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-'-SANTA <br />NA <br />PINNC <br />TBIII,DI\C <br />rcilcI <br />Planning & Building Agency <br />Building Safety Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5853 <br />SPECIAL INSPEGTION/COMPLAINT <br />INVESTIGATION FORM <br />SUBJECT ADDRESS: <br />l-I oC\ I l=,. l-n u Qsr-l Sst_.SUITE @C <br />tr,(- <br />mo <br />-{ <br />oov <br />m(tI <br />E Residential K Commercial/lndustrial <br />Purpose of lnspection <br />Requested by: tr Owner n Contractor tr Real Estate Agent (>tnu' <br />Name: Fl as <br />Address: <br />Phone <br />ACTION TAKEN: <br />INSTRUCTIONS: <br />PERMITS REQUIRED: <br />PLANS REQUIRED: <br />E None Required o Correction Notice <br />n OK Subject to Field D Plan Check Required <br />! auitOing o Electrical I P-lumbing n Mechanical' DEI^6 -D646 <br />o Site Plan tr Floor Plan tr Roof Plan tr Elevations <br />a Electrical Plan n Plumbing n Mechanical <br />n <br />FEES:o Regular Fees a Penalty Fee n lnvestigation Fee <br />NOTE: Building permits for unpermitted room additions require a site plan, floor <br />plan, roof plan, framing plan, and elevations <br />Remarks:s aC <br />=!T <br />B= Pa.r, <br />Date:8-8^rt Time ln: 3;3 A Time Departed: t:SoA.tnspector/to: 5-=Eil,*,s-r.) <br />lnspector Office Hours: Monday-Thursday 4:00-4:30 PM and Friday 3:00-3:30 P.M. <br />Permits may be obtained Monday, Tuesday, Thursday, and Friday 8:00-4:00 and Wednesday 10:00-4:00 <br />Office Use <br />Tracking #:3-L 5=qoS{. Amount Paid:Receipt #: <br />Received by:Date: <br />Date: <br />a-e'-rt <br />Address tagged by E.Lrrss-otJ <br />FORM 84 02-2009 <br />Distribution: White and Yellow - lnspector Pink - File Copy <br />E4^rr <br />B{ JRs t-r.Re - -\t+=' Rr=,tr.*.\sfi i\e.:tl<)p of- A\rrl-Sri*q <br />[rJ ruL ttr,rje. B Bs ]s,rtoLrs*+€\ A. >EH.6 FEF.r^fa {-JILL