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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' 4, °^ Tact Jo. . (714) ,53G^5431 unn.cmN atasn Public Works File No, Block No. r 9a 8 . O. ess FA - s, ft .✓ I ,..,_ Planning Action g oastal Permit Zone Land Use Approval ' ei- Noy _ by x _ Date .. r j V DOCUMENTS TO ACCgMPANY Pian gheck No ress APPLIZAT)ON J i o late Re g^ No. SOILS REPORT COMPACTION REPORT zip GEO)_OGICAL REPORT.et. rddre-t No. RETAINING WAIL PLAN State Lic- iVo. EROSION CONTROL PLAN VOCKPI LE PERM IT SIP ii I Type of Na.ur_d Type of Fill TRUCK ROUTING PLAN Soil Apprlava) to Issue FEES �.. No. of Cubic Yards ,., 0_ i Cut ° ^ ----.Flit _�___ Receipt No. Date BY Plan Check � n uatinn dlaclutlinp Labor & Met7 Y n ;: ,. F KhMARKS Receipt No. Date By Permit ����~"" GRADING PERMIT Date Pefmlt issued g'y Tota ees '' 9 1 have read this application and agree to ccmpl„ with all local and state laves applicable to buildingconstruction. •- ,• �+ 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. y ParnZee „:. If work i3 not commenced 120days from date of Issux of this permit, orif Final i) work is abandoned. for more than. 120 days, this permit shall be mull and Void. e floating. I. Public Works (White)' i 2. Appl)c at (Yellow) 3:: Inspect, 'r (Pink) i 4..Development service (Goldenrod)+