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09030086 SI ENVIRONMENTAL RESOURCES AGENCY J� DEPARTMENT OF ENVIRONMENTAL HEALTH coumy or Santa clergy CONSUMER PROTECTION DIVISION 1555 Berger Dr.•Sulbe 300•San Jose,CA 95112•(408)918-3400 Fax:(408)25&5891•Websfte:www.ehinfo.org REPORT OF OBSERVATIONS DBA/NAME � � � `, � _ DATE ADDRESS LOCATION / A A �•a n I( ` RECHE7CN DATE% lir OWNER/OPERATOR MAILING ADDRESS EMPLOYEE d SERVICE PROGRAM/ELEMENT LOCATION CODE TIME WORK AREA won I" ox— I1I�/A.A . 1.71�• /1' lam_ �/? ,/r v��Ah_, �\r�ry� Ai' �J , T C 114 d a ?-q vso a d . RECE;M BY Ile SP C AINS' PAGE ) OF 05589 REV 6104 / ' t ;slid+ tiSiVp� frtr4cs�11d��J�S�yt �f ^vti{b ci rtc+r7L+R✓u!M'"7`,m�v�'rrw.v�r:v4Y{ itht i1to wri�hc� ::v�wwryr•'r1�t^Y >3 C:1�'hkej °4ARA c�G FIRE DEPARTMENT 0) FIRE IR "� SANTA CLARA COUNTY INSPECTION NOTICE 14700 Winchester Blvd., Los Gatos, CA 95032-1818 ❑ Annual - Cycle C-9V I-E (408)378-4010(phone)• (408)378-9342(fax) ❑ Reinspection ❑ Construction PC # 0 -7U � O Final Page L of Streeetea Street Name&Suffix/`/ Suite a city Occ � Date: I UA l 1 a)0 I /-f— !�C 1 C �L,� Coal` l 5-so-U p,/ OccupL Occupancy, P Occ. l Phone_ ����T( i-Y� ` I�1� Load: Issued by Issued to r ` GL, 1 Signature FILE ITEM# Cl 1 F� I II, 1.J t V f U I J l/\ 1. iL I, t v1 C,d GL r`f S FORM®20