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NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
Ftgs d Frms
34
Plenums & Ducts
2A
Slab Grade
35 .
Furnace Comport.
3
Steel
36
Inlets & 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.
°O.
---------------------------------
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
P/L
P/
26 Power Pole
27 'Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 - Fixtures
31 Service
32 Final
STREET NAME
rcrum I,, HrrLitR I 111111v- 4- -Y,
County of
Riverside
Department of Building
and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street
227 North: D" Street 46-209 Oasis St. Rm. 310 160 N. Broadway
Riversidei*CA 92501 Banning, CA 92220 Hemet. CA 92343
Perris, CA:92370 Indio, CA 92201 Blythe, CA 92225
Ph: 787-6146 Ph: 849-7312 Ph: 65&4464
Ph: 657-3898 - -Ph: 342.8271 Ph: 922-2670
This permit becomes void if work not:commenced within 180 days from daIa'df`lsiudnca.,- OR' it 'work has beenisuspended ovatiandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm Malt am licensed under provisions of Chapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need nor be completed if the (
with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
permit is for one hundred (5100) or less. I certify that in the performance of the work for which this permit is issued. V
•
shall not employ,any person in any manner so as to become subject to the Workers' Compensation Laws of California.-
Licensii Class Lic. Numbe
Dirle. Applicant
• I Date Contractor
NOTICE, T 1 0 A . PPLICANT: 11, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BU . ILDER DECLARATION: -I hereby affirm that I am exempt from lhe`Conlraclor's License Law for the following
Compensation'provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
,reason,(Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
m 11�'revoked.
deeI M�l
improve, demolish, or repair any structure: prior to its issuance, also requires the applicant for such permit to file a
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
,,signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing
E]J hereby certify that no excavation five (5) or more feet in depth into which a person is required to'descend. will be
with.Seclion 7000) of Division 3 of the Business and Professions Code) or that he is exempt therelrom and the basis for
made in connection with work auth6iized by this permit, and that no building structure, scaffolding, falsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) 1 hap 3.2. Grp 2. Art 2. Sec 341, Title B.
`penalty of not more than live hundred dollars (M)):
C.A.C.)
Pl1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
Ra ety. as noted'above, unless such person has a permit to do such'work from that division.
ucture is not intended or offered for sale (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
Division vision of industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or
Date Applicant
improvement is sold within one Year of completion, the owner -builder will have the burden of proving that he did not
build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction. lending agency for the performance of
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the work for which this permit is issued (Sec. 3097. Civ. C.).
1,.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name
us, and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
'-Business
FO, 10 8-7 4
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address
License Law.)
I certify that I 'have read this a with all
application and state that the above information is correct. I agree to comply
0 1 am exempt under Sec. B. & P.C. (Attach Certificate).
city and county ordinances an state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
Signature of Applicant or Agent (Date ,
I
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3900. Lab. Q.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' I certify I have read this applicati on and slate that the
information given is correct. I agre0o comply with all state laws and county ordinances relating to building con- i
'Policy No. Company
structi6n, and authorize a representative o the County of Riverside. Department of Building,and Safety to enter upon
:his
Certified copy is hereby furnished.
the property for whicK I haVe applied for permit for
il the purpose of making I I rispections.
R:n. , Certified copy.is.filed with*the,Gounty Btiildinb Inspection Depqr�lmer� or,Counly Department.
a I
Signatu�e,'?f Applicant or Agent Dat
Date Applicant
Print Applicant/A'gent' Name V
APPLICANT NAME (L. F. MI)
APPC/PRMT'# Ps DATE
•
01087 4.
0, 0441'0,1`7773
NITY T,
4
0 -
%MSIVAISMUNA CE
NITY/S kTE/ZIP
Will :60lC C 4*@ uirv-. S
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5144 OD SB
ADDRESS
CITYjCOMMUhIITY/STATE/ZIP
PHONE #
LICNC 0
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ARC/ENG.FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
.PHONE #
LICNIC N
USE OF PERMIT,
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4L
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'TTOPT
FO, 10 8-7 4
Iti It 0 Z`� E,
POSTt'Als
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
Ftgs d 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.O.
°o
---•----
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 APPROVAL -S-- ------------
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
REAROF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
,.,e
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'County
of Riverside
Department of
Building and Safety f
4080 Lemon Sl. 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 �L
Riverside. CA 92501 Banning. CA 92220 Hemet, CA 92343
Perris, CA 92370 Indio. CA 92201 Blythe, CA 92225 .i
Ph: .787-6146 Ph: 849.7312 - Ph: 65&4464
Ph: 657-3898 Ph: 342.8271 Ph: 922-2670 t
'
CITY/COMMUNITY/STATE/ZIP '
LA vxNTi
This permit becomes void if work not commenced within 180 days from date of issuance. OR, it work
has been suspended or abandoned for a period of 180 days. 1
I hereby that I licensed Chapter 9 (commencing
f
CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE: This need not be the
LICENSED CONTRACTORS DECLARATION: affirm am under provisions of
with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
section completedflil
permit is for one hundred ($100) or less. I certily that in the performance of the work for which this permit Is issued, I i
r
shall not employ any person to any manner so as to become subject to the Workers' Compensation Laws of California.
License Class Lie-. Number
- - '
.;. Date Applicant ,
Date Contractor
NOTICE TO APPLICANT: 11, alter making this Certificate of Exemption, you should become subject to the Workers'
OWNER•BUILOER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
deemed revoked.
improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
signed statement that he is licensedpursuant to the DroWsions of the Contractors License Law (Chapter 9 (commencing
[:] I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be
with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for
made in connection with work authorized by this permit, and that no building structure. scaffolding, falsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a. civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2,.Sec 341. Title 8,
penalty of not more than five hundred dollars ($500).):.
C.A.C.)
I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
[� As owner -builder, (will not employ anyone to do work which would require a permit from the Division of Industrial
�arety, as noted above, unless such person has a permit to do such work from that division.
s`tr'ucture is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
r
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
❑ Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or -
Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
build or improve for the purpose of sate.).'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.).
puI, as owner of the property, em exclusively contracting with licensed contractors to construct the project (Sec. 7044.
Lender's Name
siness 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 contractor(s) licensed pursuant to the Contractor's
Lender's Address
License Law.). - `'f
I certify that I have read this application and state that the above information is correct. I agree to comply with all
I am exempt under Sec. . B. 8 P.C. (Attach Certificate),
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
,
this county to enter upon the above-mentioned property for inspection purposes.
Date Owner
_
s
WORKERS' COMPENSATION DECLARATION: I hereby affirm. that I have a certificate of consent to self -insure, or a
Signature of Applicant or Agent Date
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
- CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify 1 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 con -
Policy No. 'Company
slruction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
0 Certified copy is hereby furnished.
the property for which l have applied for this permit for the purpose of making inspections.
.� Certified copy is filed with' the _County Building,Inspection, OeDartment or County Department. Signature of Applicant or Agent Date .
....
Date Applicant -
f+ Print Applicant/Agent Name '
RSB
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APPL/PRMT q
PS
DATE
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8733
END
SIDE
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APPLICANT NAME (L, F, MI)
ADDRESS
52740
CITY/COMMUNITY/STATE/ZIP
LA QUIN'i A
CA
922530400
JOB SITE ADDRESS/SPACE
E ORRECON
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CITY/COMMUNITY/STATE/ZIP '
LA vxNTi
922530000
BOK PAG
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PRC
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TRACT
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TRACT NAME -
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LAQUINTA
617
OWNER NAME (L, F, MI)
HENDERSON
BILL
<
CONTRACTOR -FIRM NAME ,
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ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC If
ARC/ENG•FIRM NAME
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-ADDRESS
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CITY/COMMUNITY/STATE/ZIP
,
PHONE N
LICNC If
USE OF PERMIT
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END
SIDE
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ASSESSOR COPY TOTAL
FEE.
APPLICATION FOR SP8CIAL INSPECTION
T 19..a 1 8. A N A,P P_L I C A T p N U N L
a
10108701