By submitting this form, you are verifying that the violations identified during the annual fire inspection performed at the business listed below have been abated/resolved per the 2016 California Fire Code and the Orange Municipal Code Section 15.32.
Enter date and time that violations were abated.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
176 S Grand Street,
Orange, CA 92866 • (714) 288-2541 • email@example.com
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