·.ทท.· .. ~·BUilDING P·ERMil •

·.··.·.. ~·BUilDING P·ERMil
DEPA~TME'NT
or 't>Ut~,orNo
• IM~rv; o,~t~~oeN
•
Remarks
I certify that I havn
d this application and sto:~ that the cobove infor~~~----------------..,...---------1 motion Is corrccr. I ogrec '" comply to all City Ordinr.mce• and State l<1ws
-:==:~E~~:c===r=~~~==~===Jt~~!Qr:==:t
-::
relating to building construction. I certify that in the performance of the
above work I shall not employ any prHsan in violation of the labor Code
of California relating to Workman's Compensation Insurance. I fc•rthcr
agree To hold tho City of Gordtm Grove free ond harmless from any lia·
-------------+-··------i--"""'"•"'--''----""--·--1
Roof Shtg.
--·-----
---·-------JL·~~~L-~.:::~~:-::=::::::=
Rougn Frr.rme
------·-·
--·---1------
loth or Drywall
. l·as. Brown Ct.
P
Other
_F_in_~_f _____________
Utility Release
blllty arising out of iniury or bodily damage rc•ulting from work p<>r·
relout'lnt to this permit.
CONTRACTORS SIGN l\I:LOW
that I am " licensed contractor nnd tiwt my locense Is in full fqrce
form~d
------------iVc~;;;;~:"-'-"::.:-=..:...::..:=
.,..- - ----:4-~'
.-'--~..:-- .///
/
...--·..
·:::0.:-!..::'... B ~::.:c.:-~~;~.'..:~-----·_.:_ ___ _.
--'-·
./..
KUthoriz:ed Ag!:!nt
1
OWNER-OUILDER SIGN BElOW
DatEr
i'> .J,>;j
I C<!rtlfy that I om cxcm~ot from the provisions of Ch. 9, Div. 3, 6 ond P.
Code (Contractor's Licon>" L:;:w) because (chcck on")'
I om :he owner of the ..>bovc property and will pcrsonolly porlocm the
above work.
I anl the ownor of tho c.bovc properly ond I will cMiroct to hov•, off
lJQ_::i~_:-.::_!~-fj,~~~::::::::=::::._--------1
of the abovo work pcrfonnod by licensed conll'oUor$.
O I om tho owner of tiH' t~bovo proporty ond will crnpk•y pmst•ns to pMform ,10 above work with wo9on ''s their r-:)1~ compcnr,orion. I will furnish
·-'--------··---- ·-----·-·-·----·1 in,uranco for m" emplayoos "' rcquirod by the• lobor Code of Co\ltorni':l.
-.---·-------1---------------------l
PLUMBING
PERMIT
..
CIT'f OF
G A R.D'E N G R 0 V E
....
)
..::......
537.-1200
-- -·PERMIT FEES
lYI'I OF fiXTUitl 011 ltiM
Water Closet (Toi111t)
•
',--···
·-~ 17"<"
$1.SO
···-
Bath Tub
Floor Drain
Dish Wash13r
Drinking Fountain
-L-+-
l.SO
BUILDING PERMIT
Owner ~'
PlANNING
lz':,EN- -~-:_- _--_n__--__ --~-~-------~-~E-~A~~.~~a~EA~p:•so~J~~----=-_-I··-~R-ONT. 1....
'f'-
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,
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0
PLANNING
PARK. SPACES
ACTION
REQUIRED
Zo~i;~p-(;"p~~yed By _.Y':.}2
Date
;;:-,
--~-·-,G_-_H_T_I.--R-EA_!l_ _.M_a_ll,-tn"ii!d:!.':'"l-t..__?-'44:1.!
LEFT_-__-__1'-_
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8: l t( -_C}_
'3
d
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I Tel. No.~"
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tUo 15t2.J/.:.I;!)Jd.. N·(;)t!--:..r- __ )i1._;_!1-·Ha.,:r!.!:2__
I·rei.
Stoto Lie, t-lo.
No.
Arch.
[] Engr.
Pi\lliling Acfdmn-
---c~;y-· -------------zipt~-
Remarks:
Roof
I am a lic~n:;~d contrCJctor <md ~hcj my licoo-::f is in lull fol .:o
J .certify thot
Shtg.
~
- - - 1 an,cl effect.
Rough Frome
----·----------11-------'-j--.....:......:.._____:_.:..:_-J
j ;
I/' j /
COntractor
·
·
Authori~ed At~ont
Lath or Drywall
OWNER-BUILDER SIGN BELOW
-------.--.----------l--------l---------...,--1
1 certify that I an; exempt from ihc pl'ovi•ions of Ch. 9,
Plos. Brown Ct.
Code (Contractor's license taw) bccc,usc (check one):
-0-th~~-------------1----l
l
-F-in_a_l_______
'
-----·--··----·-------·t "'"
V
UT R1
_1_1_11~-~-~~~-e--------·--·----
H~~
- · ·· ··
~'/(.
3 ;
VAlUATION tt?lteNd~~W~~--L~~~t ~~1.: $
....,.-----·------.....;f..;E;;:E;,;S:;..
Pion
......:.. · _.., ·
,
'I; !!f..
Doto
Div. 3, B and
r.·.
0
_,4- ___,_ . _
~i'TU ' (/0
/
LeO)}thW (.eA.i:;:rt::::!_ s:;£{~_H._.A,ILf;~~~tD'"
I am the owner of the "bovc properly cmd will personally porform the
above work.
0 I om the owner of 1he above prop~rty and I will controct to have (111
of the above wark performed by licensee! controclors.
0 I am tho owner of the above properly cmd will crnploy per'"'" to pcrform the above work with wages as th~ir solo Ca.>ipc"'"tion. I will iurni,h
inwroncc for my employee$ as required by tho le1bor Code of C.alifornio,
Sigm>h~r<>
By Autl;,-;, ,.~J AuO.u----·----·-··i)~,"i;; ..
If work is not M':n•tccl wirhin 60 dtlys from dote of i~su~ or if abandoned
Owner'•
Building
£~e.C:k ________.__$____________P~_t:_~i~;··-----...J_~fJ'i) -·· for moro than 120 days, this ;;~~~~~l~l';wll and void.
Bond
$
Exp1rot1on
----..,..---·-·-·-·------····------·---·------..--...- ..- ···---------· .......
---~·-"···~····-~·-""'--·- '""'"' ·-·"-r··#);§~-fr--~-·--··--~-- ~~e;i~~ BLDG.
Perlmi~~~~~~:~:~o~y
T
~
IP~/f-{1
, -~~~~~~;-··-·---~------. . . - . . .::~:;~·5----·
···-·--·~·...............
BU~LDING
~ ~~'; ::~;~/~~ 2/ _['q~~~ ~~~]~:~~~~,~~~
PERMIT PLOT PLAN
I;).,S.tment of IMilding
GITY OF GARDEN GROVE
NAMI: OF CONSTRUCTION L.I::NDL!;R •
1
0
6
JI3~~J;;r;. AN~
OR• fcH
L.UGAL. Oli:5CRIPTIONI
/E"(.I)c.f__w______
L.OT
TR~CT
JOB OE:~Cf<IPTION IPL.EAGE: CHECK)
0
0
Now. []Addition
Alteration
[J Ropalr
USE
DIMENSION PLOT PLAN COMPI..ETELY SHOWING AI.L SLOGS. ON THE LOT AND THEIR USE.
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HOCffE
I'IRML.Y, I>E
PE:RMITTf'.D,
N~..t.'Jfeo
~EE
diD,E
NUM8ER
.01
OR
£loiLL
POINT
Pt::~~.
PRES~
COPIES
AJ'lEBELF..OIFJI.E,
FEE WILL
CHARGEDNO!FERA5U11E5
WCRK IS
-~
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A
J---~~~~;,~:~~PHONE
~·~~lAti~lh-C-orru·----- ----
m
E4CH
TYPE!WRITI'.R
~::;~~R~~ ~-·~~!:?.~\.:¥:. :,l,ELbr~c(f~'~b
.PHONE: 53"/•4200
----
USE
SURE
ALL
A
OOUBLI:.
STARTF.P BE FORI! PERMIT IS ISSUED.
r1 A:K~I 1£/"fR~---__
--t;;:ow;:;-.,;;;ER;--
&how
Residel!lli!..UI & H) sg. ft.
II"
INSTRUCTION!
PERMIT
DEPA"RTM"E~T OF BUIL.. OING AND SAF,.~TY
GARDEN
LOT
... , ---==:-:-:-:::=::7"""'--:-=:--=-:-=-:=::-=::-::-~~~·-::-:~~~---
_
Gai'Qge, Ruid. (J) !9..:_1t.
.oos
p:-------T.Ane.b~~-~"'
---~
· ~-~JlX.Jl.Q9Q._
NEW DUILOIN'; OR
EXISTING GUILOING
OCCUPANI;'f
lJSE Of BUILOIN~ Ah'r,
Servlce, ~hose_ _.______.L__,___ t-~1._9.Q.. ...__ _L,r>C lo!!}~~J-RE' ,' REMOOtL AO[A
NUJB,'~ OL~Nr. '
-!!.•~Ice, Three Phas!··-------·-1-·-1.00
') ".\1'C:~i no.FT.
so.n
~ /.f;_., d:£u~
M.t'ers, Single Phose
.
~
l.OO
O'E'i'ffcTRICAL CONTRACTOR
1 PH NO:
.
1-lf!-t;.
Meters, Three Phase
Pole, Power, Lighl, etc.
.----'---'-"""-'<--'-~~b-PoneiSi l 41
Sub-P!Inels 3 ~
Outlets 1st 20
Outlets Over 20
'
1.00
'
2.00
--1-·
J
1.00
1.00
i!O
.20
-·- ______ V~_c.__S..t.ein_
ACJDRE ·
/__
,
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4/ ~0
or
:•our•
£L.
5
El ectr1 c
-~2-.S..o..... M.e~H>.Se___
VA L.l AT ION
1\lJG 15-69
"-t~
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11
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.
BUILDINI··.,PERMIT
.....
ctTY of,:oAtmeN:GRQ"I
Public Ylarks--• o.votopment
--·
,
;
Inspection Requests
638-6771
.'
General lnformatlo~J
638-6661
'\
for Applicant to Fill in
APPROVAL
I~'
.."-._..~~ .~!1?
=L---
jsouNoiNSULA.t~N
=l!E~::~·G4~ t;.v~~~~----~~'i!J~/I
ZIP
9~/?PJ
s - Compe~~Mtlo~ · _... ·
til!.
lneuranGa Polley N'ttfi;.7~ Expiration OaJ;e ...-,.r • · - 0 1 c-nlfy 1hatlntht perform•~ of the work for which this fermit ''·j
WATE .. ASSMT. l'r:'i: (FT.)
._..'
-~-,.,. '
..
wot:tK.iz.Ec.'r ~L. c;;;'J.SJ.I
·
iteUed, 1 ll!all not .,.,ploy any parson In any manner so •• to bocomtOESCRIBE
·-' aub).c:t ·to ttla W1)1"ktr'l Companution laws of California.
Tn as:: rv-. ... c
NOTE: If, aft:;r m•klng auch ~-•rtlfl~ate, th• applicant for the parrr•it
should bacoma subject to· the Workar'e~ Comptnhtion provlalont
of this codo, h;J lhall forthwith comply with the provisions of Sectio(l
3700 « h;s permit lhaiJ be dMmad revoka.J.
·
0 I certify 1hat I h8va r-.:1 this ..,plication and nate _thl!t the above In~
forrnatiof>;.ls cotr«t. I ..,.. . to comply wltb&ll CitY ordln;o,nc• and
Smta 1..•11 ralatlntll to pandlno construction. I further agrua to hold
the City of Garden Grove fr. . and harml- from any liabilitY arl•
out of injury or bodlly~am... resulting from work performltd
ttl is
•_A,.KWAY.TREE FEE_
I'AFII< 8t REC. FEE (OIST.
D.. AIH ASSMT. FEE (OIS'J:
I certify ttlat ttla following Contractor's llcenM No·----·
. 8fld Cl-'flcatlon
Ia in full force and effect.
(~INY)
CONT,.ACTOfl-
•uSIN···
llliiFK·'i'll'£ii*cr--
,___
A
I
,.~"':z~::~.~::T:~J~--
TAX·CaLIIITJ~I.C:ATit
NO.
-
DATK
RELOCATION
II:X .. UtAT.ON DATE
I cwtlfy thet I 11m ex.,.pt from Section 7031,5 of the Busln"' and
·P'rofe.lonel -Coda, Olvl•lon 3, Cha.-tar 9, Contractors' Llcanse L•w,
, U!'.<let' tt1a foll-int ~lon:
.......... " ~ Owner: ~tion 70<14 0
. Minor work undar.$100: Section 1048 0
Employtc~ wotlcint for W811811 only: S.Ction 7053. 0
-·-- ·
-Other':_ _- ' - - - - - - - - - - - ' - · - - - - - - - - ·
,... ::T:::J:..~::I"l~.':.~"·"
Dl.-r•
1-
....--'-'""i".. "!'f---.--·-·
SHOW NO .. TH A" ROW, I'"OPIE .. TY LINES AND ADJAt.;ENT STREETS,
•··.··r-~.,.~~.,.-~----~'!""1--"""'!.i·.·,-"""'!--'!"-'""i"--~~~--~~.,..---~-r-
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.lil.aililililiilolioOiiililoool""'-iiio.lo"""'M""""Oollt.MIIIi,..__ _ _ _ _ _. llllijill·,..: •
•:ftttfl'ft.;.... !r.. ·b.lcetthtthwoll .•,;
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a-rt iiF G-AfiDIN oRovE ,,
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BUI~DIIIG
~ ~CWG.ks.. 6
- -- Dtvelop'fnent
~
-
OCC\J·
PANCV
OCC.
LOAD
TYPE
usE
z_oNE
FIRE
ZONE
1
_ _
Eav Proj.
Setbacks
JfRONT
LEn
~"'.:...
RIGHT
.
APPROVAL
.. e:AR
/I (
,.,
.......-!
•
~ ,#
DATE
..QJs~
LA.. D-USE
APPROVED BY
.. EMARKS:
•
-
·~-
---- -----
INSPECTOR
1.:atE4-z Eoc~tv
FOUNDATION & LOCATioN
1Lo·
---
--- ----- --
CONCRETE FLOOR
REINFORCING
.
.
RooF sHTG
ROUGH FRAME
IO.C.SANT.OIS.,
IFEE REQ'D.
.
I .... T.. I '" .....
"""
Q-
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IAII.ING AO'Dlft:
a
ITEl... N0--1'/.A
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1"1"7 e·. tt· lllf,.
OWNER
CITY
liP
P.e>IJ!3c:x,jf~rft? ¢h,JAI,J~j 'i'"ZScr:-:.
INSULATION, ENERGY
LATH OR DRYWALL
PLAS. BROWN CT.
S,~,ACH ......:;) .... ~ -..:•\.j.·"JI!...::.
NGR.ADDRESS
#"
~AILING
_,._
.
-
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--
NV,
I
SMOKE DETECTOR
f'EE REQ'O.
·....
DATE
SOUND INSULATION
.
G.G.SANT. 015.1
I
For Applicant to Fill in
Jltlf'.L /9
_
--r
General Information
638-6661
ADDRESS
Fl RE
SPRINK.
-• fiLANNING
ACTION -
••'-•
Inspection Reque~ts
638-6771
INSPECTION RECORD
ft
··-
PERMIT
-
~
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'
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·')"tA -- 1 h":•
c:;;::.A...I
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STATe: LIC. NO ft.: TYPI!;
-..
-
ZJ~$tl.q.C~~~~ C:.£ Ji'!5'"7"'Ji;. :U::
...
=·"·~·~-~""'""'
VAI.IQATION
. I .. I:Q'D , .... OVIDEO
,.,: ~AfiCEL ,.Afl
~~,-
LAND
UsE FINAL
/_..,~-
FINAL , _
~~~--------~~~~~~~R~Ev.~.~C~ODE~~~~A~M~O~U~N7.T~--Jluj,~~~~L~IT~VRELEASE
~----
po-·~e--:.-~~----SJ-..1--:--t-..:......~-r---_;__---:-r. . . . . .-"-l--'---"!-'---'----'-l
~~
WATER BOND
_PARKWAY TREE FEE
PARK. REC. FEE (OIST.
DRAINASSMT.FF,E IOIST.
. ___
F.E:E
.__ 2 tf~~>
.<--·._ .. _ _
;·---.:::m'rJ"'·;·P'I:ANCHEC-K ---
f.'
INE
--.,,; . /'~
tif;uANCE'
lBSi2
oiO'
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· -....1=. .Q_
4¥' tt.7 ......--Co-'
1:
A u • ...
.,(
,_,
.
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TOTAL
FEES
-
_ _
_
(,JftiJifyl
la_
7' J
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NEW
0
J-
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--..,....--!
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ALTEH.)i{ REPAIR
_j_
No. OF _
STORIES
-
· T
.1 ,~ .
C.1~ &
ADD'N
(SQ F
'
0
DEMOI_ISH
0
NO. OF DWELLING
·UNITS _ _ _ _ __
II work is '!ot started within 120 days_ from ~ate _of is~ue or if
ror morP than 120 days, thos permot wol! bo null and
TAX CERTIFICATE IN ORMATION
·
.··
aJ~t 9-z_ )'
'
-
CDNTIIIACTOft
.u .... E ••
oAYK
~t"\11
""'' •
...,_u-.,
votd.
!-'-A:'-:F~E::-::-E-'-M::-:-':A:-:Y~B-:':-;:E-'C~H:-:A:-:R:::-G=ec::O::-:F::-:0::-:R:-:::R:-::E:---:-:IN:7S:::-P:::-e=c-=,-:-:-l0:::-:-N:-::D:-:-U""E::-.-:::-T0
I C41rtlfy that the following CO'Itrector's LicenM .No.
and Cl-lflcation
Ia in full force and effect.
8LOG. I".:.:RM T FEE
1'"}i%t
l
.
__
.I'E
-...-.7"1''7 l
c:::::;
ab~ndoned
-
VAJ;:.~AifON
PROPOSED
BLDG. USE
.aor••
-I
.I"LAN .. ETEtniQ~
...~ ...-..
State Compen~etlon
lnturanc:e Polk:y No:2/£Q.f33
Elcplration Dio.te .
0 I cartify that In the performance of the work for which this ermlt is
iKued, I shall not employ any PllrSOn in any m•nner so as to btcome
IUbJec:t to_ th~ Worker)_ Compen~ti()n laws of California.
NOTE: If, after making such cartificate, the applic~rot for ~he permit
should become subjiiCt to the Work•r's Compensation provisions
of this code, he shall forthwith comply with the provisions of Section
3700 or h;s P.rmit shall be dHmed revoked.
0 I c•tlfy that I have reed this application and stat• that the above In·
formation it correct. I agrM to comply with all Cltv ordinancH and
State ~---ntlatint to1)ending -conatructlon.-1 futlher
to 'hold
the CitY of. G~~tden Grove frM and harml- from any liabilitY ari~
lnt ou of Injury or bodily darnega resuhlng from work performed
relw
to iJ
it.
W.ATUI ASSMT. FEE ifT:r
f-.-------
--·~···
WORKER'S COMPENSATION REQUIREMENTS
WATER AHMT. FEE IACRG.l
- ':·-,·-- -~
Pe.?o/
~~b':rH:~~::~.~~:"::f~:'"
'1'AX C-111-ftTII"'ICATE_NO.
NEGLIGENCE, INCOMPLETE WORK. OR FAILURE TO MAKE
CORF1ECTIONS.
DAT.
RELOCATION
IUf.P'IfiA'TION.OATI!'
.
.
-
-
I cllrtify that I am exempt from sec
..tlon 703..1.5 of .the ButlnHs and IAPRESE. N. TSBLDG.
ProfMSional Code, Oiollsion 3, Chaptar 9, Contr!l<:tors• Lleen.. Law, , DDRE 5
under me followlntt Section:
----------------------i
Owner: Section 7o.M 0
Minor wO..k undor 1_!00: Section 1048 0 MOVING·
EmplolfM working for w.... only: Section 70!53 0
CONTRACTOR
~
Othar:
._• ·CioJWINTJ ,.."NIIYY OWNI<II
·
I_ ... NATUII•I
,
.,.
""0-I!"TY OWNKII
AU,.if'OIItaao A•afCT
·I>A'I'C
iAOORESS
I .
_
..1
D1l~O\l07•U~79
P'.JBLICWORKS & DEVELOPMEN'r
·--~=
·····-
'I•;
·~tZi~
.10• D ... CitiPTION
/241. .:5£: C4.uof?/
GI1'Y
SHOW NOitTH Alt ... OW, PAOI'KitTY LINKS AND ADJACKNT STREET••
.i
I
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Inspection ~ests
741-5332
1:1
INSPECTION RECORD
r~ -,
~".c"
-~t~PE
~
~
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.
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APPROVAL
·-
M.41i!
=-FL=ATKJN
PRE INSPEcnoN
DATE
Oeneralhlformation ;~/
741·5307
f.
Fer Aop!ica11t to Fill ir,
I
INSPECTOR
~-~~~-----·----------.....,
~'s l_3t,;.4-?q a ,.....,.j en
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AMOUNT
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r---------------------------~--------~--------~~--~~<8
~TER~
v.an;;; /.5-EI,(' "EE ,;:; 1
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State Compensation
No.~ Z
lns.:rance PolicJ
D ; ~~lty that in the
"7PE£ FEE
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60
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TOTAL!.
FEES
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1 15c._::.
BUSINESS TAX CERTIFICATE INFORMATlON
I c~, tJfy th.Jt the icJir:·;.o.·~nq Contrac:or .s :.....-::·.·"':.•: ~4r;
an~ Class.Jfrc:atton
15 1n 'ul• '"'":.''"'-·~
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.:)j-
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i
; ,_:;. ~;;;;;~~::~~,:~:~;;: ~·' ,~~~~~=:~= ~· "~-~
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~tify that I have :-r;a:.:: 1n1s appliCGtlorj a!"l.j s~at-e- :---~~
:~::~~=~·~:~:EE
~
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.Exch;':>::n Oa:'=6 ~li?
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511
INSUu>noN. ENERGY
l:lRYwt.u_
CU"iHiJI:;!VH
If -~·.•:,:..
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·~Xt~r::~r 1''Jm &-char~ ?JJ. : :.· :r.e S,.;s\r.::~.: Cr..r....r£-. DrJtSfOn 3 Chnc1r~! ~· Contractor~ Lxc-,-.._s-:? ,__2,..,. ._.-'"'!]-£-' ·-.:,. ".::.•
0f~~~r Sechon iC.t~i.
h.1tnot ,.i":Jr'r' ;,;~·c-:" :320':- 3-.::-·:··:"
Pio.l£'-9 v~S-r!-:mg !~r ,,.. ;~r:.F:-:~ :_,nly ~etten 7'J5 3
I c-:--..-o::fy th6! I
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'Inspection~
General Information
741-5332
741-5~107
FO!'" Applicant to Fill in
»
INSPECTION RECORD
P.Cil
occu-
T'!'l'E
PUK:'f
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LOAD
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:;:;:;:;:m;~:,·~-REINFOflCING
IMSONflY
PlAN"
lt.."'TTIN
"~·
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. ROOF SHTG
I
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DATE
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INSPECTOP,
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ROuGHFAA•.'IE
API'ROJEDs-r
INSULATION'. ENEF:G_t
AEw.RKS;
ARCH
lATH
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MAJUr.JG ADORES.::
c .• ·"
• •
PlAS. BRO'N~'Il CT
~
G.G.SNITCIS
i'EE AEO'O.
I
I I
OCSNITiliS
FEE REO'O.
l.
-----'---
-
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PRE PLA."TE<
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WORKER'S COM
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In rano: Po:c1
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:.: ?AAK & PEC ~EE ·tx.=:-~
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~ cer-~f';· tr-~: m
?f..i'J-, VI/if <FEE FE
i
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c==xr=v:;ruJi? hi'' -c. "':1
'liliT'ER ASSMT. FEE ,FT l
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TOTAL
FEES
,
,
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only
5£.-'-Ct..o.)r;_
5
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for
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_
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:h~:
:..~o~o
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lor more :113n 1HU
I certlf;
1 SY
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PRESENT
- -
1
-
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fLOG
the::
1/(.;r"V. (f;:
this
·
USE
BLC:f_j q.::E
shaH "'C~ 2:~>~1 arr1 person ir: ;!i'!f -'::-:.t·~-fl:."f' r,r; ~.. -t:1 oecome subj?:·O ·--: -,.-'Werk.~ s C:r.r,(.:n5.atl0n laws cJ (,.J" ..(.·,r-1,::
DESCRIBE. VI' r,"'
. .,_
'; ~· ~
_
NOTE:-_· " •• .,. -·''';'nr; scr-h cen,t.c,:r, •• ,, ;.r;r,:v:.;;;-· '? tr.-, pern11t sr.ou'r: ·:.:..
.
TO BE~
oor
-"
"
~- ~_/
wb1e·~~ !~ :~8 V/orlo-.er ~ ~ompr:n~t.r,:- :/~.;."t~;::. ',. ':" ·~n!s cod_e. he ~hall ic,_~~ ~~ · _
~,
~ "§.:.~
co:r:~~-,.. '.Ji-:':_'""= !t)a9 DfOVISKJns cf &:G~o~- JlfJ :.~"' ~i:~- perm1t shall be -~~:··:' --·.
_L
~-"" .
re•m..-.;;-j
.
'
...... ~,.-A.rr.-0'1
0 1o::d-1 H..~~! ha·1e r':'ad th1s ~ppf!Ca~.():... ;;rt'~ -:;::.2~e :t8.~ the above tnfor:-r:;:~ {=·- ·~
corr~.i.. 1 <::.;.~:::! to comply ~h a;! (.;t'f ,.,...,,,;~:a:-.t:.-:·: anj ..state laws "'=!;:r ,·<: -:
~ ~
_
per.c.;--,;:;:;.-.:.;ructJ0n.l_furthe~agre-::·.:.ri'.A~;::.. ,.._ ofGardenGrovr- r::-.._ )
/
,:??J~S
I
':.:·:~::·::~~::
:/
1
---
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RELOCATION
,~;
1
; '
~
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J'·
..
TOM URAM
OIRECTOfl
L Utili EHLIHG, M.O.
I..,. ill TH Ofi'ICER
E.H'YiftOH..DH At, 1-AL nt DMIIOH
ROBERT E WERRVMAI<I.. R. S. MPtt
PUBUC HEALTH SERVICES
~t~,u...:; •mmr~!o Po OOK J~
"!.~.Af~ t A ANA CA 9'2702
ENVIRONMENTAL. HEALTH DIVISION
1725 W. 17TH STREET
SANTA At-4A, CAUFOANIA 92706
(714} 834-8356
September 21 1988
Frank Fossati
Shell
P.O. Box 4848
Anaheim. California 92803
Subject:
Soil Contamination Located At 13642 Eucl'id, Garden Grove, Califlwnia
92643
Dear Mr. Fossati
Based on inspections and field tests conducted on August 2, 1988 it has been
determined that gasoline contaminated soil is present at the subject location.
This Agency is authorized to enforce the State Hazardous Waste and Under·ground Storage Tank Laws and Regulations and, under contract with the State
Water Resources Control Board, is responsib1e for oversight of cleanup of
soil and ground water contamination resulting from unauthorized releases
from underground storage tanks. By this letter. you are directed to concluct
an investigation to assess the extent and significance of contamination at
the site specified in the subject above.
The objective of this site investigation is to provide sufficient information to evaluate 1) the sensitivity of the site. 2) the potential threat
of exposure to humans. 3) remedial actions and/or alternative mitigation
strategies.
At a minimum this investigation should include:
1.
A clear delineation of the nature and extent of soil and ground water
contamination.
2.
A hydrogeological characterization including depth to ground water,
and. if ground water is contaminated. site specific determination of
ground water gradient.
The proximity to wells and surrounding land uses; ana future use of
the site itself.
4.
The potential impacts of contamination to public health and the
environment.
. PERMIT
-
..
.
..
CHARGED IF WORK iS STARTED BEFORE PERMIT
..... TY OF
GARDEN GROVE
---------PERMIT FEES
----TYPI: OF FIXTURE Oil ITEM
No.
--- Water Closet (Toilet)
I:ACH
:L
'
/.
Lavatory
(Wa~h
'-·;.
:
'·'
-
~:Slop Sin~,
·.
. W,asher
. · 1Dtsh
. .,
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I
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I
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-
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l
j
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Drinking Fountain
i Urinal
!Gas System -
I·
1.50 !'
!
.
1 50
ll
l.SOt
.I
I
l
5.00
I
lSingle Dwe!l<ns)~
Only
1
!
Swimming Pool Piping
J
j
i.,...,
.
!Water Softeners
:--
I
!
'
l
I
I
Water Lateral
1.50
Backflow Protective Devices
2.00
r-~hone 54Lf
Use of B!dg.
f----'--:-------- -Yalidation
i hereby ati<nowlod;o--the .above is correct .a!':d
pro~rl:f
tb
I
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Hccn~·!~d :J'li
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,
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,..,.,..,.,.
/
DAtE
APPROVALS
~
i
J
i (
ROUGH PLUMBING
j "!
G~.SP!PING
GAS VENT
----
SEPTIC TANK or Cesspcol
-/ ~.
~---------
i
+--~~-
I
'
---------
_i----~---__:_~--
I·'
,J.'.td?2 ..Jd !~-.-·
!
'
--1-----~---~--~-
-----t---~
--------·--
-t--
--
SEWER
GAS TEST
MAIN DRAIN AND
VACUUM LINES
---
'l . -·-
GROUND PLUMBING
-----
I
un~:"~r
cf CeHfor.nia, or
.,.-,,
' '
SOit PiPING
l
1;\ri~h
s~~k!
/2~~L~~~
~r· /'?0~:?'(.'
Addreu
l
reghH'r-et!i
•m the legal owner of the .tbove d-escribed prc;=:erty.r or;d I C£?rtifb' tJutt ht
the ~rfcrmmnce of ~he wcrk for whic:h ihi:t pcrrn~f is ~s.s.;.~cd G shi.'IH noi
emp {)y ll'l~' pencn In vlc~atic:n of tha wcrkr:1en1 1o c:~~er..set~on f-'lws of the
State of Ca~ifomia..
l'ermlffee
1.50
~ackwash - Trap
. Plumbing Contract
---------Contractor's Addre
--------·----
Signature of
2.00!
1.50
_7_
I hereby C!!rtify tho! I un
1.so I
Automatic Washing Mach.
fJ c
r uired b y tho Ci.ty c:f Garden Grove ar.d/a:r
1.50
1 Sand Traps
Blk. No.
Tract No.
regul•tins plumbin;.
fn"'
I
f
1.50
--"_;___
- - - - - - - - - ---i $'12. New Bldg.
+---------t
! 1.50 i
Outle~
' Lawn Sprinklers
1
~--
:
'•
I, 1.50
I I House Sewer
--
1
t 1.;)··o··-1-.
·:·-
11.501
' -1
.
•
! Fl()orSink ~: ~-
~ ] Floor Drain
.
001
'
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~
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____lj.5o I • - I
I
_ :
tot No.
No.
~>~k] .~. ,~i -~j-· c.: _-.~- ~;-~'-
/.Jc; "'J )_
~wner
I 1.50
-.,
'·
•
'-"2
·-
1;50
'
Laundry
Tub··:-or Tray
. - ..
.
't ·I
.:.,
..
::·~
Disposa,l
_L_J_Water Heater
_L
Basin)
Permi~
Owner's Address
1.50
---
(
!
1.50
Kitdien SioJc -·
Qa~bage
~,be,
1.50
Bath Tub
-Shower
For Applicant to Fi II in
Job
Address
FEE
$
S1.50
IS
ISSUED.
537-4200
~
-
INSTRUCTION: USE TY?E:WRITER Ofl BALL POINT r'EN,
PRESS FIRMLY, BE SURE ALL COPIES ARE LEGIBLE.
A 0\'lUI:lLE FEE l'llLL BE
NO ERASURES PER.MiTTED.
·---
~----- - -
WATER HEATER
I
TOTAl FEE
Permit Authorized By
1. lNSPiCTOR
BACKWASH
2
Issuance of Permit
-""'
~IJl
...
$
Date ltJ
1'7f
00
'\1'.:)
-[2 -IJ_
WATER LATERAL
FINAl
UTIUn' CO. NOTIFIED
l
-~/ :..~·:::;/
2)
,
•.
--/
'{::·.-~:.. ,...·{~:;:/"
,,
1
JSE
ZONE
:Zoning Approved
By
··/E. ~M
Dote
Mailing Ad reS$ _ J
.:1- J ] ... !:, 1
City
lip No.
~--fru 1,.V.>\ t-t:t.c' \1 "'--
G::>At:-1Xli 0ti[·'I)C
"101 -1...-
l'emarks:
~·
-:;Wc=cot:.:::e•..;.As.::::sm::.:::.:..t
• .:..:fe.::..e- - - - - - l - - - - + - - · - 1 ' - - - --J:•::...L--1
· fire Hydrant f.F. Fee
_VI -r ·1-
~~~~~~~R~W?-(1<JC( ('1.(f1S. "1):. E-.L{jG
J 3 ._,. 4 2. -Cj ~--t"-..£-=-.-!.-A-:.~(1;>---- NEW (g"" ADD'N [J AlTER. 0 REPAIR 0 DEMOLISH 0
Landscape 8ond
·s p ~) sq .~, ( ~
FLooR AREA A -'7. ""'"""
1STORIES~
No. oF
No. oF uwauNG
__;~=~==----....,-&-lf-r-=o:~~---"'--'=-----'------I(SQ. FT.)
~-"?Vv
. UNITS
Porkway Tree Fee
4&<...,
L·l
_R_e_m~a_r_k~s-------.,.,-.......--~------------1
RECORD
.. .
.
----.. . .-----.,.------------.. . .-__:_,_...___-1
INSPECTION
.·
-
I c:ert·ifv that I have read this oppfication and state that the above informotion is correct. 1 ogre-e to comply 1o all City Ordinances and State lows
relating to building construction. I certify that in the performance of the
=-:=:-::-::o:::cA:-:Pc-'P:--It'-=Oc.V_A...:.t-::----±:::o...,.-,c.D:c:A...:.T.;.:E=--.,--+----.,--,::'N='S:...P...:.ECT..;:..:..O-"'.:='R-,--.,-,--J _above wo..J: I shaH. r.ot employ a_.'ny ,person in vio~ofion of the labor Code.
Foundation
•·• ·. ·
~ "' · ·. ' · ·
·- ,. ··: ·. · .
.,:of· Ca1Jfom•a· relot.ng to Workman s Compensot•on tnsurance. 1 further
,...,.0 t·100
~.
"'J~
J._~,.
agree to hold the City of GOrqen Grove free ond harmless from any !; 0 .:.
l
and
~~~..,..~~~~----~t_~l.~~~-z;..~·~-w~·~e~·~~!_.,_·=·.. ,WLJ~cL:I~~-:::..::::::::::::-..:::::~.~ biHty <:;rising out of injury or'bodily damage resulting from work per•
_R_.e_i_n_fo_·r_c_i_n_g____~···F-----::•_'·._··+----'__··_•_·_·__· _··--l~~·(~leV'~.to•tt>;.
·~.i
Roof.Shtg.
.,
-~·
,_ '···':'P:~/':;.;,.:
pe~~TRACTORS
SIGN BELOW
.... ···.
:}·certify tiJgt I a?/ o licensed o~ntroctor and that my lice~e is in full force
..,. . . ..
Of\d eff~ct.
,.
:.:: .: _:_: _:. :.:. .: :._:_____--t~.:z_:___+_:~~'L.:_..:!:..,..~:=~:::::::::_:_._-1·~~,L
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Authorized Agent· tr...<.J:<...t;..,._._,._.,,.,
IJ
Dote ..
' · .J...:.'-' D --~ · ~~ 1·£.-··.•~,...-.·.~~-~ (!=--f_:;!Jr-· -· ·_·_.
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TIC- I~'- 0ev<'· ~,p...,.........;;;r ....,.
,l<!rm Cf ryWOll& ;.." 1 2 ·.r'1"!~~
~~
·
dWNER-BUILDER SIGN llF:toW
Pies. Brown Ct.
~- ,·
t certify that t om exempt from the provisic-ns of Ch. 9, Olv. 3, B and P.
-
·=-=====--f C.:> de (Contractor's license low) because (check or.e):
.:_:::::._:::_:::~:_::..:..:.___}J.J'!:=::..;-:J-~-:::,.,./e~~~:!'-1-~':;:~~·;,.~,:~~TC:::'.
. her
Ot
.· , j·
..
Final
1/(J ~U,--"'C
0 . abov-e
I am the owner of the above property and will
work.
.
r _ l-U
·
~
personally perform the
..
0 I om '!he owner of the above property and I will contract to hove all
,.. ·"··.. of the
abo.ve work performed by licensed contractors.
-""--"-'-"'--------fL='--==--+---c.c.=------+,-I·O l·:a·ir(ih·; owner of the above property and will employ persons to per·
Utility Release
I
·.
1
. . . • . .
_
fann the above work with wages as their sole compensation. I will furnish
-.{-A_L_U_A_T-IO_N_N_O_T_E·:-IN_C_L~UOE LABOI, MAT. $ '. •\i:;j ~..-:ihf1:-:,J:...-'i' ,:--· l~t{f'I'P'·tor "!Y ·ernploye~.<:!S required by the Labor Code of Colifomio.
· /1C.
" ...
~
Pib~
Check
Bond
·"
WIR lNG, PLUMB., HEAT., ETC. ...!,;:;:::::::t:=.:~~~!::;~:::::=l
- r-tf~S
J flO
,~
$
$
....,., J ,_-
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A,-..;,' c.,._ J •, , _..
Building
Agent
·---D;ie-
Is not storted within 60 doys from date of issue or if abandoned
for more than I~() days, this permit will be nut! and void.
$"t A r ~"
Pe,~rm~i~t;-...:_~·:..:.·.!'J:Jl·6-f~l:....-.::::::~----·----.:rFir~'Ti'nN-------1
Expiration
Date
RELOCATION
I
..---~.,........,...,.........,.._._,:-=--~~-~~~:...J--'-~·"::.···
II-P:-R-ES.,..E..,..N_,.T....,.~.,..,LD_,G,_.-------------------------· ·· ·
... · ·
· ···· ··
ADDitE5S ·
· ·· ·
----·---...-------·-·11.,il.·illm-..u:ilit.~OI·:,ili l .•.•.'!'",_.._.. .._..Aii i oi i oRii Essii il·_....,.._............. . -t~·..
lill"llilliiiBt•d•g•,tllilins•p•ec•t~-/~·-C""'.·....
"'
....M........,........_··_.~..Ii_;.·....
·"'
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· _.·~.....~,.~f-~::~:·j:':.··.lliil~
Permit Authorized.By
~.,;
,q=-~:-.,-.~_:-,~-=~:-ig-n?-,-u,-tt-.- - - · - - - B yAt~rhorized
· If work
.. llii:·,
f!:::/
Date
.,..., ..., ,, , ...............,.!.:'.'!
. . .BUilDlN G. P.E.R MlT __
PH. 537-4200
FlltE ·
ZONE
occ.
LOAD
Remarks _____~;-:;;;;;;:;;;::;:;::;-;;;;:::;:;:;;~---------t~~l
... . . . . . ..
read this opplkor_ion and stat" that the above infor- ..
motion is correct. I agree to comply to all City Ordinances and State laws
----~;;;;;;;::-;;:-;--~-~--;~;:;;---;-----;;:::;;;;:;;:::;:;;:;---·-1 relating to building construction. l certify that in the performance of the
=--~ :.:.:.::..;.;:..:.:._~-+-__::.:...:;.::__ _!-_ _ _.;;..:=.:..=..:..;:;.:.::.._ _ _-l_abt:>'!':E!.:WOTkl s_hall not emplqy O"Y per&.<>n in violation of the Labor Code..
7
California relating to Workman's Compensation lnswance. I further
to '•old the City of Gorden Grove free and harmless from any lie·
arising__out of injury_ .or boclily damage resuhing from work perc.. ,
relevant to this permit,
Reinforcing
CONTRACTORS SIGN BElOW
} -onrn--l.icense•d contractor and that my license is ir full force
"Roof-Shtg.
OWNER-BUILDER SIGN BELOW
Plos. Brown Ct.
1· certify that l om exempt from the provisions of Ch. 9, Div. 3, S and P.
Code (Contractor's License Low) because (check one):
.I am the owner of the above propllrty and will personolly perform the
Other
above work.
O I om the owner of the above property and l will contract !o hove all
~-~~in:_:.-~a~l______:_~-fLJ2,~U~LJq....:i..{..J,~=::::::::==:::::-~
of 1he above work performed by licensed contractors,
0 I om the owner of the above property and will employ persons to perform the above work vtith wages as their sole compePsotion. f will furnish
-:--:---,----:-:-:-,..,.-,-.,.--..:......-.,.-.-.,.-,~,........;c...,..~~-----....-....-----+Insuronce for my employees as requ:red by the Lobar Code of Caliiornio.
------------------[----------"-----------------~
O
IJILDING PE.IT PLOT PLAN
..... ·..1! pul)i.l. . Of .......
ertt·
.. OF .•ARDEN
.
.
. &ROVE
,
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'a LOCK
T!'f:ACT
J-~~~~~------·-----~~~----i:~IT~Y~.~--~--~~~J~Q~&~O~E~S~C~Rril~P~T~I~O~N~t~P~l~t&As~E~CH~E~CKKti---------------------L---------------,
0
New 0
Addition
~t«ation 0Repcir
0Mo"a
0Demuliosh
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BING PERMIT
INSTRUCTION: USE TYPEWRITER OR BALL POINT PEN,
PRESS FIRMLY, BE SURE ALL C8PIES ARE LEGIBLE.,...
NO ERASURES PERMITTED. A 0 UBLE FEE WILL Be.
~-·
1".-'i
CITY OF
GARDEN GROVE
CHARGED IF WORK IS STARTED BEFORE PERMIT
ISSUED.
537-4200
For
to Fill in
IS
Permit No.
PERMIT FEES
TYrE Of FIXTURE 01 ITEM
EACH
Water Closet (Toilet)
~th
I
$
$1.50
Blk. No.
1.51)
Tub
Shower
1.50
Lavatory ('Nash Rasin}
1.50
Kitchen Sink
1.50
Garbage Disposal
1.50
Laundry Tub or Tray
1.50
Water Heater
1.50
Slop Sink
1.50
Plumbing Contra::_~AfL}a_L1/
Contractor'~ Add~ess<;,~
f?];:_j£]?}/'-
r Llt..JiJFJ:ll'' Ld.." v~~v::Z.
City Lie. No.
.50
1.50
1.50
1.50
1.50
Drinking Fountain
1.50
l.50
Gas $ystem - Ou11ets
5.00
9)
2.00
__/
---------
PERMIT
.•. PLU-MBING
...
.-
;,;,·.
C1TY OF
GARDEN GROVE
PERMIT FEES
....
I
-
INSTRUCTION: USE TYPEWRITER OR BALL POINT PEN,
PRESS FIRMLY, BE SURE ALL COPIES ARE LEGIBLE,
NO ERASURES PERMITTED.
A DOUBLE FEE WILL BE
... '" -·· .
I
-TYPE OF FIXTUIIE 01 ITEM
fiAC:H
Water Closet (Toi!et)
For " -••
Bath Tub
1.50
Shower
1.50
lavatory (Wash Basin)
1.50
Kitchen Sink
1.50
Garbage Disposal
1.50
Laundry Tub or Tray
1.50
Water Heater
1.50
Floor Sink
·-·--·----
1.50
Dish Washar
1.50
Drinking Fountain
1,50
Urinal
1.50
Gas System - Outlets
1.50
House Sewer
5.00
j'Single Dwelling)
lawn Sprinklers
J..,
-
NewBidg.
-~
----
-----~--
.
--y.
/f>t -f'' "7
?y; ._t::_Q__J::_/_.,//J.··
-
.:$/?9'-'-
3 _~i~-~~---~~: ---------~-------
--~
---------··- -------- -----
Old Bldg.
--
0
- --:;~:L 2-7-78 -----n-674tJ*·~:·-i; ~~~·[:H-.Ou
Validation
I hotreby
- th~t-1 have re~d ·Ibis opplicatlon • .;d state- that
1he above is com1<t ond l!iJree to comply with ell ordinances and Stale Ia~
regulating plvmbiRSI.
I
15""o
I hereby cettify tho! I om properly registered witn and/or ll<ens<>d ~•
requirwd by the City of G•rden Grove anti/or Siale of California, <:>r tho! I
am th• kgal owner c;f the •hove described property, and I certify that in
tha fo:rfwm•nce of the work fo.- which lhls permit is i•suecl I •hall nol
..,p oy •nf; penon In vloletion ·of th• worr.man's cc>:np.-nsetlon I&Wl! of fflli
Stah! of Co ifomla.
Signature
of
Permittee
)"1'1.C.. .,_
\
•
6?G?-c~
'-.J
Add.--
..............
j
Swimming Pool Piping
1.50
GROUND Pl.UMBING
Sand Traps
1.50
.... . "'"''"'"
DATI
-~
SOIL PIPING
Only
--.
----- -----
Plumbing Contrac:to•__ ~)l.j' _/[/.:;.~::};7_,(_ __
2.00
'
-
Phone 33?- 9_?/
Use of Bldg.
l$-o
Blk. No.
----------
-----
--
Contra~\Jr s At1ar~~_y~P98L t>/;:__1) r
1------
I
-------
f< LliJ/1:.~ l?_ __
-
1.50
-- f-----·
1.50
I
'Floor Drain
''
--------~-
Owner's Address
---
-
,-·
Tract No.
---
I l,s-t>
~~~1
F-lJC
I ~0 Lot No.
Owner
IS
Permit No.
to Fill in
~~~ress /3 ~ 7 2
FEE
$
$1.50
Slop Sink
I
CHARGED IF WORK IS STARTED BEFORE PERMiT
ISSUED.
537...4200
f
~
2e.~//J
!-:;_;. 'Jt.J
·~~~>/
.
e.,.;~
ROUGH ,DJIIURit.Jr.:.
----
GAS PIPING
Automatic Washing Mach.
--Water Softeners
1.50
Backwash - Trap
1.50
Water Lateral
1.50
Backflow Protective Devices
2.00
------····---
GAS VENT
1.50
--·---------·---
SEPTIC TANK or Cesspeol
SEWfR
GAS TEST
MAIN DRAIN AND
VACUUM LINES
WATER HEATER
BACKWASH
' ••nc• ,pf. Permit
.; .TOTAL FEE
2
''
:·'. ,r.rmtf .. .._ • .. ly
..
. }i.~
$
'
00
ll lao
~·te z~ ·2.7-1o
~:Lo~(/i·
·.
·.
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,;.,:'··~lib·,:·;.",,··.·.·.. y;
, .:L :~ • .; •.
WATfR LATERAL
....
flNAl
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·UTILITY CO •.rtu uru:u
;:.;.·.·,t:1u!:. ,· -
'',
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~~I) 1-C·{~:./
ka ~.:z , . ~'J. p£
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ldg •.~•rt it;:
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. BUlLDlN_G .P.ERMIT
.
--
DEPARTMENT Of BUilDING & SAFETY. GARDEN GP.OVE
"FIRE
ZONE
..
~-
USc
ZONE
E
OCCUPANCY
0
4--·
·11EMAR!::S
--
...
PH. 537-4200
.s=:r
tl
0
SETBACKS
EAVE PROJ.
l
I
LEFT
I
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I
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RIGHT
E
PARK. SPACES
REQUIRED
II EAR
~-
........
Parcel Mop
fi.IW
.1
I
I
Dedi~ation
!
i
lk'1ds
Provided
Water Bond
Water Assmt. Fee
· ltmdSCGJ)e Bond
DESCRIBE WORK
TO BE DONE
OATE
FlOOR AREA
(SQ. FT.)
('"~ (- -?1
..
and Location
r ~-!-
q:_J
cl '---~-
Reinforcing
---4lo:::::;-- ""-. be·
RoofShtg.
Rough Frame
"""
!;:-..
lath or Drywall
---
I
Utility Release
WIRING, FLUMB., HEAT., ETC.
~-
Plan
Check
$
$
•'
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P~mit Authorized By
·lktg. folf)tiictor
,··J ·
ki.:.······'
: •.,_..
.
'
$ ~OD
FEES
Building
~f) Permit
~
Expiration
... .Date..
e~
k~ -.:~i~~ ..,) -:.·, ....-:~.) .r~~~
·;.::·,7
~.~ '~.---.-: ~ ;··--.T.:-~.j .r~r
---··--------~-
1
Ll
NO. OF DWElliNG
, UNITS
r¥6:
.J:.\ J~
· ~-v~! ~ J
..
~Authorized
Agent
"'"'\(:.~or
I (
OWNER-BUILDER SIGN BELOW
I certify that I am eYempt from the provisions of Ch. 9, Div. 3, B and P.
Code (Contractor's Lcense low) because (check one):
'-~_/:;.=fJ
ii.!- ·r·-·--;C.
I
.
I
VALUATION NOTE: INCLUDE LABOR, MAT.
(. c
1!.._1 am the owner of the above property and will
I
.
0£ ~Jk "Zi
Final
~(..C)
--1- f O!J -~
REPAIR Q
DEII'oOliSH
JNO. OF
. STORIES
con;;:~ctor
--
I'
Other
,.,
r_~~c-.Fil::::::::
AlTER.1>(_
:!
~effect.
~ J
' lclu:.r:,V~-
I
ti? _. I.:;,.-:-?c;.
Plas. Brown Ct.
Bond
j
(·
BlDG. U!;C
I certify ~hot I hove re:::d this opphcalion and state that the above informotion is correct. I ogreo tv comply to all C:ty Ordinances or.d Sto'e laws
relating to building CO•'strvction. I .:certify that in the perfo,---,10nce of the
above work I sholl not employ an)' person in violation of the Lobor Code
of California relating to Workmen's Compensation I nsl..lrance. I further
agree to hold the City of Garden Grove i•·ee and harmless from any liability orising out of ir.iury or bodily domoge resulting from worr performed relevant to this p•rmit.
CONTRACTORS SIGN BELOW
I -o>rtify that I om a licen$ed contractor and thot my l;ce"nse~t force ·
INSPECTOR
I
Zip No.
.
~
'···
EA. t2- :r- I
-
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____________
i PtiOPOSED
) l
ADD'N r;
NEW Q
INSPECTION RECORD
APPROVAL
~N~.-ei:.!-J.o. ~~4
City
.... 7"7 _-,..,
Validation
Remarks
Fcund.Jtion
9i'V1e
·L.l~!-J'"\ -~~
j ~J
__j _
i
I
k,;
+ nss
-~~4
UE
ZiF No.
t
1 Stale Lie. No.
, TeL No..:..:::::Ow:Hl-4-".Z..
Zip No.
City
---·
-6~.) I .0
j- ~I
I
Porkwov Tree ft>e
\CJ cO
l
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Fire Hvdrant F.F. Fee
Mailin~t,7dres~
l ll l 'h{3
No.\
1
Moiling Address
PRESENT BLDG.
! f\ I ., "Tt--I
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Street Bond
•.
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A
Jl'Y'rl~~g___
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lt.!ctor~oV~
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PUBLIC WORKS
-
1:2 ;.Y1 \A/_.(" 'D.elli:.]QO~
Fcf{,rch.
ngr.
iJ?I~
j
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Tmct No.
\Clboo
Date 7/31/?c
Jtj_.£4it.£(
-;
7
1
~emarks :(.f)N{), 1tz ' C 1.:. ?£:..2: ;./..K· p_
Req"d
\~b~lc
Mai'ljng Address \)....
·zoning Approved ~y
Amount
"r 1
J..(" \-
Lot No.
PLANNING
FRONT
IPerm~ttJ OOf
Job Address,
CCC.
LOAD
L . A n J. 5
t!.• L.I p '()8- ?c
PlANN!NG
ACTION
J.L_
~-'1../TYPE
~
INST;.;>JCTION: Fill IN AREA WITHIN HEAVY tiNES
USE TYPEWRITER OR BA!.L POINT ?EN. PRESS FIRMLY. BE SURE A>.t COPIES AI!E
lEGIBtE, NO ERASURES PERMITTED. A DOUBLE ffE WILL SE CHARGED If WORK
IS S'rARTED BEFORE !'ERMIT IS ISSUED.
'
I
I
0 I am the owner of the above property and will employ persons to perform the above wa1k with wages as their sole compensal•on. I will furn'sh
insurance for my employees as required by the tobor Code of Colifornta.
··-~
~
---
-
$~
.,
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..
0
pers.:>noll·f pe,form lhe
above work.
I om the owner of the above property and I will contract to hove oil
of the above work perfmmed by licensed contractors.
!!y
-Owner's Sign'llure
Auiborized Agent
Do'o
If work ls nat started within 60 days from dote of issue or if obondoned
for more than 120 days, thia permit will be null and void.
e>--t>
..--
RElOCATION
!'RESENT BlDG.
o;e. .i1·y~,_~:D:: !~!?~~.::;~
.
.,
-~ Abti~ESS
'
'
.
.
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----·
'
ADDRESS
'
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1,-,.,
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'
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·
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0' 714 P Street
515 v~.; Ness
San F;o,,ciseo, CA 94102
0
. '
or ,c·AuroANtA
:STATE' FIR:EMA~SHAL'
Avenue
S!lcra~)flnto,
lOi' Sou!h Brcad•,n:Jy
Las tlngel~s. CA 90012
CA 95814
CERl'IFICATE OIF COMPLETI10N
NEW CLOTHES CLEANING
ESTABLISHMENT
SBDC Lie. No.
. . .• •
. has completed the· installa,tion of a do'tlles cleaning establishment as p1er approved plans and/or
permit dated . Jlr · • ••
and the arrangement of machine1:y, equipment and
devices is in. accordance with Chapter 2, Part 2, Division 12 of the HeaH.h and Safety Code, and
Chapter l, Title 19, California Adniinistrative Code.
10, lltOJ
,.
'
'
,.
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••
'
·,·.·
'I
•
Thisestablishment .shali Qe maintained fu.Uy in accordance with the provisions of the docume..'1ts
·. set fotth above; togethe~ with all other applical;)le state, county, or local law~ and ordinances. No
.· changM or additions codstruction or equipment shall be undertaken ·.vithout the express approval
in
of the State Fire Marshal •. :
···.,,
. NOTE:
.
·
'
.
'.
·
·
'
to
and
Purstlant
the ,proVisions of the Business
>professions Code; a state license for
()peration, together :with a "n~w esta~lishment" fee may be required by the State Board
Dry. Cleaners. S~e enclose({, no tic~· fr~ni ~e.Sta~e BAArd of Dry Cleimers (FM-1).
· of
~:--·;_,.~·-.
!-.
~';·;··· '"·,'
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.
-· . . ·· .·.:-·~:1:';•·::-.:
...... ;-_: " ... ,,., ... ~
; ALBER'r E.. ~OLE
.·State Fir~ Mar~hal
.,. ......
By
~
. .............
. ...-=...
I
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!
t..A,II.~
··-·····
FORM
C~-3
. Rev. 12-69,
. J:
~·.
• .....
'
. Senior Deputy·
,..
..•
:
F' -. *
BUILDING PERMIT
QTY OF GARDEN GROVE
D81Mcp.Mnt Services Department
Inspection Requests
Gen~ral Information
638-6771
€38-6661
For Applicant 10 Filltn
INSPECTION RECORD
-----
--------r
APPROVAL
·~~\
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t;
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7
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•
lu £'-'?R -:x~-!-1U'c,r •.,._C.. ~(-_t:"-.. -~
1!.4fL'~,.._, ,\_:".i:;;~ ._<.
•
•
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.:~:!~7:A ?-~6~~7
& Electric
Box 2865
.
k·
At--~·
WORKER'SCOMPENSATIO
REQUIREMENTS
L....;',
1=-··..,;_
~
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