Fire Inspection Self Clearance

2. Fire Inspection Self Clearance Form
   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.
4. Business Name*
5. Business Phone Number
6. Business License Number
8. Business Address*
10. City
11. State
12. Zip Code
14. Business Owner/Manager
15. Email Address
17. Date and Time
    Date and Time

    Date and Time
    Enter date and time that violations were abated.
18. Click here to verify that all violations have been abated/resolved.*

    1. I agree.
20. Electronic Signature Agreement

    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.

    1. I agree.
22. Electronic Signature*
24. 
26. Orange City Fire Department
    176 S Grand Street, Orange, CA 92866 • (714) 288-2541 • fireinspection@cityoforange.org
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field