HomeMy WebLinkAbout10191 Kaimu Dr - CofOBUILDING PERMIT A 3.50!s
APPYCO t to fill to >,ifea within heavy Ane$ a71y.
A&DRESS
o.
�.
02.
ei'lttdfirYt
�61y
fp,ontrac.t ff _.. �. ___..,
�aars3-/ 4
'tv
X-r- hitet or E
+1o�+ros
plv1#
' QC.X'�,'
cit,?�l//tw �fv��.'�t�.
_._..L _.. 7
._
Sinto _ .. Zits
No. of !� ^� Nn, ii_ _. I Check One -
Storlus yFamil,e+� I
sq. Ft, Ciarag.) - D'es criiltion LLL } fit. NE W
of tNor k�' G
Ii A00
REPAIR [�
U OMOt . El
CiTI' )F �Vo A N 0,B3
DEAAYMENT
DEMOPMENT SERUfCES
s
•1•
P.o. nox 190 CAL.IFORNIA 02648
f714i rm-041
�1u1 din A
Oct -
Occupancy
7yt�b csf,Gartstrti�itiiyn tlt.r„ i c+eci
Urn no UYe P�tk�ntr t3oncos fta�t .r,+r i ..
Piannino Action� tati pYvir*
nAttel lr ermit 2`r.: s
fay.
F'orrn t AuttAM
< Chrar.k..,._
PerrTtit tsitrtlil ,
_`Uate _ �.-- Gunsotvation .'
Gommunit'f t:r+richnnnnt
Ubtary Fine. Sa. f-t.. ...... _____ __.___ FPO c _------.
i
fZen+arki'.
Inspection Record
A nyrovai ..a _ _ _. Date__
and Location
Valuation
(l:sctuding t.:aUor tar Mat.! 1
/���
fYEt OCA7E (
Floor Staos
w
! have this applica on, anti agree to cornply with all local and.
Sheathing
_rear)
state laws applicable to building conttruction,
I , i am validly roglstered and licensed as required by the City of
Huntington Ueath and the State of California, of
Framing
D 2. 1 am the legal owner of the above destrlbodpro err
I have filed with the City of Huntington Beach:
Loth or
0 1. A certificate of consent to self -insure Issued by the t?irectnr
pfy�yn+i
of Industrial nalatlons, or
0 2. A ce(tificato )f workers' compensation insurance issued by
Brown Cant
an admitted Insurer or
Cl 3. An exact copy or duplicate thereof certified by the Director
__�__�✓,_____,____,_____
or the insurer, of
4. 1 dirtily that in the performance of the Mork fof which this
,
t 8'.Iiing
permit Is lis+ltm, I shall not ernp+oy any person in any manner
so as to beC(-jr:ne subier t to the workers con)ponsation laws of
the Simr, of calitorna.
t,nnds;atain3
�i�"Frx=�et*�ikTt+4��r����:rX+u[srit�e�
tru, d r rrcct, lrtdr vts de aratio+ was Axectitt+ +r the-- .___.day I.arnci Ose —.._
o! �1 In 0 at iia 'rtiangt n Ve Cai 41aA .p�, Conditions
.04
i'arm tt:+, Final
if work is not rommenca. 1 'U days .from {sate .3t rssi;e of this
perrtlst, or if wi-rk Is abanria for -more than 1: 0 atay;, this pern)it CT ity
.nari be nuii and void. Ret�,�sa
INSPECTOR