HomeMy WebLinkAbout0000APPLICATION I IT PERMIT NO.
Applicant to fill in area within heavy lines Only
ADDRESS
CITY OF HUNTINGTON BEACH A��g
OR
DEPARTMENT OF PUBLIC WORKS
LOCATION
P. O, BOX 190—CALIFORNIA 92548 F'
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(714) ,53G^5431 unn.cmN atasn
Public Works File No,
Block No.
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Planning Action
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oastal Permit Zone
Land Use Approval
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by x _ Date .. r
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DOCUMENTS TO ACCgMPANY
Pian gheck No
ress
APPLIZAT)ON J
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late Re g^ No.
SOILS REPORT
COMPACTION REPORT
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GEO)_OGICAL REPORT.et.
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No.
RETAINING WAIL PLAN
State Lic- iVo.
EROSION CONTROL PLAN
VOCKPI LE PERM IT
SIP
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Type of Na.ur_d Type of Fill
TRUCK ROUTING PLAN
Soil
Apprlava) to Issue
FEES
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No. of Cubic Yards
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Cut ° ^
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Receipt No. Date BY
Plan Check
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dlaclutlinp Labor & Met7 Y
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KhMARKS
Receipt No. Date By
Permit
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GRADING PERMIT
Date Pefmlt issued g'y
Tota ees ''
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1 have read this application and agree to ccmpl„ with all local and state laves
applicable to buildingconstruction.
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C } 1. 1 am Validly registered and licensed as. rariuTred by -the Slii of
}� Huntington Beach and the State of California.
C. 1.2. 1 am. the legal owner of the above described property.
1 have filed with the City of Huntington Beach;
-
(
C I L A certificate of consent to self -insure issued by the Director of
Industrial Relations, or
INSPECTION RECORD
[ ] 2. A certificate of Workers' compensation insurance issued by an
admitted insurer, or
Approval Date
Hough Grading
INSPECTOR
r 1 3. An •sxact copy or displicate thereof certified by the Director df the
insular, or
C 1 4. 1.certify that In the performance of the Work for which this permit is
Issued, I shall not employ any person In any manner so as to become
Final.Ca .f%�-atu
of En
n gr. Received
-
subject to the workers compensation laws of the state of California,'
I certify (or declare) .under penalty of perjury that the foregoing is true. and
As Bu)Its
correct, and this declaration was executed on this day of_ _^
{.
19.at HuntingtonBeach, California.
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ParnZee „:.
If work i3 not commenced 120days from date of Issux of this permit, orif
Final
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work is abandoned. for more than. 120 days, this permit shall be mull and Void.
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floating. I. Public Works (White)'
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2. Appl)c at (Yellow)
3:: Inspect, 'r (Pink)
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4..Development service (Goldenrod)+