00026853 (SPIN).. _. .. PtHMII APPLILATIDN... .• • _ �„ . ; _ ,..... -
County of Riverside
Department of Building and Safety
4080 Lemon J1 20d..Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North "0" Street 46.209 Oasis St. Rm. 310 160 N. Broadway
Riverside. CA:925011 Banning. CA 92220 Hemet. CA 92343 Perris CA 92370 Indio CA 92201 81 the CA 922^5 t`
Ph: 787.6146 Ph: 8497312 Ph: 6584464
This permit becomes void it work not commenced within 180 days from date of issuance. OR. it work has been SUS
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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 effecE
OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Cade: Any city or county which requires a permit to con-
4,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
r;(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 penalty of not more than live hunderd dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
.. structure 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 his own employees, provided that such improvements are not intended or offered for sale. 11, 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 contractor(s) licensed pursuant to the Con-
•4lactor's License Law.)
❑f am exempt under Sec. B.8 P.C. (Attach Cerblicate).
,i bate Owner
M'WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cerlificate of consent to self -insure, or a
f; certificate of Workers' Compensation Insurance, ora certified copy, thereof (Sec. 3800, Lab. C.).
b❑Certified copy is hereby furnished.
❑Cerlified copy issiiled with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, M!)
DAVE
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CONTRACTOR -FIRM NAME
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FINAL DATE
SPECIAL'. `xNWTN
FEE *30.00
ARCIENG FIRM NAME LICNC N
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ADDRESS
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APPROVE DATE -
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FORM 284.208111-B,), INSPECTOR
Y
Ph: 6573898 Ph: 3428271 Ph: 922.2670 +
pended or abandoned for a period of 180 days. - a
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-1
pleled if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which This;
permit is issued, I shall not employ any person in any manner so es to become subject to the Workers' Compensa-,
tion Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, alter makingthis Certificate of Exemption, you should become subject to the Workers'
COmpensallon provisions Of the Labor Code. you must forthwith comply with such provisions or this permit shall bel
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will
be made in connection with work authorized by This permit. and that no building structure, scalfolding, falsework,
or demolition or dismantling thereof, will be more than thirty-six (36) feet high.. (Chap. 3.2. Grp 2. Art 2. Sec 341„
Title 8. C.A.C.).
❑As owner -builder, I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Safety, as noted above. unless such person has a permit to do such work from the division.
❑ Division of Industrial Safety Permit No.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
mance of the work for which this permit is issued (Sec. 3097. Civ. C.).
Lender's Name
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state
that the information given is correct. I agree to comply with all state laws and county ordinances relating 16
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
to enter upon the property for which Iyhave
[yapplied forthispermit for the purpose of making inspections.
T,grlture°olvA'pplicanhor9§eO,- -!-6
Alrr � 1,,t�
APPLIPRMT N PS
00026853 n
DATE 4.7 A`2 6 w
10/ 08 F
SPECIAL'. `xNWTN
FEE *30.00
3;l,.1ea9•$
TOTAL .
FEE°'�.�
CA
CKy
NC
COUNTER 8.1.
., Imo/ 1!
.COUNTER L.U.T.
4726911
S T E C '1 A ,L I N .S 01 f '.C:. T 1 0 N P e, R M I
TOTAL ',01 t M%T"COST IS
NO. I OPERATION I DATE I INSPECTOR
BUILDING APPROVALS
1
Set Back
2
Ftgs & Frms
2A
Slab Grade
3
Steel
4
Grout Blocks
5
Bond Beams
6
Roof Deck
7
Framing
8
Vents
9
Garage Fire Wall
10
Fireplace P. L.
10A
Fireplace T. 0.
11
Exterior Loth
12
Internal Lath
12A
Drywall
13
Finish Grade
INSULATION
Thick R
Value
7A
Walls (Batts)
12B
Ceiling (Batts)
12C
Ceiling (Blown)
14
Final
a lCJ Z
_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
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final %) _ 2 i.. A'7_
T
NO. OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
33 Ventilation System
34 Plenums 8 Ducts
35 Furnace Comport.
36 Inlets 8 Outlets
37 Combustion Air
38 Compressor
39 Appl. Clearance
40 Fire Damper
41 Smoke Detection Device
42 Commercial Hood
43 Final
°pN ADDITIONAL INFORMATION
NO.
SEWAGE SYSTEM SIZE & LOCATION
Pit L.Line
REAR OF PROPERTY LINE
P/L P/L
STREET NAME