u.L;-~.uu"~...........,. -+--+--+--
~n1n;f/ . 'i.E" ... , ... ~~~A.!. {; I if"1f1)V;:..-.'i.~j" ------------·. r--· !------·---~~- __ ,. . -if·-,.>-;r-=f.. ITEM j- CODE r---£-~E~-A ~!~.~~~Y._co. ·- 2 .. - !' . .. !'/ Pion.Ro. te~t~~~.; Foo. ·. n 1--- ·------------- -_ ''~"''"·'Eo - o- o ./ ,L.- -- ---· ..... ------ ....... _ .. ____ _ t _ • ..- ~ PIL. Check .
i IDIE~HifiCATiON CO!DE P';;;;;, --· --- - _%.)_~-- -d!/11S.J)_ ,--· ~----1··- ... -------psua~~~~~-:~ ·-- -·- r-:--- ... ?·::rs- 6 00
1--
WORKEFI'S COMPENSATIO:~ REQUIREMENTS Stoto Componsatlon Af.I20000'// 1/1/81 h•ouronce !Jolley No·------~·--E•p!rotlon Oats ___ ___,_,. 0 ! certify thatln the performance Of th" work for which thl• pormlt Is
lr.su~d. I sholl not ompfoy onv JJ'Wf''-\ln In any mannar so es to becomo !lubjcct to tho W-orker~s Compane.ation lawn of Crlifornla •
NOTE: If, aftor moking S!Jch certlfleato, thQ applicont fer tho permit !ihouid Dacoma subject to tho Worker's Compens.ation provinions of this code, ho chall forthwith comply wit!l tt:e pi'ovicions of Section ' 3700 or his permit shall bo deemed rwokod.
0 l certify that I I!JW& <O'id th!o appll~rttion and om to that tho ab:>VO in· format; on Js ,..-d'rroct. I cgrec to comply with pll City ordlnonccG ond Stato IDwo fl'tlno to pondlno con:;t ctiOIJ/1 further ooroo to hold tllo City Gordon Grovo frco o har"lJt;, from any ltnblllty nrlo-lng ou lnJu<v or bodily d eo '"" ltlna from work pcrformod raiDV to. thlo P~trmit-
.Y/ ·.(d. 4 1 1 QISQ_ p · RMIT APPU~A T tU'"C'4 Ut!-lt! ~ t,jAfe
BUSINESS TAX CERTifiCATE iNFORI'JJATION I c tlfy thot tllo following Contract<>r'• Lieenso No·--------end Cla!!:l1i.:atlon loin 11111 fore& and &ffect:.
(PRII'fTJ CONTRACTOR lab~'~:~~g~,igt;rfJ\fr!"~fi OATI:l:
:lUGINI!:GU TAX .COFlTIPGt;ATI<: NO, -ai"f:ifi'A\=i'Oi=i~
t cartlfy that I om exempt from Sllctlon 7031.5 of tho Buainc::.a and Professional Code, Division 3, Che:Jtter 9 1 Contrac:tors' Liccnso Low, under tho following S&ction: Owner: Soctloro 7044 0 Minor work under ~ 00: Section 7048 L EJllplovco worklno for wnncs only: 5-:>::>tiMI 7053 w ~-~ ..:.c"~-::=_!_:_:.--=~L-:.:...:.=_..c:;::;::_:;_;-;:-.::.c:::_::..:-::=::-4 · • TOTAL .FEES I 30 00
u·..:;;.-::,:H ... PCPt.o~l"f r~o. I c:J.~CT~Hc PCflMIT r.:o. I . -~--·~- "'-' ~-·-------F ·v ~r;o;n;;:;;-o;~ '~I:..F~67;,:.fu--1 ~!l-?vt';.\'-11"V owt~!!:N .. ---~--~··-- , ____ 1 __ ··--~-~.-·--·---·- -:----tAtiO'·(.;W--_·-]A:u~"o!!.:~~~;:;;;;;;·-.--1---o;,-,-~--- A FEE MAY BE CHAP.G;:,_,:~:""'::.:::;;c"ffci\l~rJUE TO
Other:___ .~-.·--·-··---- ·-·---·
!~ ·.r~T.lfl~ b not ~tar1:cd wi?:hln 1-~0duyafrom d~to of ic~uo or J . Vl 4 f (;, ~rb NEGLIGENCE u..:::o'JiPL€TE WOf>K, OA FAILURE TO MAl<\~ ~~~;~:-:'~!~E!~~:~r more th~~~~~:·· this permit will bo- .• . ~_j--~. ~~ ... ~-~ \.. (. C:Of!RE"CTtONS ~=~ .... ~~-·-·-·-· ....... -~ ==-- --~
B
i
CITY OF GARDEN GROVE Public Works & Development BUILDING ~RMIT lnspe~tion Requens
638-6771 General inform.tion
638-6661 P.C. :If: INSPECTION RECG;'fD For Applicant to Fill 10 I CCICCU- occ. FIRE CTO IH>D .. !!SS - - ~ -,
I PANC'f TYPE LOAU SPRINK. APPROVAL DATG INSPIE fl - •A r !: ~---~ -- -7"'-tb b iH"nAJCLE '1'"'0D ~~~~E . FRONT ~J RIGHT !lEAR FOUNDATION & LOCAnON • U'T r.-t:=-m.:irr~ot\'&ra.-·r.,_:lirr"1,.. . . . . !FIRE Eav ~"!..: · ---- CONCRETE FLOOR I f I S H ~ Q ZON~ $1Jtb3cks 0\VN~R . rnL NO -~ j------ REINFORCING
• ' :zc~~~4NG PLANS ROOF SHTG rlri.M-?!2:'riJ{o"_J?IbJ.rl:_ __ c;L2_,Jw. _____ zfp·--f)ATt ROUGH FRAME . . ·- . ~~o~~~oY _________ .... __ INsuLATioN. ENERGY I ~:J;:jfg_U: .. t:JC/$:(!.-v'QK._j_.IJ{t!i·:IE-~MP.P.xs, ....... --~-~~···"~-.~- ......... ·---•= LATH OR Df~YWALL . ~~[] ENGR.
~ ~~ROWN cT. --~MAILING /Joo~-rr~!l___ ------·--crrv-------~.-;;---~i
--- ----- . -- ·--- ----- ~':'N'?_I_N_S_L_'L_A_T_I_O_N ___ -------. _ _ __ __ _ __ SMOKE D~~CTOA____ ----- l!L, NO. --et.sn~~-~:$TATI! uc, r:o. W TY~~-~1 "fL--~----------------·--· .. -· PARKING --- -- --=·--- .. ------~-~[~~~~~:1_______ 1:~J-~:~:;\ __ _ G.G. SANT. Oi5.l ,o.C:sA.NT.OIS~r -· ~f"o"ir'~--Tif;fC=' LANDSCAPING VAL!DATIO" .. =:~~~·~:::~-- -. -.... ---·-· ~~ ~ ::· -F'EE REQ'D..:__j_ _FEE Rt;:Q'D. I I '. _f ;.. f) ' J. "t.:_! , -- -REQ'o PRoviDED IS::.;.;cc 6"00
1?..741
!PARCEL IVIAP __ ·----- CHJ:i.:V =t: '~: } .~: ·;.; 4-; 11'/W DEDICATION LAND USE FINAL r-- FEIES AND BONOS FINAL c;e,~k--r.:.4!:: ':2...9 -@ I ~-t-----------------· :::1---------- UTILITY RELEASE I I REV. CODE! AMOUNT
I c-·- --l- . -T IDENTIFICATION CODE !ST. BOND I I I -- - - -- -- - -- ----1 ! I l ·-·--··---- - -- t. I ' !WATER ASSMT. FEE !ACRG.I WQRG<EA'S COMPENSATION RECUIIREMENTS
~----- .. ---------·-- -.---- --r-- ~-- Stoto Compan«>tion ~, ..-.oJO ~ R ASSMT. FEE (FT.I JnsurancoPollcv Ndd!.WhC0i9548 E><piretion Dow 1-J~)!·t -------------- ~---- --- -~ -~----- ---- 0 I cortify that in tho PCl"'formanco of tho work fer which this purmlt l!J PARKWAY TREE FEE i!inu.cct. I chnll not oms)foy ony p~-rson. in onv m.onncr ~o e-G .to become E
t .·~ subJ~ct to tho 'Nor!tor'n Compen~atlon few~ of Cohfornta. ---~-----~ -- --- r----- ---- ---- NOTE: If, nftor molclno ::;uch cortlficato. tho oppllcont for tho porrnit
I PARK eJ nrc. FEE ((JIST I shoul~ bc(_omo cubjoct to tho Workcr'!l Compon~otlon provl!lion:; ~- .. ---- :--_ • _ of thi~ co=..), ro <Oholl fo,-thwith comply with tho prCivi~ion:; of Soction ~· rc:o . 3100 or h .s permit ::;holl bo cJoorncd rovo:Ccd. , OdAII'J Av.;.~MT ·FEE (DIS r. I ~.,..--ccrtafv ihot I hovo rood thl:t oppllcatfon oncl Gto!o that tho e:b0\10 In· [ ------------j-----'- ~f---~..__ -- formation 1: corr"ct. I ogroo to comp'y with oil City ordincnc~ ord Stoto laws •olatlng to pond;ng conotruction. I further agroo to hold -~ .. --.. "·------===· =~ .. _ __ _ .. - thQ Citv of Garden Grove frClt and horml<ln from arw liability orl&- FLOOR AREA . '. • N0, O.f' INO. OF DWELLING
~ · ·--- -- lno o"t of Injury or bodily damogo ra•ultlng from wo'k i>orlormod l ,. . PLAN RETENTION FEE c; / ! /,(.} ~olov :uothioperm.JJ; . ~ _E~_F_!·~ ... ·- ,f(JrU~S ____ ~~ITS --J --------~ ---------- --- ~~- ,. ?"'J..t!./1-"Y:\ ~~ _ .-j'J'7tf.c7J:iii'":f.fi"'·f S I:!.. ~L If work is not ~nartcd wnf-;in 120 doy'!l from dtltO of is~Lio or it [BLD~:_':LA~CHE~K ___ -L~ 1/-) _____ <£ I/~~ ;:::jfu~~~~~T~~f~~Ut~;C~TE !NFORr~~., ~~?~dono~~:_~:-~~"'' 120~ovo. this oormit will-~•_:~' _ 'ta., nc. PERMIT FEE ~~~~ . '. ~ lcortifytllotthofol~wlny(:o.nntroctor•o LltanooN.o. ZU. l 5(.(2._ A FEE MAY BE ChAnt;r;r1 FOR AE·INSPECTION DUE ~0 -U ,, . .,_ 1./1.? ) '2... I h () and Clotolflc~ltion ·~ 12._t1; /).' forrtr J!;.i;""'..,___ .,.~ I'' NEGLIGENCE, INCOMPlf:TE WORIC, OR FAILURE TO MAKE - ----- [ I ~!):Sy&&~Fft'ff2- ,(../, 1,.;,. - -''·<?'i<t'li·::l.;_Z_ll CORRECTIONS. issuANce ' 5' 1' : (') (} '"A'"•' CONTRAc'l'o.. '";t:;r;;:;gA,'i'ris•:t<'f,r~" I OAT ' ---------- ........ ----- R~L ... O .. CATiOM - j ~ ... -.==-7":=--·--.--c.c=~~r-- ~-,- z obz~ 6 ::toLftJ_ ll.: '"
_), Jf .. r,.d, I 101-J 1 CUOINI:!59 TAlt cr:.:nTIPICATO: r40, ctXl-UlATIDr" bATt! ----- ~~ ·------~~---------TOTAL j .-, I certify '!hot I om Ol:Ompt from Sdetf<>:l 7031.5 of tho llusfr.c;~ and ?Rr.:SENT BLDG. ~.~ jj _ ,f ·. j f'EEG Z r• ! cj. .:> Profc:olor.ol .~odo, Dl~f~lo~ :JJ, Chop1or f>, ContrQttore' Liconoo Low, ADDRESS !'"' • /" iJ undorthofol,owlngSo~-ttOn. ----------- ·----------',;----;-----. -L-_---- ---- --~ Owner; Sl'lttlon 7044 0 !'wflinor wc.rk untisr S100: Ssction 7048 0 MOVIN'i ("'71 0~":11: 0
' IEmployco wor<<iflD for WOGO> only; Sccl;lon 7053 0 CONTRAf:TOR II C;t ()/1 r:; ."?.:( Other; ----· ·- --- --- ~-----.. -----.- -- ·-··-----·-- ~--. ! . r_}___J_ (/"- - (Pn;r-n·J P~OPt:nTv QWNUn IDI::H-=ATUR'r.l l'ttOrrt!'·. Tt" oWI'l~R QATC: 1-\0DRE.;JS )_:~:.'':,;~.:_~;;;/~-- =·~-----~-- ~--,_~v..!~t¢RJze·~ nor:NT _."'=-=·-----·-· ~=~-.,.~;:;.Do~~-!J·1Q
cON1'~Ac-TQR--~-----·--
,f}.q.1='lr.!.):..li.JU~Cjq.-'l // 1::. '=, .;~ ':: "',12rxr. ------ ,.. "'~-~.!--.1-E~ M ILING ADORI:!lO CITY
........ ~ .hJi._(
ZIP
.I4.51 Ml- Li!lt111q, eff R D '"" b11-0<tlb ~~;t:·; ~;6 >'b -1 PRESENT PROPOSED BLDG. USE BLDG. USE
IDESCRIBEViJ= TO B<i DONE
F·; i) i~- (:_ . I) f)' ~ J "") I? .;; I ' I(.' =•; 1------·L\!:.:. ~;;,...f.A.il_~:_'I.Lc ... t..;_ , ev -"~Lt.-··· NEW 0 ADO'N ~TtR. 0 REPAIR 0 DE<-.I!OLISH 0
:·or UuildiWI lni:p./.::2 /\·.v·•;,,.., /-::<1 i':·HIIIW·:J/.••1 I,:" I ~erfify thP infonn;1tinn lu;r·"P.>n 1~: cn•••p/Un nnd «.:nnco;l,
llli!l~~~~m~~l!~t~;e"'"*"~~-""'~~""" .& a LL¥ N14W!!UIUIII8££ &&&£ 3 .SU &m:Ct-£JA1£&.fift!'!liiPJIJ
~£ CHV OF GMlDEI"J GROVE .;,/'; ... Public Worf'5 i:J1 Developmen<J:
[?Q ~lf'l'TI'Qil~~ &~II r~f!li'.ilriMIIJ ~~llilkr tJ t.ru~!J~f'Jth ti biT~b-~Wtij ·
lncp~c·lia!1 Rcquo;~g 036-677~
G:JnBr~; :rvY·nrm':t!i~f! SS8~t!Sf:t0
.;_, li\JSf'ECTiOr,J R!ECORID fEES Fou t\pr;licant 10 Fill i;1
1 :3::,i;l:f, Fcl,\SE sERVIC!i s1zE u uc 0 ')H ] IF NOT usTEo aELow ! No. EAg ""-E lfAo""cs;;rl.-<#[0-7'152.:. ;;"-'~. :;;:rg-p~-: }~.&.=:.. 7-.L. •. ~.--.. ~-~. -n I SEE cooc: ,, "''. ~ I' i/o."' ' ( • :z..-·- I 4 (1:;,. I' ' liMPS VOL';'$ RIG.CONDUIT----------- ------------ - ···-----·1·-----:1 . . OtZ .uc. (/fJ . C) Q!C, If). : l'f.:)Rf.:-:PHASE SERVICESlZE ~Yaw~;.;-[] 4 ','JI•e 0 uc-Qoe! Rc>~dentlnl IR
1 8"
1 ~~«·~: --- - . ___ __j -:.. . • '-.!{}. ,e ' ~!!_~_: __ -~=-·~L!..."-- j ! [GJCnge, A'''"' (M) SQ. ft l . rl LOr NO. OLI< NO. ru;cr <IO,[ CJ-~;,.C'fHIZ:. P!Zfrt':11T !!Ct. 1~ :----·~---~-~1 PS VOLTS , _R~G-!:~N-~UI1 S:~~1 ccMotH,~JI~~~-Pha"7;--- -- ---,---- , ____ J _____ ] -- f;·:-~t L:_-s-:~-f;fjC\t!
l ;l,I':'HOVAt ! DATE 1• '"'""0" '"'""' ""'"' ""''''"';;;· - d !Si'?t 6oj :;;.;.· L,.,,,En ~- ------~ .J ·-:.__'~.!.-~ .:. -~~1'! 1- --- - - l ·- - -- ---- --- -- ;!::._1 -- ---" - -- ----· --y-;;Ho"" ,
.i, • ~~ •1 ~c::JT Ad<.J I M.Jtut l hrc(• Phase ' 1 [! ~ _ ! ; 1-'·"""'G'Ourld ::J. cf-79' ciD -- -----------f- --- ! -~1. 1/.lfeo//1.( 1-J?.oJ?J .,.....c._ I i : •• -.·-,.- ------ ~~- t t -~ Tcml)r -•\t'nwc~rPole ____ --r- -+-- --- L----rl-0\~•~'r;r,nr)nL·:·: //~. / ~--u ~"'"---~.-,-.- - lr; ~ .... ~.7.,. I Pole, Pov···~t '-'ll'''• otc. I ( !j - · !
f~_-:.d'"'___ l ·· · - Su'' Pa""'" I •J> ~ -' t ' li 2 () J 2 tl-/!Che/50/,_/ J..i 1/z tlf.4jLJ li 1 I ~ Sub Peon(•!•. 1 (h I 1 I ~- ~·c -- I _ "-? '- '"" I ::') · .• .., A . J ,_ · t' 1 '. _ N-\'i ~1 V1Lr:IUH;. o~ fl...ti~THoG tJUILUINC loccur-AI~cv fU!;..._ r.n• u•~Jt.J:;-' _, "''·, 1 I l f:,,:~ .• OUgn ! loutffi!S -- ;-- - r : f;,OOIT!OH AriL/\ jRt:;MOOP-LA~~f:/1 G~OtH• orNVfl:iHnCP!JIJIY1;'1,
ll -=~~--------l·--- --- -------~-- ----hF ~· ~~;-, t.W4Wif1)- ~- n --;o~ I z.: 1_~ --- - -~~· FT , 00 r.-r .t.tld ; • ~'-.h..:r - fl. ~ - j ' t ' ;:_ if-vl'oLIDAYION
,..:n=.:ures& 1nm / ' --- t t t'- Y~ (;:..., V l,
L ___________ ----- -~;::.\-::=--:';;::;;:~~--- Foxtu•os Mn<c o •. ,~'· etc _,____ ' ; 1 jl J ( 01.;--4 ~'7!..) ~ I! I_ ~ I -p '--., '.- Hea•o• No< OvP< 1G50 w l I I ll(ttfo. 7Jl o/(.. ,_ ;' d I,
[ c· t/ ' I .... , I I I f r.:~r::CTJHCAL CON7RACTOn 1 GTATt: LIC. NO. Ct. 'rYPt=: I 1 ' DPfH --- -· ·--- --· !:·;;~~."- _ ( _ :. _ }~---~ ______ _:c._ -Ho1 Wate• Hooten ' I -- _ • 1 ,, ~ , ·;
------ _/_ __ / ----- ' W10hc• L ~ I ---~ [i
r - l \ l·-L i \ _o-~.~,~;"~· - . , _ --=-=--- ~ ~-- -- ~-~-- ~, ~L-i_l_~J~f:l«~_~ r: ~~-~~- z "2 ~--:>: o _ _l1 ~ ~--·-------- -----~·-j <2tG£v ."'-;;-------J Dom~'-~"':'_U_o ~· ov~n T : _ t JA"D"css ctTY --y-piioNc ~:;; ~ I ! I )_ ' -..l.p fO"posal I l .., ,,/.2'' J.I,J'?!t;r i~ "7 h1..1:::-~7-C<t5-11 r 1 /'-;-'), -.... -- - ~.. ..1 ll· ,;;~- --~- _g,.v • _ flj < ~(t'J~'"?j_l:.Ct !_-: ____ ' _ l-~----- _ --- --~};-~ _ ___ ower Appar~ltus 1-i P. K W or
1 , /•
' ' ( '2i';"~- f·V A. Moto,;, T"on•lorme<S, o<c . . i'j WOfH<ER S CO:VlPEr.JGATWi'J H:OQ:.JIREtJlENTS 1
J 1
t:C~- - - ·- · 1 -~·-r-~-- Stoto Cornp"n!'.!l'i:ion ! : ~---~ -~·-~------------_, ____ (=_____..1 ~~·n~_Ovar 1 Cddl r -. -·!- ----[------ ! ___ , ~ncuronc~o!Pollcy No; ___________ Enpiro1iun Dotn _______ I ' .... , -~~ I fo 1 N 0 10 h r i l] f cortr.v thot In \flO pcrformllt1GQ 07'(h0 .. ;;!: Yor VJhi~;h this perm .. 1:: ~ ......_ 1. • "·--...... / ver ot vcr unc. ! _ _ t ~ 1~::uod. f r.hcll not: employ ony porcon In any rmmnar &O or: to bc::omo 1
rJ .... ,J -........._,___ / Ovzr 10 Not Over 30 e.Jch 1 · ! ~ubjoct to tho Wurttor•z.: c.-rnponc~tlon lnwn of Ccllfornio. :-------i.3-----"'-==-·.::~-- ---~-r-- -1-- ~ - _j _____ ·t· t j··· _j ""''' "· .... ""'""" '"'" ""'"'"'"· '""''""""''"''"" "'"" i !.>ill l n £1cJ"" ---- lndv. Ctrc::utts ! I I ' Jj 5hould bccorno .. UbJCCt to ·ho Work;or·~ Cornpor:!><Jtion PtOVI!'>!Oil!>
j v-<\1.-tA .-?td 11 I~, T .. · C , ~ ~. · [ of this ;:od<J, ho sholl1orthwlt:-. complv with tha proviciorJc of Go-:t•on ,~-------.-:\."_~-:::·.:.1(·';;o.. \ . ---r~ ~-~--·- _ _ --·-· __ ,_____ --~~~- loc.k ; --~ ------J! ::::700 or hi;:~ permit ~holl bQ c,o,,mcd ro•Jokcd.
I 1!/ if)"\J:t_..;...__, !.iJ '~ . ....._ l ~·'Jrl ~~ D ; ccrtlfV that I hovo r<1Wd thl!! upplk;lldon und Gtl:rto thnt tho obovo In
\\ \.: .. A '·· • -1 for motion 15 correct. I ocroo to comply wl1h oil City ordln::Hicc:; .-:rtd '. _ ! '.\.~-::/ ____ '--'\.' t1;ft;l --~. ,/ ·,qn 1 •HJI n· -ii St.J'::O~ lowe romtlno to pcndlno f:on~tn:ctlon. I further nt)roo ~·"'hold I~ ~ ,1'''1.,... ) -,.. -<.\,...)){{ r • · -- J tho (.ltV of Gord~n GtQV(J frco ond hormlc:~ from ony llc~;illtY otH::·
i ~~::c, 1 l8~//"bf'(J.tj "' \! 1: 1 l J inofotS!t;:... f ir.j.ury or -?Pdily d.on1c. co rc~ufting from worf~ P~Hiorn ..• vd i · I (~!'.-~ , . -, rolcv nt O~P"fJrflJJ I) _ ./ _ ~---··----· L ___ j__ _ _,£,",. __ ------ f- ---·- i' + ---1 ~ Atc~r.~':A-4..- l..f./_tv/7:? ( 2crv<co I · 1., -...,,.___ J - L · l ---- s~~~~~Ts;·;~~;~~:~:~·~·;.;t;\~E :;~;~r~tf-r~~--- =---... · ~ ~""'~~--~-~~~-----!_ r _ _ _ : _ ---~~ I certify th~t tho follawino Contractor's Licon::o No·--------~--- __
1 ·~·1 A.-'-1'([~' , ~ \! _j _j 1 andCir.oolfocotloll _____ Jolr.fullforcoo!'do\1cct. I ~"-~:;.'\L ~j 1!-(;Jl .. = s~, ..... _~1/\ .. .J ~L- ·-- -- r----~--:..-"----·u -------- -·--------··--------- ------------- ______
1 J ____ _!_ ~ __ """"-=----- _----/J.,. ... ~ !TErfo ! CODE + F~ES rl f.-rHn'lj cqrHnAcTon {tHGfiAT~JncJ c:;oNTRAc-,.vcn 'I r) 1r, ,_,_~_,T-::'•~ ?J;:. . .,_., T:: ~l<:f-~ i r ~ -~ -~ ~ ~-· -- r-· · ---~ on AIJ7ti'.:l ~I .. CO AOC..IT
1 .; h ,\!~ <I , 6 .---Jt/ !.f. ----"-'t• if/_. c;~' ;.~·;_~~:} ~ r~. "" :>~ .. '\ P!.,n Rl•trn~ ·· F (h~ , ---· ----··-- ----------
! ""· "1 HI>!(~ 1 1 L'~"~- /1 <)Cj/" -- + t ·1, auot~H~G!I -rA~ ccR,·•r•cA"Tr rlo, nr.•••nA'rror~ ur..n:
'= ---..··~"-2____J-=.!.-= .,...-L~~-=~r.::_ ___ ......,. ~~-~----= --==- ~ P!nn Chod i ! 1 I ccrti1y thnt I .::!rr Oi'tcmpt from Section 703'!.5 of tho Bu~u c~:; ond
I mc:~n~ FiCA ":(1(}~1 CODE ( Pu.not : 1 .. >j;.c'1 ; ;: 2~1·~1 f'•ok,ioncl Coda, Clv.lolon 3, Choptcr 9, Co.,uoctoro' Llcom.' Lnv,, ! ·---- r - -----/"- -..... '"'I •" .r - ~ ·- ' ; .:.- W_- __. --~-----,.' cndor tho foiiOI/JitlQ Soct!on:
• ·~·· I r' ,, __ L ___ ~C~---j ~,( -- ~ ~~~f~~~~~~~~~~~~rl2,q;f;~;)~~~\o~~~~~~~u;ha~f]Oo: scction7048 [J
TOTAL HE:; f----:- tiJ &! 1~(~1 Otno.:_ -- ··--
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doyc ·Jrcm1 (::::He· o: i:::;.mJ or
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•hi- prrn-;" ,.,.1! (·o nu'l 'nrl ;lt, .. _,;:'l j/-t&-1Bp NEGLIClENCE, INCO''''PLE.Tfc V'.•rJRI;, OC< •0 AIL\lflr I 0 ;,PP.E
--"·---~~~ .. . :_~-~--" __ ,_~~_:__ ~~ ----------- -- -t-J-~~ ;___- . --~-),:;~,:~.;::::.~-;;~~:-,==~_;-:;::;:;:::::;-:;;: "-· ~"--'~~~::::;;=:::;,~~-:;~L~;-;;.;_,,
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CIT\' OF GAI<UtN GilG\/t PUBLIC HORKS AND DEVELO~MENY
BUH .. DWG CC~rJIPlElHJN nm-m P.tQUW[~H::IHS
o1VB f\O[;RfSS ~........::/'J~f<:b_. £)~:~};;~'t5'le~,,·,·::5~::':3'2:::l .. ~---.. ~~-lW.Tf. _ J?- .'?..-~~-: 7 .l~ __ BOND Alvlm!N": $ <,?~~-~;'-~)~ ~.~~=:;:: .. :?f~6DAvs
L Bliii.D!NGP Elf::CTfUCfllo r:JJ~1fHNG 0 AND f:ltC!-lil~HCf1l PfJU,Wi
FYi\lALS,
2. lft!~mscrw 1. NG f il NAL.
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---·-····~-·--- ..... ~!ilf'-=---'~:::;-~"~"'''"'"'~~-~~-~+ .. · ""y!=~::.._ __ ~--·
'i':Jl:l')G[)YHJIC~f~ ISSUGO I'UrlSU~Ni' YO 1'1ill r.i(HJUIPGIJG(JYS tH' !li:W'I'i!lN ~00 (H'VIll! lltJH'(H;rj CUI~OJrJG COOIZ.C!!r.!Tt~VItJG TIM 'I', A7 ','~lC ?tt.M~ 0~ ':ZGU·'!!:'JCG~ 1'111S ~'FOUC!~Mcr ~7A~ H: CCr.'lP~HHJI(;l1 \·18'")1 TfH~ V~CHOUG OmJGD~i·I(;CS 01-7 TtH:i: CDYV OGOYl ~YQfJ G C'Gt1 ~t"?fHHJV'UOrJ OR tW~ P'OO ?t4C POl.t.Ot"JHJO:
,JOO ACORESS
US£,; OF BLDG. --
1
~--~--------------------------------~"------------------------CERT~ F·tc·ATE ~of OCClJPANCY
CJTV OF GARDEN GROVE -PUBLIC '~VORKS a OEVELOPIME~T "(HI:! C£11"f1FIIl~\'E lSSU£1:1 I'UQ~UAr>l"i' TG THI! IIEQIIIII~.WENTS CF S!CTICIN JOt OFTH~ UNII'Oim OUIO.DINCi COOI!t-Citltfii"VUIG THAT, AT fill! 'l'tMl! 01' !~GU~f<!Cr;, 1'HIS S'I'P.UCli.mE WAS IN CCI\IPL1f4N~:I! l!fi""H TH£ IJIUIJOUS Oftl)lll.tfi~I!S OF Tli!t CIT'/ llf:I~Ul UGH 0 C'(;~~TII\HiTION OR 1.15~ FOR THii: FOI.I.OWING:
JOB ACORESS
(:;ROUP-USE OF SLOG.-- ... lf.d~hil ----GLD!:. ~PPRove:o ev _]o'~ t'JGbinson
· 1 il''JJ.~ 3riiJ-::M j
ZONING REM/.iRI{S
DATE
e1.cG. owNER Uu; .. -13~u i?~Ftt~;~;
!II l [~jf'' rn~j •If r"']l''"'j _:__::""-·•· ~ "-' '--' SY ~~}f.lr---=" II Sl.OG. OFFICIAL
l' \EOST IN A COi'J..SPICUOUS P!LACE
?~~:£2~:llf75===-- --=------------~
· .. r-v:i"'f'rn~ ·--:--AI) ... ,,"-:•·s aiS'!i Uifi:rJB:.iOOw St ... K~~~~ late &o;~n~.;..,J --· -----
DATE __ ~tJ_'JJ'_QO_· --
t;Lg---.. ·~ .. -.aaa..mDti~&~vl.-.............. ,._ ____________ _
ELECTRICAL PERMIT INSPECTIOf; RECORD FEES I ~;!;-.;l;LE~~:.;-~\::RviCE SI_ZE_
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Condut! . I
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APPROVAL DATE
! 'Wtrrnq R·•t:.J'
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Ftxtur~s & T r:r;-:
I i il;lotors
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f IF NO' LISTED BELOW I SEErrJD~
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HNAL
IDENTIFICATION CODE ·D----·
NO.
2..--1'2-II
I
-z.. I
CODE
EA
d-o:] S..-,-
..::>) I /?lk!~;P~''-' ,./(.•t-?--1-'V\ .!;/vitA ·.:,-•• , r "'1.-.-,r _.,...., ... ,. T01 AL FEES
._-... i
~UILDit~r;_.
FEE
-+FEES
Inspection Requests 638-6771
General lnfcr:o1azion 638-'3661
For Applicant to Fill in ~-----A OCJH E:: 'j~
144& Oe#Lhf'tuOO£) . 1-f ' . Tr~;~r.·r r.•.). ELECTR'f.c; PS:~•-":7 ~~p
I l'-o.J;] 4 fll V tJO
F'- -:,•, ':
L!N'CoL.AI ?72DP,
f" )t. ,.._,fir<'_, H o)IL(.)I"• •
<~LMULJI LA Iff A
St.: r ....
ul7'1 6761<;~A7E UC
eze:-z:r,
£,•:...J/
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4-11/1-. L~l~-f2~11)~ CITY
Na. /louywo&o o::~-o·o.~.E
WORKER'S COMPENSATICN REQUIREME-NTS State Compensation . ~ -/ Insurance Policy No---~- _ ~~- . E:o:.pirat10n Data __________ _ IJ I certif'l tha~ in 1hn nnrftJrm::mce ~ .. ' ·ha work for whic~; :r_·~ :!e .. 'l'1i'! i;;.
issued, I shnll not 'Jmploy any persvn in any m,mner so a~ ~J ~-.:corn(! subject to the Worl~f:r's .:ompors,::i::on laws of CJ!:fc~,..--;:.
NOTE: If, attor ma":in~ ::;uch cer;:r"_:.J:t), the <JPOIJc.:m: k: : .. ,_ ~-u·•,it shnuld become subject to ~he .',c· .. q}r's CornDens;::~u:.·· :.... •:.. ~ 0 r-1~ of this <..ode, he sh<JJI forth·:;!'":, cc~·;::ly with tho:: ;:;rc.v'~··~·: ---~::; :·':,':Jr. 3700 or h1s 1-..,enni: shall ~-e zre~rns·:: r~vokcd. I cmt1fv Th;,t I h.1v~ road •hi~ :l~~::- 1 i~:otion and :;tutc th::;t ... ~..-:." ~t"~-··c ;-, •o. rlld{lllo\ ·~- ~._orroct. I .J[lfL'O to -"-l'lv \\11tt1 ull Clt\1 v" • "'. '· \_ ., .n:d State 1.11·•~: rDI:ltTng to P•In(~Tnq ."'-"'"-.:.• .. u;..1Ton. I t.,r•l·:'" __ .. _ ~-~ ho •. ~ t/W cq.v ol Garden Grovo tr..;o j."'U 11Jrmlt~55 fron .J.~-.·~ _~:.- I :v ar_"
o'!A" of rnjury or bod1!y d,Jrr::,;;c- rcsultinq -::rc~ ·.:.:r,· :.:.·r": ... r ... ~r;rj
r./f2po~ '7-/?-7-j ... t.:rt <1l "''f_'f~~ .. , .. (- ;i"jl;;~-~-,.~-• . ---.--... ;-~~ -
-~--- lllJSINESS TAXGERllf:"Ti.<.TE INFORIV';A~/' -I COrtTfy ,,,,jr th<:? fo~~~~Jp.t')ont:-act:")r'-;. :..iCI~nse r-.~o. ~ -~?:."'..~~~- -
:i'~!JZ--~v-;s ;1//Yf''tl.:::Ji'oc: '7 ..; 7~-; 9 -,---------~ --7-~/~;.,,:~;:;-_-;;c- ----~-·---
Au7.-~'-;;!r~o ,,,,r •.T
-·-au~IN~s.~. TA~- c-CR'TIFICA-TI~-:;Q- ----1 certify that I Qm exempt fror..., s~:-,rm 703'1 3 :::·- '1"'.' ~ ~-·· n·ss :Jnd Professiono! Cooc, D1•Jision .3, Ctt;:,~:;:.r 0, Cont~.h- ~~--~ _ :._ --~c L::J;•, under thv Tol!o\.ving Seq_1ion Owner SoctiOil 7044 ~-: r>..-1•no· .·.-:-·1: 11m~8,- S10J :3:•J:' ;:~1 :'O·L Crnployee work.ng for wuges only S-:.~~..,·~)" 10b3 --··
Other
·r~·~~~~:
L;~~~okr,~~~,' ,~;~;~o~r,~~;'~{(, '"2:~~~:-'~~,'~o;~,~~:-~;~~~~,~~~~~o;,~~ _L : ... "' ! . A f L:--.;_,:--..-, -~::__ -~~ ~- V., _, lrl-17-7~ NE(;U:;Er,c_:~. :·.J~0'WLE. re .. _ -----=-==' ~/- e;_ ~-~:~-- 1'... CORf-H:.CTlC"JS. ------- .
_] _____ .. __ ------ -----·----· - = "' •<>= --
,', - -~ ..-·, C;P
CII'V OF GARDEN GROVE INTER-SECTION ME~
TO: WATER ENGINEERING & PERMIT SECTION FROM: PLAN CHECK SECTION
~CHECK:
Address: 74-4'6- 7t:.f 72- Ot2d-1-Ltft~WcidD 0\'lner; ____ 1.--,..._c.;..l(_(_-c_)...,L-~tv_. __ _.;;.t ~'/~.-~~:..:;...) t._)..;;;;c;..;· ~;;;:"~,-'T~~(;..;:t__:;..:-s,:::;....._, ______ _
J -, ~ t u <o 11? ~~1-~L-._ _____ :_,_::~tf.l..;;;-t:;..,;r.___.__;;..;;;. __ (.;:;;·;..)..:..N::;..:::.L...t.Y __ -.::--------·z_ 7 OZ. Land Use Case No.: .J?u1~03- ?Go.
Use:
Plan Check Number: Number of Stories: Fixtur~ Unit Count (As Per Uniform Plumbir1g Code)
Required Water La~al Size From Meter = ( V':z._ ''~
Bathtub x f.IJ, = Dishwasher __ -x- -F.U. = Kitchen Sink x F.U. = Shower _____ x F.U. ~ Lavatory x F.U. = Urinal x F.U. = Hatet· Closet -x--F.U. = Washing Machine ------x------F.U. = Irrigation --x F.U. = 1 oo Hose Bibb --x F.U. = ,_ -- FU -t:,?(, Mt!Tc: ___ x .. = 9~-
ftwt-.1 L1 Nat.J.i __ x F. U. = ________ x F.U. = Total Fixture Units ~
WATER ENGINEERING SECTION: ~-
9:1 8ackf1ow Prevention Required? Yes Reasons
(Figured on lOO~~ale unless Otherwise specified)
----------------------------------------------------------------Have Pblg. Plans been evaluated against 8d1g. P1ans? Yes_ Contradictions? By:
Yes No Data:
Fire Protection Requ~~2~ Per Res~me Sheet
PERMIT SEC7ION: Demand = ,;._.c) gpm :·le te r S i z-a~R:;-e-fJ~u:,..i -re-=-d-;-----,Z...,.';"""ry'----Cost/Daposit -----------(check one) Atlas Sheet ~Jo. Location & Si:e of
Existing ."lains -------City ------------------------- Other-----
By:-----Date:
No
--------------------·-----------
(DS-0060 2/77) il.I~V. 10/77
.. 'f ·.~.-· ~ ~!.-..- " ' '
~
CITY OF GARDEN GROVE Public Works·& Development
BUillllllPEIIMil. INSPECTION RECORD-
lnsl*tion Req11nu 838.f171·
Gtnenll lnfonncttior. 138-t811
For AppliCint to FiH rn
i~gy~~2-.rYI'~~NE~~b-~"'-F-J~~~K.K -~~Pf.'IQIIA~ .. . nQAT~-- -~N~EC!OF< ...... ~44&o~~~t.?DO I ..... _-·, ;. •. 1 I use F~oNr l LEFT RIGHT REAR FOUNDATION & LOCATION •...... ·--- liB y ,.,_,. ZONE . L01' NO. TftACT NO, 'Oak -··
. . ............... Eav.!'roj. ·;,;......,~·I·;;;..;· .. ~ ·..-:.:. · .... . 'FI~E ~ . I -. ..,_~, CONCRETE FLOOR .. ZONE Setb•ck3 OWNKft · .... ' ~ TKL NO ··-
REINFORCING j. f2 /J ' ' PCANNING -- .. - ~~'9'f>Y". r;QQ'FSHT0 L/A/t.LJLJV /'I!IJJ/e/27".,1' t::O.· /·4/5:..51~.:7141~ ACTION PLANS ~~ [l;i';m::rNO'A5ilit118 c.11h z;;;·~-
ROUGH FRAME /).
~~Jlo~SE~ BY .. ~. OATE'Z.-lt\-'"ft~JLATION, EI~ERGY -~·~··. r:·· ..... h,.srsz. etr, £.:;4_.~· ------~~~~~;::,;,==~,!._ . ..! .. ~·==-~=== ·---~~LATH OR DRYWALL ~ARCH ,... / ~ I .REMARI'\.S:.. , r 0 ENGR. ~h..;g_g; __ ~Ef,$.$_DC,;, - .. I
·••· ~::~:::;~;ON _ --~~-----~=-- ~:·~=GADor.m //J,ijic .. ~~< .&. Zl~~ 1-----------------·-----·---------lt_sMOKE DETECTOR __ rr··~· NO. , .T .. ,.. uc. NO. a. TY....
1
·-- .. PARKING /-415 -.5e4-.. 0dd1/j ~ ..... ~E~·~;g[f.IS.I ]F~~~:J,-gls.J I DAH ,;.,T,.-'F LANuscpr-tNr, _ vAL'"":'"'/ / --q·7l~!J /.~~;;· =-- -.. -~~:~
r"'jif:Q'D PROVID!:-:0 71'/f?j ~~~ nt tf!;Bu/~i.V6 fi _
PARCEL. MAP I /// - '17 /.J R/W DEDICATION - LAND USE FINAL --I-· l..ttfi/AA.fd 1-::tz.!f.. .. f'/ZCfT. L"'., ~C. •
FEES AND ~OI\IDS FINAL 77ii77..J ' -7' ~-z~ CDN'fltAC1'DR I- ./.. ,1, /. /.L ---=-_-_ ... --~--·-·· -~ --. -f UTILITY RELEASE . ... . 1- , /-H:J/ ltJ. Afi11J0c;er .~ A.i4/'UJLJI!?H
Rf-:V. C.ODF. AMOUNT .___l.. ~6, ADDRI!:S!f"- --·- --- . CITY 'ZIP'
sr, eoNo -- -- --~ !oeNriFic~TI()~s cooE
WATER __ BONO . .. l . . ... I. ... 'l TEL. NO, (J,"f!~~r..~f.t!.-... ~~E -;,;:;;~ ASSMT. FEE (ACRG.l ,__ WORKMEN'S COMPENSATION REQUIREMENTS '/it{.- $ 2 (p- ~~~/ ~:Sq9£J{p -.. • PRESENT / j PROPOSED WATER ASSMT. FEE \FT.) i I certify that I have read ihls application and state tnat the above BLDG. USE /r.JF.II/ SLOG USE
,.:.._.______ 1
~~~o;~~!~f~g i:occ:,~~~,;,~ ~~~s~r~~t~g~~~~~~~1~ ~'!r ~~~~~n~~~r~r~~n~~a~~ - • ' ~--PARKWAY TRl:E FEE i .. th., abo•• work I s.•uu not omploy ;ony.penon ln.vlolallon of the Labor.lc91"$~~1111:;WORK-"7'" . . )II')
1---------------+----+-----l.---- fu~~~ero~g:;.~~~:~r~~~drt•~:tl~Wv ~~ ~~~~::'~~~ •• cl':Z'f!~~·~~~~~~~~~:~~· .. n~ -roBE DONE ...J..AJfl•1.';11!/t..t...N?7av v,: PARK & REC. FEE (OIST. ) l lla~/llty arising out or InJury or bodily dam•ge rosulling from work ~ r;n~ ,...... _,_, . .< 1 L/~ _. _,.-,,.....,_...,._....,
1---------------+----+-----l . ____ _____:. _ Qer formed relevant to tr.Js permit.-.. . . . . . ... "';?'~ - _:::;,~.,'~"*"-~-~' ~.¥~~1TL
-,..---- CONTRACTORS SIGN BELOW DRAIN t>SSMT. FEE (DIST. ) I I e<·rt:li lllat I am a licensed "ontraotor and that my license Is In lull force NEWB! ADO'N [] ALTER 0 R"PAIR 0 DEMOLISH 0 ~ .. -·-------- ____ ------- an.o.cflccl;/h'.:!~CJ/9S4.!3 .. t:J/9. . UP. j. /·&:J - · -
,;/1;c£Ot:it..A1 hE'\ ~ ~ J::$ffllt]ikvL.J~f,;E£. #13:1? FLOOR AReA .I NO. oF !No. oF owEL.LING
PLAN RETENTION FEE -, 7-... <nNTU<T"'" · ·· · · ··· ""'"o"r2eo·•on-r .... bAU (SQ. FT.) ..(.t)(l/0! STORIES / UNI"iS_ · · ' '-J OWNER-BUILDER SIGN E'ELOW --- - -
1 certify tnat t dm e)(empt from the;t provisions ol Ch. 9, Dlv. 3, e and p If work is not ttarted withir, 120 d1ys from date o1 issue or if
~Lp~. ~~~~CHECK /f'_,.,. & A r.:od~ (_Contractor's ':-lcen~ La~~ b~~au~_f.~he~~.?~e.J.~-- . . ab~ndoned for more rnon 120 day&. this permit will be nult and
~'-' CJ If' 0 11 1 am the owner of !.he above property and will personally perform tne VOid, ~~~~~·-~ BLDG PERMIT I'EE oibove wor_k. I certifY ll>at In the performance of the work lor which lhls A FEE MAY BE CHAR~G"E~C'"F"'o=R-,;R:;:E'"'·"'tN:-:c'S;:;P;;cE"'C"""'T"tO=N.-.:O;;U-;;E.,-:;T~O;,.-
. /BS 98 permit" "'~ed, I shall not employ any person In any manner su as to NEGLIGENCE INCOMPLeTE WORK OR FAILURE TO MAKE
lr---.,.._ .. ,_ .. _., ._. __ , __ --·~ "··--·~· ...... -· ·---·~-~ ____ .. become. subJeC't to the workmen"s co,-npensatipn _.laws of the Sta.ttl of CORAEr.TtoNS '
ISSUANCE Calllorma. ~ ' ............. _ .. -·--------------~---/.,. DD 0 r am tnc owner of the above property and I will contract to 11ave all of RELOCATION
p=:===:============l======l==~~*~~=l the above work performed by Ucensed contractors.
vrt<LuATioN ·" Tou,L w.c... -· ·-·· ..... ·-:l:~:i- PREsENT aLoa: ....... ~~-~·-·-·~--~-----~~--~---~-~--~
..t ..r - ~- FEEG 0 r am the owner of thP. above property •nd will employ persons to ADDRESS 5 .....- -.r,. ~00 ___ 1.1 A""L ~ ~/) Pf!r1orm. tho above work with wa:on u their sola comptmsatlon. 1 will · ...Jj;t.~ '.:.JZ furnish msurM1ce for my employees. as·r~qulrecs bY the Labor Code of ----·--~~~·-~----,......-- ... L_,,,_ ·---
rou·r:fo1u7..co •v PAT& California. MOVING
I . • . W.C. " l\J:~i<- CONTRACTOR .
-s.~~N \,...C ~.Ll... ~' 'Z- -l 4,-l~ . 0
Y AOI:lRE:;-----·--· .......... -..... ------.. --~----~-----
' _ .,._.--- -~:-----c~- O.PFRft $ S:IGNA1"UWII' AU'THONI:l .. Q .-oi(NT D"Ta. .
I n.I<:Dt:I"TI"'.:::t
...-----· ... -----,..---..-~------------~--
#8 llulldlng Insp./ tt2 Aneuor I 413 Fi1o I #4 Pormillc~> ! <:erlily fhn inforn•olion t1croon i1 c~:mJllrJt:t ~nd correti. By ·~----·-----'"--·-···------·---········-·~DAII• .. ---·-··,.-----~.~. -·-·
OS•OQC;:.,. P/"n
CITY OF..GABf>EN. . ..f3ROVE ~- ... . . HEATING, VENTII.ATIIIG, ----·tt ... e> Public works & 0tv&l~mant ~· -- -- -• ·REFRIGERATION & AIR COND~- PERM IT "'" ~ INSPE~TION RECORD FEES
,, Inspection Requetta
6:JW71 o.n.rtllnfOJmition
638-M61
FDr Applicant to Fill in APP-_ROVALS DATE INSPECTOR _ TYPE OF fiXTURE_ OR IT-EM_ 1 NO. EA. $- FEE
ADOR.::GS
t _ · . ------··----:-:-.. -~--- '"t . __ . 7446 Orangewood Suite 100 f-F-LlRNAC_E __ -·- -- - .. - --· --- .. r!:-'!.'!'.~:_e_to_&_O:.._OnMeL&100M_5BO.TOM.u_.B ___ T_U ___ -- --- .. ..) 1-UU ~o-r No, •Lk No. ---;"tr..,;oA:rc"F'::..N"'o"'J----....,.,-i--•,.._.i ~ A I .t----. Mora than 1 Incl. _. • · ._ _ -~~ _ : . .
.·FUiifJACE.VENTS ....... ---- - ... .. . ~:::~=~:::;:::::~:~~~e~ter ----+-- OWNER ---·- --- .. ·_ -~;-·-:·::.-=:-: -~-
f <ij,;sPif.IN·c; ~ ·; i..J.JJ! .. ~ 4A.1 ;~:::::::::: :; :::::::::::: :~:: ~::::: Lincoln Properties - • .. li'df-~ , . -~ __ . · OW~I;RS.ACIDIIIIJ!";. .C::l'l'1' 1
OUCTS -·····- -- . -·- .:,.--: -- A-~ U Installation of Appliance Vo::_n~tc.,:O::.n:.:.:.!IY ___ --1-----1-----1----+--·-1
/'!' 11~ -'-'!- (.(J_ ____ Ropair, Alteration or Addition tO any 7446 O:r.angewood' Garden Grove · ·- Heating or Co-olinn·Svttem __ .NEW"i'un.oiNca-... o,. .ltrXII'I'cHa •ut:LUIH~ u..: Ofl...,..... NtD
... 1 -----:.:,:: 1"\rt. AODIT.ON•Aitf£11 fiEMDD£LAttCA 011'~~ ....... ~l::_nc~i~d:e~n~ta~lc.,:G~a~s~P~i~p~in~g~--------+-~ -~ ~ Ench A&ilge Hood Jnct. Duct ancrr .. n··- - ~--:- I'JQ, "'" so."· I r.Mi .
KiTCH"N HOOD L j - I -------;;- -~ VALIDATION' -
·sil'iGLE oi;CT FAN VENT
1---------l------
- ----··-·----~---- -·- Ear.h VClnt Fan Con.-.ected .. o a_~l~g~~ Duct /' r-· b lJU 1
·"""'
A-Ht HANDLING ' · l Each-Ventilating svstcm ~ot a Part of a 'I enan~,. Improvernen,;t:A t/ ~-(Jl?
/9.01 l'·N_ f Hnatlng or A1t Cond1tlonong Systom 'G r'{v '7 ~ Authorized by Permit -· (.; f 7 {_ IJ:::?# fV(.\p;()RATiVE . Boilo'i"c:ir Compress<>r to & -incl. 5 Hp. 1 5 QQ HEATING COOiTRACTOft ~~
COOLER -t··----- AbsorptionSvstemto&inei.1QOMB.T.U. _ Far Weat Air Condo ilOILER'CiR- AIJiler or Compressor to & incl. 15 Hp. __ __, ___________ .:_1_......1__::_==-_.:.-.,...,.,.,=,.....---1 COMPRESSOR ADDRESS CITY --~-o~------ ______ Absorption sv<~am to & '"~'· sooM B.T.u. JJJO Castor Street Santa An DECORATIVE Boiler or Compressor to !!o 111cT. 30 Hp. t APPLIANCE Absorption System to & Incl. 1MM B.T.U. ....,________ -------------1.------
STATE &JC. NO.~e, TYII&
312478 c~2o
... __ ,_ ------- . - . . WORKER'S COMPENSATION REQUIREMENTS Boiler or Compressor !0
& meL 60
Hp, -- StataCompenoatlon CC-20-)68-100884 J-2,5-8( I-- --+-- - Absorption System to & Incl. 2MM B.T.U. lnturonca Polley No. Explrotlon Dot•-----·-· . . . -0 I certify that In tha performan<:allf the -k for w~'ch thla pwmlt II
Ooiler or Compressor over 50 Hp. --1------1--- luulld, I lhall nat <!mploy any parton In ony mannar.., as to b4come · E E . 0010, subjact 1o the Workar't Corr.penuotlon lawo of Collfornla. 1----------1- -!---- nch vaporatlve C ____ ---f---- 1--- NOTE: If, after ma~lnw su .h certificate, thaoppllcont for thw P•rmit
· ----- Air Han<IEng Unit to & incl. 2M C.F.M. __ should be<:orne subfact to the Worker'> ComJ)ensatlon provisions
f-----------+-------------1-- ·-_---{-~~'Handling Unit to & incl. -~~M(;~F:M. I l-----1-- -1 Air Handling Unit over 10M C.F.M.
--- --------- - -t- -- .... +--1---·---- ----- --- .. ----- --
---~---1--
r----·-----+--
2.--VC:., "Tl DN. /!.__t.A_t!5,
UTILITY CO. NOTiFIED
!---------~--~~~~~~~~~~
r~;t~bfr; 8~~---, · _____ _
of thlo code, he shall forthwith comply with thaprovltlont of Section ' 3700 or his permit shill be deemed riiVok<d.
Ilia i Clf'tlfr that I hoVe r-..1 thia iJ>pllcatlon and 1t1t11 that the ab0111 ln""'"-formatlon Ia •o1ir.-ct I OllfH to r:omply wlttl all CitY ordlnonces ond
State liwo rala:lng to pending construction. 1 further ""'" to hold tho City of C,ord•n Grove froM and horml- from onv lliblllty ari .. lng out of InJury or bodily domega ruultlng from worl-: psmormlld ral111ant to thlo ptrmlt. 6-1 2_
7 9 PK"MIT lt.PPI.IC"ANT atGNATUft. DAT.
BUSINf'SS '!AXCEifftFICATE INFORMATION I certllv that the following Contrector'a LlcanM No·----and Cloulflcatlo~-- ... --1• In full fore• and affliCt.
,,.,.INTJ C:ONTftACTOit I•~~H:J¥:::,,i~~r':~:J~" OATIE
aUIINaa• TAX f;I:PITI,..ICATI!: HO. •"'-"l"lloTION OATK I certify thet I am exompt from Sactlon 7031.5 cf the Buoln- ond Prof-lonoi-Ct>de,--Divltlon 3, C::heptet 9, Contnet<~r&' Lie•,_ Law, under the folio• olng S..:tlon: Cwner: Sactlon >1144 0 Miner work undor $JOG: Silction 704ll 0 EmJ>Ioveeworklng for Well" only: Section 71153 0 Other: ____ ------_, .. , ... _.
''""IHf-t •~to~KftTV """"f=" '"i;i-."NAT~fii~J'"":~~~~ """"""'·.-.q-ti~Cit AUTHO.IU%.1:P ACif!NT ; .1_. I===~.~A~ .. ;C:V;$;E~===~m~~~~:;':===~=-==~:::==
f" If ·,~;;rl{ t'J ,;;~·~t~rted vJit·h~20 doy$ -f~~~·d;te l)f issue or BE CHARGED FOR AE.·INSPF.CTtON CUE '!'0 J if ,ID.:!r:!":1~.mo;d for more than 120 ~avs. t:.;s p$tmit wiU bo tNCON!Pt..ETE WORK, Oft FAILURE TO MAKC ~~~ ~ud void. ._ --- I i. iJj_SPf.C'i'OP. Dl ....... -iJ-1(1:
SeptG.;::tw:r 5, 1979
U nco 1 n Ptoperty Compm1y 553 Pilar1m Or1va Foster c·1 ty ., Cfl. 94404
Attention JoM flattm'y
Subject: Letter· of Cor:pHunce for 8ui1dbg Shells Located c:tt V7t!4JL9rang.§_;.;;}.i,(}JL Glardetl Grove - 8uild'ing "/\"
7422. ClrangE·,:oo;.J, GiU'den Grove - 81..dlding "U" 73Gl Jaig Oi•ive, Gar-den Grove - Btd1ding "C 10
This 1etf;el" c~::rUf·ias tllut buildhog sr;e"!1s and p~operty for the ~bove addr~sse~ confilru \·tith the l''e'l;.ri~;c,,;mts of the G:;n~d;m Giove r:.:.trtidpai Code fol" tll2 use, conditions of use, e.nd corlstri.iction ol>;S I"IO[H"OSEmte:J •
• !._ separai;c pemH lviH be r~quired fo:r r.:E:iich tmit inter·ior. Upon receipt of final 'inspections, a Certificate of Occupancy VJi11 be issued.
If you have any qu::sdons Ol"' need a:k.l-1tiona1 in-fon-.JatioGJ, please eont;;-;t this office at {114) 63&-c561 .•
RtWr:~ W "t. HDLLMD. Director Dep::ll":.;;::(i!nt of Pub] ic l·lorks & Oevc1op.'":lent
3y'y;~#~ t::::.·J Hi ng Inspect'ir.m Sap~v·v-!sor..•
cc: Uncoln hopal"ty Cor.ii'J'lny ~~51 ;{~ch"'ison Drhe, S, .. dt~ 105 ln··Jne •. CA 92/15
-
riJJiilBiNG I PERMIT Inspection R!iquests 633-6771
" r.IT!f of. ·f!AROE..J\1 J1RJj\;e Puil~ic 'Y''Orkr. i!r Dcvilthpm!Int
"'!NJP0rind:<J REC(li':ID FEES\ i'or Applie<!r.t to Fill in
General lnformatior; (i38--6661
l-,_-p~-;;;~~s--r--om -l~~"~"o'""'UREORm~ •"-l""""i~-$~. ~fiE-~""'"'""' ~ -~-.. -w~---.. --r-·.--.-.-~- .1/ .:-,---·~-:-- ,. :-1- wute;c,mot !toilcti--~--- ·---·["-- -·--:----" 1 ~<r..,,{~J7' ~"'-".>-• -"""''-"H'" ' ..i:':l /..-'{9/ ..;; ; ~""' t'.omo ~'r ·,, 7-'l' " ,•, ·'' ------------ --· - ---------- ---··- ---+----- ~-L,;_'IJ_ .. · ~- ~·r'"'_"J<;;:: ~---'-"'- '=:;.{ _.a;.7/_' 0'..-:1_, /"'.' t " ~ ._ ·, <= ...._ .tP ..,~.~:o .... =...-L"""' '::;;f 5:Jth Tub · · L L.~"f NQ.. ar;::~'Wo .... , ·-'tf~"f.,;YtTu.l ---:-~Jltl\1~ ., --------
~-~_;,~~"~-~:rnb~~~-1----=-·--"'--· -- 5~~~~~=--~-~-----r-· --J :· .. 1·-··-::-=~-~-=-~-=~ . _j · I 0 5_5 81 i ; _______ I __________ ---· ~--~ ~;~;:;~5:;~:~Busml _ j- ___ ---------1---- O!.'iM"-R·---------· - -------r~wur.e------
1 P.<>U<lh Humbin<t -- - • -- ·------- ---- - --±---- ~~ ----- / ·- 1.' #_'} ~ a I f .. _ :........ · j. ____ ~-'b_a_r;e_D.~Pil~iJ~--------- ......... ___ ----~· )__ _ _ ·~..-:/'"<1-t:"_<f::J,<!'f',} ,;t'~:!t,;pU~-i'?rJ.fiL. (~ \ Gus t'iping _I_ ln!:'!!._d!.~- :rubo':.:!!:'.~------------ ·-------+-±--------~-----1/ "'""'""" s """'"Guo · ~~y-r- -·e1t'f'v--·-
. ·-t~· ·--------"" . -·"~~'·--1-- -~~-···=~~---- r--t...:WI:i'U-,.-,-,-"-"-"'' '1<:;,·,-,;.,'i'ioc'Ui'i:O,~~'"" I''" tier. ouii.iiuw -,;:,,: --- 1 AODITIOt..l.- •~;;c:A 1 r~c::t.1QDC:. ARO.A l Gn~ts~· o::~n •~'1JMC~f~ ot UfH'I'U
r· ------- -j --_---- -------- --------+--·- f'>.Fi_ =-·n,_)b I ' 3.:;; Vent
\ Sewer ;ir J (I 7 g • j ·--.. ·----T-- v<;~IDATION___ --- --'--'; f;::-r_-:-.1.-:j~.---;-~;~;-;;~i-;an~ . -f-~----- t- --- ............ :=c·~= ~0 c. r:; f'/1 '}{:, - rc·:l:~!( :J . : V0G.tH.Jfll Lh,cs t 1 1 'f.>/ r 6 r;.. ~.., . .;!.-'1 Lr ' 1 ~.4 , ~''t'IL r----- ---------- - ----------~ ---·i- ·-------·----------~::""_!_____ - G:_::' -~ '!'-'' ~~~]\ ~ J~ : ·- "''-UMDI~C:. cnN'I'fJ'Ar.-rnn -r ... - ................. a.- c •• -··-·~ ~-f _wzn:'::_Haatar _ • -~--- ·----___ __ ------
' G..::ch:v::lsh
; _ -~~--------~. --""~--------~-· RainwZlter Drain
t '.'!CJtor L~tor~t I ~~ r---------- --~f-~J;;;iJP,-r:tr---------~--~-Jl? j_~ . ---~J!1.1A ____ _
. Sa-;;-cTT;a"iJ(/Reccpto-;s---~=-j-----~;;:;;ti~;;;i:;;ng Machine"''l----1 ! S
1/-'"rliuj)'t ~ 'J/1!_ v;'j~ , a~. ! "_\
- 1 --~---ruc: ----/----1 .. --. , .. u ... ~o·c.~2': __ _
~~=,~~=£.~~~~-··· -r~ lI
0 I C(jrtify "that !n ttw pcricrm:n~~ c-hht:- wotk fer whtch tt'iS5 p.ermit is l='Zucd. t :.hoU not 6fflp,o-tf a:nv ;:mr~on ~'' any monner GO os -:o b~eomo oubjcct to tl'le Worker"• Com:>ansation lawa of Cilllfornio.
NOTE: If, after mok£flg ;r;::.:.::h ccrtifieoto# tho nppHcnnt for tho po:-mit ~hould bccomo ~tJ!;,;(;::;.t to. the Workor•r; Componrmtion provi!;ion:; of thi:; cc.c'o, ho ~hoH fc:rth·~vith cornpDy with the provif:ion!f of Sc!;tion
~ .:Y,700 or hi3 permit thr.:i~ Do d-t·Jnl::~Gf rcvckcd. L:i~ ccrti~v t~ot I h:No rc::1 thi5 c; • .plictlition :mrJ cto1o ~ho1 tho r,;bovc ln
lornmtlun 13 cotrc;;t. I .:::rc:~ tn comiP'V with oil CitY ortllr-lancc;; and Stcto lm·t~ rc~otin[J 1:J ~cn!!lng con:nruction. I further nut.co to hold tho CJty of Gcrdon Grc:•Jo 1rco P':Od hrJrmlcs'1i frcrn .:my lltibil!ty ~:-lo;lno ou , I · rv or b~ily Comoao rc::ultlnv frc;~m work Performed rolavaf .t spor~ _ _ _ /. .-70£
==~~~~~~-R~•~.U~~-PPU~;A"ij!'~Ji!j}~li~TlJRii! ~~Tc ~ IY.iiN .,:fi/uf!~fi'fiFICA.T!: III!FmlMATION I ccnifv that tha foUowtn;t (;ontttJ.t.tor'' U;:;on:::o h·~. end Cle!:;iflc:atlor.___......, • ...__.,.~ .... :....lit i"rl f(Jif forco (lnd effect. c;~,:~- --m_o ;;·ai/Vr=-1t1
--------- .. ... {::1!.--f...- t-L=-J----F-\61------- _ tTEIV1 I _____ CO~E__ _ __ _ ; ~ ~:~;~·-;: CQ. J L I Pion Ret::mtJon Fea I _,__ -----·
· Jf.. I-;;[) ~ ---- ou~:m~o:?:'!l5 TAx Ct:H'r-I}'ICAYr..: rP>. C.1U'fflATION t>ATr.:
r~ ------~~ --~~----=-=-- Pl<1.l Check } I +-- I C(lrtify 1ha't I am l:"t~m::;:: ffOftl: Sc.:ctioft 7031.S of tho 13utoir•c-;:; and
·---=€OJ?liJ:?;~~r:g~i~~!JYfrf2ri-?l=l CPmN.-) coNIRACTon: PAT'C:
ID!:f•JTH'=ICA7!0;,I CODE Permit ------~----""7 ..... "'2.~~--,_ : •:;;;->;;,.: , .:::;- Profeooioncl Co~o. Di·,;,;~;"_ :>, Cfic;>ter 9. ContrGctoro' Llconso i.ww, ~ T ~~~---·------~· r_...._ __ l ______ ..,.._r_______ . ~ -'-~-...,·-~~~-..:-,-::!~~~--- undiJrthofoHc:numgScr.tJC;n· ; I 'I ls-:.uam::e I ·~ ...... ~~ ~&> c~ Ow,rn:::r: Sct:t~tln 7044 [] r.,!jf~:Jr \..~.:ct!t UJiciC;' G-:1 O:J: ~c::;tlan 7048 0
t 1 ~·-~~~----~ A = Employc:J v .. w.rrk1ng f(lr '-"'~,::.-::;: onfv~ Gcttf~n "70£i3 D
; , ,,,,;:-·~ .. ~:. _:; '"'";c,,;;;ii,;: - . .,---:'" ,;; . .. . t~:;;.~:::~Lf-!;,--=-- :=::::::::;,~,":~~:.~: ~::''~:":';,":··::'·~ ·:~.:~~::· , ' 1
I l ~~i 1 h/ ~1 _ 'lE'JLiGf.NCC:, JN<-V "'- -7, :,-:;;<;:, ,;n 1'"1'1 •tne, 1" \"''"E ~ -'"~"=~~.,__,. _ _.,__,_}_M----~~ O ~ • ._~~~-- _l:od:l'~-~~~-. ~~~J ~~.!~~~:=--£~K-4~:::~::~::;::-..:::.::.::~-:~ _ _:::.:-~~~~< ~-=~=-;= i
;___ _, ________ _ r.0~
. _ _l
It
·pllJM91Na PIIMIT IM~~~~eticn Requ..u '03Q-5771
Gel*'ll tnfCimlltion a~-8~61
--Tfj]~tf:I;~~~l~~~~f::~t;~tt PATf:
III:U.INaS!!i TA.:ll'r, CJr"TIP'ICI\Ti"t4'i-.J.:--- kXPICII'"TIOH UATfl:
I certify th•t l· om e><~ompt from SOICtlon 7031.5 of th~ Buslno;s an~ Profonlonal Cnda, OIVItlon :s, Ch&pt~ 9, Contractor$' Llctn .. Lo1r., Ul'dar th<1 follc.wln!J Sactlo~:
I '"""u"..- t__ ..., ,., ... L . f:2 I K""-". Own-..·: Section ,704l 0 Mlr1or work under $_100: Sootion 704.3 0 r · .. _Employee work eng fQr wa911 ON!~-: Uect:oh 705!!1 D
·otM<: ____ . -·--·--·-~·-·-··
-1;;.~-;;o;;:~rY~O'Wfili:i~ ~fit~q~~=i~~~:-Ji;.~J.j~Jijj~i~~g;; P"T~
r .. ;~~:~-~~-&·--~~;~"'ft;_, withi-;;-;;da~ 1~;,;-~;-;-;-~;~cr if ,--, ' L' ;e~. - Af"UMAV""fiE· CHA~GEf. ___ FOM RE~tNSJ:f.cnoN OlJE TO ,L ~~-<.!=~= :nore tl>an 1~0 dnvs. this pom1it •:~illba nuU *"~ ... · . · _ £.~;J~~~- INCDMi'LET~ WORK; on ~A~~~-~-~~ L l!"~~(Jft.,:;·J·()~ -- "'--------- · - _ . , 'l:J.-«>O:.•t•Jt
CitY OF G.I\~DEN"'GRO\'f::~ ~·..,"'!~r~k$·"·~~t.
1Jfsm.rsoN RECCRD
r I
r .. ----
·--, ,,
·-· PLUMBING PEMin . I': . ·~ .
:Inspection A.quttts . 63U771
o.n.rll • ., ... ...non ....... ~::·
WQRK~i'!'S COMPENSATION 1\lll'JIREM&NTS State Compen .. t14>lWP 1'} 7(/!/:J" '1 I nouror.co Polley No. · '!«MplrMtkln Dirt* ' ( 0 I -tlf'l' thlt In ttlap.,/orm- of~ WOI'k tor wtt'-11 thla pMrmlt Is
IHU-.1, I al\"11 n01: tmPIOV tn'l-tllft in •nv man.,. so .. to t>«omo subj.ct to the Worker's CO,._IIIMI 1- of California.
NOTE: It, oft., moiling such cortlfleat«>, lhll .ePPiicant for tho pormlt 3hould bocor.>e aubi .. t to th• Workor't Compenutlor• provlslont
~I• cad•, he sholl forthwith comply with tho provlilons of Section
0 or his permit shall be dlemod r..,ok-.1. o:rtlfy that I heY• reed tnla application •nd steto tflet th• above In·
· · · I lllfH to cOtnPIY wlth all Cltv ordinances end pendlno c(lnatructlon. I funh..- "'"to hold
fr• and lrarml- from any IIMblllty arlt· r~tultlna from work i>•rfcmnld
tt. ~-f
D-'TJJ!
JIU .. JNIESS TAX C ... 1I,..It;ATIC "9• axt"tftATION0~ I cartlfy that I em IKimPt .from Section 7031.5 of the Bualneu ar.d Prof-ional COdl, Dlvlolon 3, Chop- 9, C:onttecron' Llcan,. Law, undar ttra following Section: Own..-: Section 7044 0 Minor work under $1 OO; Section 7~ 0 Employao working for w•gaa only: Section 7053 0
Other: ---···-
CI'TY OF GAf!DEN"'GRO~E.. - 'tlublic·ytorkV,~_S!ev~pment.
S€wer
t.frt!in Or;Ji~ 4lnd lJ-acwum !..ino5
t .. ~<:Jt~1· Heater
B:j!:kwa~h
--m'~PEi'TiON R::CORD
iilUMBING PERMIT- lmpeetio" R_eqv•;M;r 638· . .$771' ·.
------------------w---Gener-' lnformathm
63a.fi661
~----·----~----·-1--' L-=J-1 a r · ~~ /f I I ~:~;f;~sf~~:~~~~;---- -····-· - ·-- - .fJV --.!~~-~~~-~-·-~-.:__L_--~·~---1 ------------~--------- .... . ______ ......, _ _ .::---: . .. . . .-- , r= r WORt<En·s COMPENSATION fiEO!JIREMENTS
'-t"~htcr l.nxervl
' .......... . :-.~w~-----·--+- -·~- -·- ,., ... ~-- ~--
i ~---------+ i
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Stet• r.ompo.., .. domf(' 7 (j ''1/A.I:l (." •1-/- ·JC} lnn:rar.o" Po!lev Nn.'.,~:.t.!t~t~{kp!rlJtlon !:l~t•------1 C f certify that in tile lhltfOrrntn<:e of thtt work for which this permit i$
~ued, I Ehull not qmploy anv pc:-aon In any m•nr;;6r ao ,... to b•c::ome o. ";ject to the Worker'• C~r.tp•n13tlcm l•w• of Ctlifornlo.
NOTE: If, nftor making ouch eertiflcotn, tho applicant for tho pormlt !ihould bocomo subject tQ the Workcr•n Compensation provi~ions
~iSc codo. 11" s:ho.ll forthwith compSy wh~ thf t)ttjvislon~ o• Sr.ction
0 or hin permit :::hall ho deemed rovo~~orJ. ['.. tify ta~nt g hovo f'Cild ~hi!'! o~pllcatlon om! ~tLH.O ti·,n-.: tho obovo In·
..- formotlon f.:; correct. I eurco to comply whh oB City ordlnom::c~ cnt; $toto laws rol~tlng tQ P'JtlUir'fg construction.:- I 'fun:tmt e;,:reo to held tho C;ty Of Garden Grove frM "nd IHrmlr.t~ from nr.y JlabiJit"l ;:Jr!:r log out of I lurv c;; b~llv .P_" mage rcsult1ng fr~m work ~erform_:;l
X-:rol?' ~: sp1
m ~- d,~-&--~,7r...j Fli:~ '~AUT '!'>Jl:HtA."i·u"l: ------~..£-- ~---~----- . ----i'-
3\.!SJN£:55 TJIX (;L§ftll'li'ATE INF:>RMATIOi'll I ca lfV tho~ 'tho follow!fiQ Cor.tra~tor' • Lle<m.., N<>·----~------~ntl Claulflcation....,__,_ ____ .. -.~I$ In f<lll force ~.id effcc.t.
(PRit~.r}-~ONTfillcTor.:r- -.·,__·-·cDg~~·i~::~l 1~~f::T!'C:~rT~n ..... "<=o;.-;;--
--- --~ !lU!S~l~I:':!JG TAX CIEil1'1PICATe NO. mX.FIRA'fl~ttJ unTE:
i certify that l o.n OK""fOP'ic ·rom Section 7031.5 of tho tlu::.inc~~ ~n6 Profcsalon<l1 Coda, Olvi~fl'~ 3, Ch~pt{;1" D, Cotltroi::!ter~· t.=~onc.::: 1.-n·w,. tmGor tho foUowltlQ Ger.. lion: Ov.mrii: Soctlcn 70'34 [j ~l1lnor wcrk unrJcr $100: Sstiion 704.3 C Employc:J wortdno for !w~~r:t;r.J niltv: Gc~tlan 70!33 0 0rh~"~~~~-____ _ -------------~-"
. (P1Wi1-) FRf~t'F.~y·o;J;t.;·;~·· '1~r:.i.:~;~j;;,-;;;z;.~.;;- iJ-I'ttH_._r <.<'!' !l~;""!hc;:itH.,.CU Anr,r~Y
c~,-r~
A·~L:LfJ!AYrn::-n~~~Hf:r;-~t£=;o-·r~·~.·';-~~;~i~ \. ·, rt ;·.j 0u:· E'H .. :GUo£NcE, tNCo~,."i~'l c-r.- :Ne;n-~. •.t~--~ 1 -'\H_l ~iH
-t0E.-E5.!~.!.L0~t!_-__ ........ _ -,~-·-~ ........ ~--"-
F'-
CITY OF GARDEN GROVE Public Works & Development
INSPECTION RECORD
W~ring - Rough
f--•-Heiiter
ELECTRICAL PERMIT Inspection Requests t:38-6771
Generll lnformetion 638-aM1
For Applicant to Fill in
·-""' ---":]
CITY OF GARDEN GROVE Pu'l'i~ Works & Development BUILDING PERMIT
INSPECTION RECORD
Inspection Requests "'38-6771
General Information 638 t~661
For Applic.:.nt to F1ll :n ro;:-:-~------- --==----.-)Fe ____ ---F~~-~-----.---- ------ --------- -- --------- ~--- --------
P _ _;.:c ... _ ~- r-.'i->E:~ j~ ~()A.O SPRI1"iK. APPROVAL OAl"E INSPECTOR ,_._('·..:~· r-u·s-;"___ ~ FRONT' LEFT T RIGHT REAR-: ----------- 744_L_c·_R - --· --~ ZQ:\JE. r -· J-· ------1 ;:.\uNI'J~TION & LOCA"TION i:.OT NS; . Bl.K l'iO: ~R~--~wMrt NO... I F;"P-~--E.,?-o,. ..J /: : .-~- ---'---- /?-/ J,-•5,):__! i --~ 0 9 j S g 1 zc;N"E • lS .:_: ~-~---~>1'- ~--f't_;------J -- \ C:O~CRETE FLOOR ,L.! ¥~}:! /.?t..t~- __ I __ ;,'t;l __ 0 R :,:-~'.'. ·,:; ~ ~.:d- s' 0 ~: \ T ~-t::' ~- .t ~~iNFOR~ING 0
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STA -:-E :...1.::. ~~'::! ~ -..-PE
3J7.:-<""' - ________ :.___:::___~ . ,,~·:;~' __e·Q'~--[,~~;-= -~-~-- ~- t~ -~ --r ---- st, y if .;;_ ;;-;? "'"' I -'''"·"'""' I ' ' I ~ fJR,-I2L_.CWLfT r'
:;_..:; :.;..:.-.,.- - S. ---~- -- . - -• =.:::. -.:;.. ..... -·
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~!:ES A,IJD BONDS ~--------_ _;:_:·,:._:__~-_:_-==-~--rzn:;·;.._/;~~-~- -=-:---Jco~.RA~ToR ___ ,__ ~- -=---------<Ev cocE: AM-OU~'<T ___ 'T L -;y RE.E->SE I 1 I(,; l I .M_; 71:. !LF_.Id __ ~ ----L;£i.JJII£_j_
;::: ..... ::-:2
MAIL.ING AOORESS '"'::"1':-" :tiP
-o- s: ·.::- ~ IDENTIFICATION CODE ' . I
·;,:...-::.::-:3_•.,= j "'E- ~( ..... 1 s-A...-E'--· • .. .;:
t )N REQUIREMENTS :' ;-+9'- d l ~~~ I ~~:~;:~E::~c~~!~r,~~2-;· ~:~~·~~~:~ .. L·i( ~j ~
. .-... ~ -:.-= .:..~s·~"T ~-:.. c: ;::; ::.:. WORKER'S COMPENSAT'C Sta-:e Cor.oe~s.atior: 1-J I i d i . . ,~ .::_ \r· !nsuran~& Po!rcy I'Jc _l._W,,_,_, ____ Exp,r-at1on Date~.:.£.-.j __
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L~------
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TOTAL FEES
:::. ·-1 ~ ....-: -/,..,._
I 1 ----.,_-""c:~~IJ·
·-. _.-:<_. /7,.... --~~./ .,.J" ~ I 7
-- / ·- ---- ---
= ! c~rtr~·y ;r,a-: :n ~e ;:,~~fo. r-'3r'!Cg ot -:ne -.·.-·Jric. for v.hic~ :r-.is ;::iH'T:·t IS ·ss·Jea l sha:i .,o~ l?,....,olny ,, ... Y CtJ•s~r: :1"' <~ny manr.sr so ;;:;; to :.'oco·ne su~,ec~ tv tr:e ·,•.on~.er s: -:ornOIJnSJt·or, law; of CaH"o•-·1:}
!'-~QTE cl~ ~&• ·•:J"" ..... _. ~~- . .:>#!•" ·..:a-:t• -,:.-,e ,1~1pl,cJn! ··~· ~ ... ,..:- ~)l?rn· 51""1-:)~•c ~;Cl'-::c...r....,o su· ,"·-: ~~ tn•J ;,C'rl,;~r s CO~ir:e~5.Jt .:'"" ::·ov:SIO~:.; :::~ ~ni;;. cc:_,e '"1e s~ail ..:or;r,_· ... lt~ ;.::::-·:=1y .·.i~h tl"".!? ~ro,.•si~rsct s~-.::~10.1
-ij ~~~~t~~ r~~a~8/·~~~.:;:~:dt:;hf::;o~~;~7o0,.;:~d srate rha~ tne e>.bove in-fol"mation ts correct. i .agree to COf'l"';OJ!y with all City -orc•nances a('ld S~.are laws ;-elating to pending ccns:!"uction. I further a;."'"<Je to hold -::he Crty of Garden Grove free anc: !'"".a~rnle~ from anv !!ability ~ris· •ng out of injur1 or bodily da:"""nai;e rez.u.ttinq from "·..-cr..:. Der1or~ed relevant t~thi$ pf}rr-:it
:5'- 3/ . 7 'i' / ch" ·w !1'.~· ~ -"-'?'-"'-. ·-·--·· -7 .... :~~ .. ~~--~F..:I..~CJ(if SJG"--A~~~E
ou"'""c"" ,,.x CERTIFICATE INFORM~TION_._ ~ i certify that the t'ollopn~ Contractor'~ Uc~ns-e !'-Jo. '1 I 7 => .c-; _.
a~:-:>C_!!!!!fi_ca~:)n ;:1..· • '. ~ is: :~;un "force and effect- ___ ~. .... _ ~N c ,--.,,,! ,,.,,. lvc·~.c::;.y ~_j__ 1PT<'I'IT} CONT-.:AC~OR (Sl.:.NAT:.SP£:.!~0NTRAC70~
QS:, AU"':''""~ <:CO A~FNT
!lUSI"H~::55 TA.:W. CE.UT!J:'ICATE '<tO, I!.._..""IR~"!'":=·~ DATE
ceni:''r ~~at 1 am exempt tror.; Se-;:t;vn 7031.5 of thll S..1siness ana ;:;.o<fess.ional Code, Division 3, Ch.:~.::rer 9, Contractors· l....i.c:ense La·.-. •. ~ nd~r tt-.e following Se.EJio:~: -. :: . .v,.,e:-. Section 704..1 _ M~~or •-·.-ork under ~00: S.ec-:-·on 7048 ~ ·~r j:J;VvH• .-..;~,..;·..;.;;;;;; ~ur .-.-~;c:o ~:1!V- S.!':~~~..., 705'3:.......;
-------
;~_ D•~/v't~~/1-iC -.;..:.<J~- '-- \ j ____ --~ c>:: c£-.t._;_L~~-?.2~)
:E_~O: ~:~E:"· ~-~~~~~~~~:~~~D. ::·;)~,c:~~~·;; s ~ cT.12..J,./...f·J.. ST":;;!::.S___ -l'~;.,...s J ·~ ·.· .. ~rk-~s r~c: s:ur~.;-:.,...::--;:n :20 ~.a..--;-:-;;~ .. -;;; ~f ss • y- ~- 1 ,::~-a..,':!c~ec ~cr mote ":he- ~ 20 .ja·..- s, ~r s- :-o:'"rr • .... , oe r· Jr~·~ -. .:-'::1
-~ =::E·-~-~, 3E C1--iAP::-::n :=oR =1:: ·~s::;EC• C'\.-O~E l-2-....,.::_~~ GEt...CE '"\.iC0'~1=·_::::-t: l'.C.?~ ca :::~ L .... ~;::TO \.~A'<'= C:C"RECT'.:J'<S. -------------------- _____ _ i
RELOCATION i Other: _______ -:=-----.---~,-.:>=t--,-,i--"=-"'a1a~·"'*' ../_~ .tl•..-~-·~.1 A~ ,r--'1'"/,--~~- ' } · cf"I"~RTY OWNER" ~~owNeR I JC".~:,.._:....:q-:;.. 0'"~ 1-zEo AGENT
:·;:~~~~~:~ . . . -·-· . . . . -~ 5'· 31· t'J
ClAn. lAODQESS
CITY OF GARDEN GROVE !Ovi'NO·---- ··--- ··-·-·--·-- --- -
' L ___ ..,_.:.,:1;;~-l~.L - /- :~: -~ '· ~
PLOT PLAN PUBLIC WORKS & DEVELOPMENT 1
I ( . ' (.
·,'/!(>'·.'.' .. J ·----~ ........... f.
t NAME 0~ .::C>N5TRUCTION \.ENDER Br: BRAN<..tt
1, .• , .... ,;:--;«:;:··-·ij""""" \
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l__L·~-L(c j ,., ODh.!"SS
L _________ _
•
.AN .A..PI?ROVt::O 8¥
J~ : ...
CITY
S.HVW NOH r~1 /~lrh'OW. t-'IIOPERTY LlNEt;, "'"0 ADJACENT S.TFH.:C T~.l
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.:' g,,,d,nq !rl"IJ ::'2 /l,s5•::oi.O' .::3 PcrmiHI:!f:'=·! ~ -•· 'C(:tt. 1 , ~~H.~ nform<Jtl0!1 llr}•r.oon 1·, ,:orr·pl~~tfl,lf'"!d COr'l'l.~i
CITY OF GARDEN GROVE, CALIFORNIA ! 1 l91 ACACIA PARKWAY. P.O. BOX 3070. GARDEN GkOVE. CALIFORNIA 91M2
Dear Applicar:t:
8ebe your application for a Business Operation Tax Certificate can be processed, it is necessary to YBrify that your buslneell ~ conducted in accordance with the provisions ol the Garden Grove Municipal Code. IN ORDER TO PROCESS your certificllae, answer the questions below and retum the form along with your application. Thank you for your coo-;>eration in this matter. Please print legibly. Business Address ?:iJ ~ or:,\:\Gt:::co<~ AVl ..... GL\Ril.:l2. .. GRO.:V..:.:. CA .. 21611. Unit!Suita ---- .. -------·----Business Mailing Address _ _s,..._:,.._,; ... :,_, _.i_.,\S..__,._.:,""':;;""o_._v .... E ___________________ _ Business Name__ T;!Q"~--!L:~s'3-·':.'-,;~r._.:;.u:;s.l.ii3.::-r:-::..l~-------------------------O\!«ler's Home Address (No P.O. Box) __......._.."'-...._·_.._,.u:..~.....o;u.....J...w..I.LJ..au.~:.JJ...J...':;...--J...:..i.o.J.~-"--__.._~.~---------·Jill Owner's Driver's License Number . ____ _ Stale Contractor's License Number ....• ..c.~---· Class---··------------------Resale Number _;;;_;:__2_~:.. :; -=-=-~-~ .;.u,L ____ Total square footage of proposed use----------------; Nt8wer all Q'-dStions and check appropriate box.
1'ype of business 0 Office Only
' 0 Retail Sales (] Wlolesale Only
· O Combination __ % Wholesale Customers __ % 0 Industrial/Manufacturing O Other __________ _
This is a: 1Q New business in Garden Grove 0 Business name change (previous name)
Retail Customers 0 Address change (previous address in G. G.)
How many people are expected dunng peak b_usiness hours? __ Employees _L Customers How many business vehicles art: used? '' - 0 -Trailers
YB 1. Wtll chemicai or industrial liquid wastes be produced? 0 2. Will there be any welding done? Acetelene, Arc, None 0 am~be~~~ 0 4. Will there be use or storage of more than 5 gallons ol flammable liquid o! any ty!)e? (flash poir.t below 100°F) 0 5. Will there be cutting, shaping Qr sanding of wood or wood products? 0 6. Will any processes involve the use of hazardous materials? 0 7. a) Will there be dining, dancir.g, entertainrnent or assemblage of persons? 0
b) Will occupant load be greater than 49 persons? 0 8. Will there be storage of materials exceeding 12 feet in height or tire storage over 6 feet in height? 0 9. Will there oo repair of vehicles beyond the simple exchange of parts? 0
10. Will you be selling or showing material (movies- books- video) depicting specified anatomical areas or sexual acts? (See Garden Grove Municipal Code 9216C.3 for definitions) 0
11. Wtli you have employees or yourself modeling or entertaif'l!:lg for someone (customers) nude or partially nude, either at your location or being sent :o other locations? 0
12. Will you yourself or yocr employees be giving massages or manipulation either at the location or after being sent to another location? 0
13. Will your business have rap sessions or counse~ng sessions efiailing sexual activity or introductory serviCes? 0 14. Will your business offer any type of service or product or entertai'tment which is characterized by an emphasis on matters
depicting, describing, or relating to ·speCified" anatomical m::~ters as stated in Garden Grove Municipal Code 9216C.3? 0 15. INill your business be operating anything ;nvoMng gambling, bi1go, horse racing, or games ol chance as stated in Garden
Grove Municipal Code 8.20.0'i0? D 16. Will your business be involved in ;lalm reading or fortune teli'lg as stated in Garden Grove Municipal Code 5.65.010? 0 17. Will an alarm system be used at the location? :;, ~ vO p:. _ :.; : ~ .J :\:, ~
A. When will alam1 system be operable?---=---=-~::::-::----::::-:--------·-------_;,~ B. 'M1al type of alarm system is to be used? 0 Robbery [N Burglary D ~ C. Is the alarm·
Q Supervised - Alarm company is instructed to call you prior lo calli:19 Police Department if activated. 0 UnsupeMsed - Alarm company is to call Police Department upon any activation of alarm. 0 Audible- Aarrn only - Also known as l.oJ?al ~·~.alarm ,gj{Tipculy ~ ~Ved- I..., , ,, Alarm company name and address: (Name) ·.;.;~;-n,;c ~LCUlU n ;) . -'"'" ~.. ,_\ L·~ • 9271S
(~l----------------------~rr~~r~~---------------~----------Primary person IQ Jl(ltify)Q iP1 ~: (Name) ~·:.,;y,y;;.; ..... ~ion;...,.......,...,,------...~·..-:.- --:+~1"1""-------'!!!1! (Telephone ll') .;;j,.)- .:l~-.1-;;:~~'t - (Adclress)~~~~~~~~-~~~·~~~__9~:.-n-.,.., ...... ..-i
