00017528 (HOTL)ry PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Leman St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880'N. State Street 227 North "D" Street 46.209 Oasis St. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning. CA 92220 Hemel. CA 92343 Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787.6146 Ph: 849.7312 Ph: 658-4464 Ph: 657.3898 Ph: 342.8271 Ph: 9222670
This permit becomes void if work not commenced within 180 days from date of issuance. OR. if work has beer suspended or abandoned for a perioo of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect
El
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5, Business and.Prolessions Code: Any city or county which requires a permit to con-
struct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
mit subjects the applicant to a civil penally of not more than live hunderd dollars ($500).):
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for safe (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however,
the building or improvement is sold within one year of completion, the owner=builder will have the burden of prov-
ing that he did not build or improve for the purpose of sale.)
❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a conlractor(s) licensed pursuant to the Con-
tractor's License Law.)
Of am exempt under Sec. B.B P.C. (Attach Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby allirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
❑Certilied copy is tiled with the County Building Inspection Department or County Department.
APPLICANT NAME (I^ F, MI)
LANDMARK, LAND CC
4R)� 0 AVE ODREGON
1 hC°r�/1cluNyv1STQTA21P CA 922530000
JO(3rSL.EA40RESSl/SPACE ODREGON 1•
'^�M1 till VVII
AVEr7 i.7 f{`A I`9`2CS,330040
ti77Ci0
('ITpT JZIP
{
EEK
31
ab0
lI45
6
I
5s
'air
E
SE
A� o 0 0 LOT
ry1,QQ I
1J 3
SB
LT6A6T0
`JCTJ f kJ) SSW 1/4
OWNERsr6gAd.E ,6 [•1,yryy } LANA/ CO,
PHONEp
VLNi{N'iQ�jQi'�IhA�gMPTii,`AM'LAYNND CO � XNC
Ll�y e44 6
T1W CLOCK TOWER FL.
T�AT3WC�h,Lh1,T1fCISTATE/ZIP CA 939 3000 p
4�:7 7 Vv
R4�FF0�11::`CV��-3i%w 5-2888 [=INSPECTOR
FINAL DAwT7EW
ARCIENG FIRM NAME
LICNC fI
ADDRESS
CITYICOM MUNITYISTATEIZI P
PLAN M
TOTAL
FEEt►
APPROVE DATE
Dwi G.1f." 11IEL UNITS IN 4LDG 3
Eb 0
R T N
07Eb
Oyb 1
0Sod 10
-0 1
1
YLFP+l1)
157Q.N
PPA
LOTSZ
END
Fy$TD
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this
permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers' Compensa-
tion Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after makinglhis Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will
be made in connection with work authorized by this permit. and that no building structure, scaffolding, lalsework,
or demolition or dismantling lhereol. will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341.
Title 8. C.A.C.).
[:)AS owner -builder. I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Safety, as noted above. unless such person has a permit to do such work from the division.
❑ Division of Industrial Safety Permit No.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
mance of the work for which this permit is issued (Sec. 3097. Civ. C.).
Lender's Name
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
that the information given is correct. I agree to comply with all state laws and county ordinances relating to
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
to enter upon the property for which Mave applied for this permit for the purpose of making inspections.
Signature`drApplift or Agent Dale
Print Applicant/Agent Name
APPLIPRMT MPS
00017r;wE3
ESTIMATED
DATE 34506
CD 04/30/t�2
PLAN REV FEE *ZU1,50
TOTAL
FEEt►
0 .50
CA
CWI
NC
COUNT R B.I.
COUNTER L.U.T.
Yz q PERMIT FOR STRUCTURAL PLAN REVIEW
TOTAL. PERMIT COST IS $201.50
CONSTRUCTION ESTIMATE (NOTE: Not to be used as property valuation)
Description FCC Group TYAQ Sq F* date Valuation
PRIMARY HOTEL 213 R-•1 V- 1665 $31,30 $52114
SECNDRY PATIO 329 M V_N 404 $4.90 $1995
SECNDRY AIRCON 900 R-3 C 12525 $2.60 $4225
Est Plan Rev Fee based on Total E:slimated Val'tr► of $583;38 i0: $201.50
FORM 284-208(11.81) INSPECTOR.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T. 0.
P'
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal ^-
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test '
25
Final
Tank Pit L.Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
r
30 Fixtures
31 Service r
32 Final
1
STREET NAME
PERMIT APPLICATION ,
County
of Riverside
Department of
++080 LE'non431. 2nd Floor w r 135 N. Alessandro Rd. Rm. 203 880 N. siateSheel d
Jeiversitle, r
Building and Safety
227 North "0" Street 46.209 Oasis St. Rm. 310 • 160 N. Broadway r. t
` ` -Blythe.
CA�]!501 Banning. CA 92220 Hemet. CA 92343:
Per:°s. CA 92370 - -e, Intlio. CA 92201 • CA 92225
+
... Ph: 781.6146-. Ph: 8497312 Ph: 658.4464
�• Ph: 657.3898 .' . -Ph: 342.8271 ;• Ph: 922.2670. ,
' This permit becomes void it work not commenced within 180 days Iron date of issuance. OR, if work has beer suspended
or abandoned lot a period of 180 days. - -
-
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-'
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (comment
pleted if the permit is for•one hundred ($100) or less. I certify that in the performance of the work for which this
-Permit issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
;ting with Section 7000) of Division 3 of the Business and Professions Code. and my license is in lull lorce and effect.
- tion Laws of California.
Date, _' x - .Applicant ' ,:
NOTICE TO APPLICANT: It. after makingthis Certilicate of Exemption, you should become subject to the Workers' ,
OWNER ,BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the.
Compensation provisions of the Labor Code: you must forthwith comply with such provisions or this permit shall be r'
following reason (Sec. 7031.5, Business and Prolessions Code: Any city or county which requires a permit to con-
:, deemed revoked.
:u slrucl. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
nn
permit to` life a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law •
; DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: - • - -
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
t
❑I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will
empt therefrom and the basis tot the alleged exemption. Any violation of Section 7031.5 by any. applicant for a per.
the applicant to a civil of not more than live hunderd dollars ($500).):
be made in connection with work authorized by this permit, and that no building structure. scaffolding, falsework,.
mit subjects penally -
+❑
or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2. Sec 341.
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
Title 8. C.A.C.). - , -•
structure is not intended or offered for sale (Sec. 7044, Business and. Professions Code: The Contractor's License •'
❑ As owner -builder, I will not employ anyone to do work •which would require a permit from the Division ofIn-
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
- dusirial Safety: as noted above. unless such person has a permitto do such work from the division,
through his own employees, provided that such.. improvements are not intended or offered for sate. It however,
Industrial Permit
the building or improvement 1s sold within one year of completion, the owner -builder will have the burden of p(ov-
❑ Division of Safety No. _
-•- -
ing that he did not build or improve lot the purpose of sate.)
!rl
- . ..
❑I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm that. there is•a construction lending agency for the perfor-
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
mance of the work for Which this permit is issued (Sec. 3097, Civ.. C.).
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
Lender's Name
tractor's License Law.)
Lender's Address F -
,❑I am exempt under Sec. " BA P.C. (Attach Certificate). ,
P NEp
Date ° Owner ` -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
that the information given is correct I agree' to comply with all state laws and county ordinances relating to
WORKERS', COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety ;•
to enter upon the property for which i have applied for This permit for the purpose of making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
. `'
LICNC N -
-
❑Certified copy is hereby Iurnished .,. .' �• ..ra -
` t
copy is liledwith the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date "
c
1-k
Print Applicanl/Agent Name
APPLICANT NAME (L, F, MI)
- - '- s -
^ .- • -
,,
03 +7
u
C.I ITVISTA
• r
JM SITE D S S EAVE
CI IC ITVISTATEIZIP
0BREGON
N A
nn
d C C
N h S
Ct
IS
O
- - LOT -
ffA T ,
01
- • .,
O NE APIT (IFJAJ -
PHONE 0
CONTRACTOR -FIRM NAME
-
a LICNC p',� -
pMARK I. AND
S
co, XNG
334 6
inn r,
IC MM IZIP
-EF .
P NEp
CIA
BLDG. INSPECTOR
INAL RAE goo
AR EN FI E -
-
LICNC N -
ADDRESS
` t
CITYICOMMUNITYISTATEIZIP
.. rf ✓
' - -,
CA
CK
I NC
PLAN p -
PLANS EXAMINER
COUNTER L.U.T.
-APPROVE DATE -
USE OF PERMIT
-
...
•
J "+'
.' .
N .
B SS B
RSB OFC
ZONE R p
L T 2
END E,
1f:.
.!.
APPLIPRMT If , a PS `
w/ r_
. DATE
w�
,,
03 +7
u
• r
` t
TOTAL .:
FEE
CA
CK
I NC
COUNTER B.I.-
COUNTER L.U.T.
-
9
UT
APPLICATION, FOR TRUC71lRAL ..PLAN REVIEW
-, T "H I- a I .5, A N A `P F' -.L. V C: A +T -I 0 .N O N LL Y
You, Mtist�,see -the following DeparT,ments" (if -listed) 'fnr 'c*oncurtence-BEFORE
a Permit can be issuedt-
Descri 't,ion - _ - ,.� - - Dept to see -�-
rHOLD-ROAD', 'H-AL1'H i. - Y -' LAND U5'
.. _ •0; Cy,p//17�f't wt// �/N®T."Ile
�
�4 Zr I r
-6,a ^
/ �f
' + -
FORM 284.208(11-81f APPLICANT L "r - ' ' • _ - - -
7 PERMIT APPLICATION
Couniv,
of, Riverside
Department 0
Building and Safety
t
,
-.
4080 hem Se 2nd Floor 135 N. Alessandro Rd. Rm. 203 88o N. slate Street.
RrverSi48, 92501 Banning, CA 92220 Hemet. CA 92343
227 North "D" Street 46.209.Oasis St. Rm, 310 160 N. Broadway
Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 1-76-6146 Ph: 849-7312 Ph: 658.4464
Ph: 657-3898 Ph: 342-8271 Ph: 922.2670
'
This permit becomes void'if work not commenced within 180 days from date of issuance. OR, it work has beer suspended or abandoned for a perfou of 180 days.
-
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby aflirmihat I am licensed under provisions of Chapter 9 (comment•
pleled if the permit is for one hundred ($100) or less. I certify Thal in the performance of the work for which this
issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
Ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
tion
ion Laws of California.
❑
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
+ Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be "
following reason (Sec: 7031.5, Business and Professions Code: Any city or county which requires a permit to con-
deemed revoked.
struct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
C I ITYISTATEIZIP
permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
of hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will,
empt therefrom and the basis for the alleged exemption. AnyJ3jolation of Section 7031.5 by any applicant for a per-
mit subjects the applicant to a civil penally of not more. than AVB hunderd dollars ($500).1:
be made in connection with work authorized by this permit, and that no building struclure. scaffolding, falsework,
TOTAL .
FEE
or demolition or dismantlingthereof, will be more than thin six 36 feel high. Cha 3.2, Gr 2, Art 2, Sec 341, .`
Y' ( 1 9 (Chap. D
❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
.
Title 8. C.A.C.).
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
OAS owner -builder. I will not employ anyone to do work which would require a permit from the Division of In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
dustrial Safely. as noted above. unless such person has a permit to do such work from the division. )
through his awn employees, provided that such improvements are not intended or offered for sale. II. however.
❑Division Industrial Safety Permit No.
the building or improvement is sold within one,year of completion, the owner -builder will have the burden of prov-
of _
Ing that he did not build or Improve for the purpose of sale.)
❑I, as owner, of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Con-
tractor's License Law.)
01 am exempt under Sec. B.8 P.C. (Attach Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. ora
cerlilicate of Workers' Compensation Insurance, or a certified copy (hereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, MI)
-
BD ♦ '
ICU
-.
!°I 1
✓•
7
CW/ I NITYISTA Z PE
C1�rJa'
JOB SITE AODRESSISPACE
`
0
ISI
C I ITYISTATEIZIP
TOTAL .
FEE
80 CCw
TWN -' WNV Stw S
CK
NC
COUNTER B.I. -
COUNTER L.U.T.
TRA 1'
LO
MOD
A T
a'3 1 9
fA,
OWNER -NAME (,F,Mq
- -
PHONE It
�
i
CONTRACTOR -FIRM NAME
LICNC If
x
AD RESS
inn r1nrTgJ4R
G PJ__
CITYICOMM NITYISTATE121P
.o
dw ,:r
PHONE q '
BLDG. INSPECTOR
FINAL DATE
...:i
ARCTENG FIRM NAME
LICNC q -
ADDRESS
-
CITYICOM M UN ITYISTATEIZI P
PLAN q
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
VX LA
1 -
BON L UZ
FSB SSB
SSB
RSB OFC
l
ZONE ORD q
LOT SZ
END
SIDE
ff
4
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
mance of the work for which this permit is issued (Sec. 3097. Civ:. C.).
Lender's Name
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I haveread this application and state
that the information given is correct. I agree to comply with all state laws and county ordinances relating to
building construction, and authorize a representative of the County of Riverside. Department of Building and Safely
to enter upon the properly for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
• Print Appficanl/Agent Name
APPLIPRMT,q PS - � DATE21
0 le a%w e .� I tJG
'34503
7
TOTAL .
FEE
CA
CK
NC
COUNTER B.I. -
COUNTER L.U.T.
. 4 ,
E 345131
APPLICATION FOR STRUCTURAL' PLAN REVIEW
'f` H I S, 1• S A N A P P L I O A T I C N' 0 N L Y
uMust see the following' Dwpartl ent% (if lasted} for concurrence BEFORE
,-,a Permit can be issoad a
DescriHOLW-•ROAD, H ALTH LAgD USE
NBT �t.
_T
FORM 284.208 (11.81) ASSESSOR "
c 0 k Sr IR, 0 c rl i U N FEE
25698
$.407. U0
P L�,UMB ING ;'r,,E
D
AVE
P
aN,
YOU" 3 0 01
-0.0
RESSISPACE
I. T
P A
$1 17:51
Y."
si1S
$4'1: 04
MTtROFALM
05(
K
valo"
1 zi
P -R-1,
R, I MARY, ROTtL 1665 s'",
f al 10
$521,1,4
I I
$1
Y'.. AlL N 2
I. T LOT
3
on e-., -
6 , ' d
f "base 6 �oli�l -kto-all .'Va,
S
B.;
C L -2F E c c' ati
T6-cuTiahs,40+..- Hoi 60 -%C:,Oo
TOTAL
• f V 4 FEE.
$ 00
s 4 216 4 0
CA'
El�
cx Y I '
1,C
]
_,ACT ... ..
w �r.
COUNTER L.U.T.
0.1 0 T�T 00; 0 or o 0 e. 13 TU Jqb b-
U.1 03., M
OUTA-HONS �e -.V
PHONE di' -
0. 0
- - ab lb
41. it I - -.4, , PA Fti
A.
To f4d
44.:
S� Ck"� T
1 0
1
pul
STATEIZIP'.
F� ii N,c A F UT'�l ap'Olic,61b 0'
Il'l 0 N 1BLD R F!N
'I"'
-ARCIENG FIRM:NAME 1 71 _N_
ICNC N
ADDRESS
CITY1COMMUNITYISTA El IP
Z
PLAN #
PLANS EXAMINER
%,JAPPROVE .DATE
N
0
T
-ZONE ORDp
LOT SZ
ENAE)
S E
c 0 k Sr IR, 0 c rl i U N FEE
25698
$.407. U0
P L�,UMB ING ;'r,,E
plis,7. 0 0
r-.LE,cXRi6A,L F 15' E
$2 .131
,EQ f.A-L F
I. T
RF_F . UNb 'PLAIN REV, FEE
$1 17:51
Y."
si1S
$4'1: 04
MTtROFALM
$1.50
K
valo"
1 zi
P -R-1,
R, I MARY, ROTtL 1665 s'",
f al 10
$521,1,4
py P �1&
t.� X9,01)
$1
Y'.. AlL N 2
3
on e-., -
6 , ' d
f "base 6 �oli�l -kto-all .'Va,
C L -2F E c c' ati
T6-cuTiahs,40+..- Hoi 60 -%C:,Oo
TOTAL
• f V 4 FEE.
$ 00
s 4 216 4 0
CA'
El�
cx Y I '
1,C
]
COUNTE1
]
COUNTER L.U.T.
0.1 0 T�T 00; 0 or o 0 e. 13 TU Jqb b-
U.1 03., M
OUTA-HONS �e -.V
t n
Mi
R Al G I U R 'A E.': 'R M-
Mc
3 VX �') .
Jv
I. T
T., c 0 sa $ 42 6 146
L y as , Z
w u S, prl Vqa
ope
ON- 'EST I MWT i' Not. -to ,b 11
b6tcrip'ti-66. P, Gr UA�p Ft R a't 6
�'.,cc 0 _ *,�
valo"
1 zi
P -R-1,
R, I MARY, ROTtL 1665 s'",
f al 10
$521,1,4
py P �1&
t.� X9,01)
$1
Y'.. AlL N 2
3
on e-., -
6 , ' d
f "base 6 �oli�l -kto-all .'Va,
C L -2F E c c' ati
T6-cuTiahs,40+..- Hoi 60 -%C:,Oo
FF
$ 00
vap", 4oler-4 0 dl
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Yl�*PLAW REV OtE
!2 -INSPECTOR,
FORM 284 08 . (11-81),
$46 00
150
$2.
$4,14
$1..50
V,
IN
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS '
1
Set Back
7
33
Ventilation System
2
Ftgs 8 Firms
V
A,3,1
34
Plenums 8 Ducts i
2A
Slab Grade
It i
ev
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
7
Combustion Air or
5
Bond Beams
39
Compressor
6
Roof Deck
3arance
Appl. Clearance
7
Framing—
oziliq 0e,
4
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T.O.
P'
t
ADDITIONAL INFORMATION
n
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth /
12 Internal Lothwr/
12A Drywall G
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Fl .1
PLUMBING APPROVALS
15 Ground Plumb CM
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer a
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test✓
:1 t5a��l
25
Final
-
Tank Pit L.Line
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
'
PSI
26 Power Pole
27 Conduit
28 Service Entrance i
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service.
32 Final
STREET NAME
4'P LItl P�Ti'.I YY Ii'1\FjMI)
LORD` MM
i
4� 0 $t9'0 AVE CDBREGC;N '
IT�(ICO T,€IZIP CW! ?5000G36
i RESSISPACE AVE i0 RJ 1Y1�.4i{: N 1
�9"iCO�U/�„$Tfj EIZIP 11.rY7 T�( ����ii C1
UFZ L.,
S4
6
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02
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.PHONE.p '� ...
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AM
CLOCK ' OWER PL
gAw.wm-ISTATE/ZIP -"` ' CA X39230 .
0.'000
0U0
INSPECTOR :
FINAL DATE- -
ARCIENG FIRM NAME
LICNC N -
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
EO �W 11 L Ww"'9 IN
.4�
p
r yi7,p w�786
LOT SZ
"END
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{ I G:JU-LLJ
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I s A H. A P P.; L: A, C. A CIN C? NL Y
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
P'
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding,
30 Fixtures
31 Service
32 Final
STREET NAME
CANT NAME,JL, F, MI)
A U 0 0 R -com
NANITwSTATEIZIP EM,
4 bit -4
TE,ADDRESS/SPACE
E xwoco
".,."—TY'STATEIZIP.
I -PAG I. PRC . I C..I PN J,RNG ISE IS
APPyPRMT-# •Pst DATE 34503
TRACT NAME
;j I 1A
OWNER PHONE#
lk hk4olt.' .1 ANn r
CONTRACTOR -FIRM NAME,
LICNC #
ADDRESS
t.orw Tnmrg p il.,
CITY/COMMUNITYISTATEIZIP
PH oNEN
BLDG. INSPECTOR
FINAL DAT.
E
CIENG FIRM NAME
NC #
J.LIC I
:ADDRESS
PTYI.COMMUNITYISTATEIZIP
"I'll ;PLAN#
PLANS EXAMINER
7 APPROVE DATE
V USE OF PERMIT; - -
BL
ZON FSB SSB
SSBx RSB
OFC, i
TOTAL
A
FEE
ZONE ORD #
LOT SZ END
SIDE
CANC
I: COUNTER B.
COUNTER L.U.T.
3 4 E F31
'APPOCATION -F0R':.8-(,RUCtURAL- PLAN REv i r., w
P P L'I C A T 1, 0
I a- A 'N AG H
L Y
l6v 'must see t h Q f-6 I'l o wing D'OpSo thdat s f l'i Wt o d:) f Or - concurrence
a -0ermi.t- coin be* i d -i
T, i.i.
D es'ci r .on
Teu.,to See
A USE
-E)AD. -HRALTH
D
J.
�FqR�284.208(11.81) I.NSPECTOR -
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T. 0. E]
No
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
PSL P/
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME