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Applicant to fill in area within heavy Ines only. ?'
BUILDING 0 j CL/ /11 LAA
ADDRESS �
Lot No.
I z---
Tract No
'
Block �NO. -.
Owner
YM
Address
16,n // c z_4_1 m L r✓
City State zip
Contractor
Lit-fLE
Tei. No. �„-. � �'
Address.
Lic. No.
City
Lic. Class
Architect or Engineer
Tel. No.
Address:
Lic. No: - '$
City State zip
Sq. Fti -i /4
0. of
IN 0
No. of
Check One '
Stories L..
Families
NEW Elf.
Sq. Ft. Garage
.Description
of Work
ADD �J;
j 1Yt
? A
Ql,hff C:Xf-J..! fltj& <2,,e/4C
REPAIR Q�;}.
ELOCATE ❑�!
_
i
Use of Build inp �^ _
'1164 G.DEMOL.
Valuation
0ncluding Labor 81..1.)
I have read this application -and agree to co ply with all local and"
state laws applicable to building constructitill. tK
❑ 1.: 1 am validly registered and licensed as required. by the City ofif
HuntingtonBeach an d iheStateof California, or t
'p 2-.l am tre legal owner.of the Ibove described property:
I Have Huntington
filed with ahe City of. Beach: (t
❑ 1. A certificate of consent to self -insure issued by the Director of,,
InRelations, or
❑ 2.. A certificate of workers' compensation insurance .issued. by and
admitted insurer, or
❑ 3. An exactcopy o+ duplltaie thereof certified 6y the Director"
or the insurer, or
4. I certify that in the performance of the work for which thls
.permit is issued, I shall not employ any pe,-son in any manner
so as to become subject to the workers compensation law ots
" the State of California.
I certify (or declare) under penalty of perjury that the foreegomg 13
true a�ndand thls declaration was executed on the day
+conrrect,
of ; 19-f at untington Bea? Iifornia.
1 y Permittee. -
If work is not ccmnienced 120 d ys from date of Issue of this halt
or if work is abano'8ned for more than 120 days, this permit hall be;r'
be
null and void.
�v
CITY OF HUNTINGTON BEACH
DEPARTMENT OF BUILDING
•
AND COMMUNITY DEVELOPMENT
tom. J (714) 536-5241
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,
J
Building ddr
Plan hetc N
- ccvpancy
Type of -Construction
E. Lo,d
'Grp Div
Use Zone
Use
Parking Spaces Required
IanningAction
4. yes
Coastal`Permit Zone
No.
Land pfovedus�
B Y,'
Dare'..
ES: �f
rrnit32-
6r...t �z der
Dat
P
$cl�.(J��
Perri . ji
D®
bnservation
$ `
Receipt No. d .�
TOTAL $
Remarks: -
OUa 1967
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1'
r a a
2 ,/, i1�ir�1i,•ec
v n
Inspection Record
Approve
Date
Inspector
. Fgundation
and i,:ocation
;, Z :..
v
FloorSlabs
Sheathingz
_
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✓✓✓���--CCCiii.
Framing
!
''��.7• c�fi..
Lath:o,, —
zs(
Drywall
Brown Coat`
3~.. .�
Parking i
Landscapin
•01 -
Land Usa 7
Condition
Final
.�
Utility
Rolease
►�'
arl
�2��•C2"•... �.A'" tL��.i�"br6z'8%V1r
l
710 --��
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