HomeMy WebLinkAbout0000APPLICATION PERPERMI PERMIT Nt .
Applu.uit it) fill in area %Iitliirl lu'a liti- 0111\ CITY OF HUNTINGTON BFACH
SITE ADDRESS DEPARTMENT OF PUBLIC WORKS
OR P. O. BOX 190 - CALIFORNIA 92648
LOCATION
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Yes I l No
try r+r Land lase Approval
by Date _
del. IV': —�� QCUMENTS TO ACCOMPANY Plan Check No.
APPLi ..ATION
i dreSS StgiF, Rq!. f.G.
SGILS Rt POAT
COMPACTION RCPORT 4
City Zip GEOLOGICAL REPORT
ntractor " PT.I fV,) RETAINING WALL PLAN
d ress blara!_iI—WQ EROSION CONTROL PLAN
STOCKPII E PERMIT y ^�
TRUCK ROUTING PLAN
ype of Natural TVPe rf File Approu [ tp issue ! FEES
suit - ! No, of Cubic Yalds ^ �4T
Aecript Nn, Date By Plan Check
aluavoo- Permit
IrscluId Labor & Mat.l 1 Rureipt trio. Date By
REMARKS *W
Date Permit issued Y s,y rota) ees
GRADING PERMIT S .
t have read this application and: agree to cpm9lY With all local and state laws --
applicable to building construction.
(j 1. t am ralidiy :registeredand licensed as required by. the City.. of
.Huntington [leach and the Slate of California.
t i 2. I ant the legal owner of tho above described property.
1 have filed with the City of Huntington Beach, INSPECTION RE ORS
[ 7 1. A certificate of aan5rnt to selflnsura Issued by the Director Of INSPECTOR
Industrial RelationF, or Approval t7atn
[ 2. A..L•ertificata.. of workers' compensation insurance issued by an Pughugl, raL, ding..
admitted insure-, or
[ 7 a. An exact copy or duplicate thereat cer"Iffed..by the Director, of the ..3-
i",urer, or Final Certificate
I ) 4.1 certify that in the performance of the work for who h'Tbit par+nit is of Eng I. Received
issued, 1 shalt not employ any person in any manner sv as to became
Sup)ect £o thrworkerscompansatlon laws at the Stara of callfcrnia. AS Bruits
I certify (or declare) under penalty of perjury that the fardgoing rs true and
.correct, and this declaration was executed On the_„ day of
19 of Huntington. Beath, callfarnlaa�_._„
Permitter Final
.:If work Is not e,smmenced 120 days from date of issue of this permit, or If
tVOr1C Is aha ndonr+; for more than I ka slays,. this permit shall be Pull and void. -�� ....
Routing:. J. PuLlIe Works (White)
2. App.iaont (Yellow).
3. Insp"tor (Pink)
_ 4. Development Service (Goldenrod)
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