0002228 (BLCK)AFFLIUAN INAME IL, F, MI)
DAVIS MIKE
ADDRESS
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AVE 0BR500N
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BOK
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PAG
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TRACT LOT-
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TRACT NAME
Y31. K 189 SC:V LAQ 19
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PHONE #
CONTRACTOR -FIRM NAME
LICNC #
.A'DDRESSY
CITYICOMMUN ITYISTATEIZIP •
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP '
PLAN # _
PLANS EXAMINER
APPROVE DATE
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ZONE ORD #
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'FORM 284-208(>>•BI) INSPECTOR
,, 1 -R+ _ ._ - M. .. _ ..
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs $'Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
1 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.
FI
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
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
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
i PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Stare SUeel 227 North "0" Street 46-209 Oasis SI. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343 Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787-6146 Ph: 849.7312 Ph: 658.4464 Ph: 657.3898 Ph: 3428271 Ph: 9222670
• This permit becomes void it work not commenced wilhin 180 days from dale of issuance. OR, it work has beer suspended
or abandoned for a period of 180 days. -
�❑
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
P^� LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comment-
pleted if the permit is lot one hundred ($100) or less. I certify that in the performance of the work for which this
ing with Section 7000) of Division 3 Of the Business and Professions Code, and my license is in lull force and effect.
permit issued. I shall not employ any person in any manner so as to became subject to the Workers' Compensa-
tion Laws of California.
•
Dale - Applicant
-`;❑
. OWNER -BUILDER DECLARATION: I hereby allirm that I am exempt Irom the Contractor's License Law for the
NOTICE TO APPLICANT: 11. alter makingthis 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
lollowing 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
i
r 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 0l the Business and Professions Code) or that he is ex-
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
ex-
' empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 any applicant for aper-
❑I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will
mit subjects the applicant to a civil penalty of not more than live huntlertl dollars ($5000)) .):
be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework,
❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work• and the
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.).
+ 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
Law does not apply to an owner of properly 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. Il, however,
work which would require a permit from the Division of In -
dusirlal Safety, as noted above. unless such person has a permit to do such work from the division.
t ' Ihe'buitding or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
❑Division of Industrial Solely Permit No.
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.
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
. 1-11 am exempt under Sec B 8 P C All h C fl' t
--
( ac er t tca e).
Dale Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm 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.).
❑Cerlified copy is hereby furnished.
�.❑Certilied copy is filed with the County Building Inspection Department or County Department.
:I
2f APPLICANT NAME (L, MI) "
0,3605 AVE OBREGON
.7 CITYICOMMUNITYISTATEIZIP
LA 'QUINI'A CA 922530000
'? sIOB SIJE� QRESS/SPACE
(�yS I AVE ODRCr»GON
t
kT!'atOW�b1`fl'YZIP CA 922530000
BOK I PAG PRC C TWN RNGSE S
774 114 019 6 1 coo0
00
. 00000A 3009 Wf1TSB
TRACT NAME
BL 189 SCV LAQ 19
J QYVIlEOYV ( F Ifi I KE PHONE 8
CONTRACTOR -FIRM NAME LICNC 11
ADDRESS
t
CITYICOMMUNITYISTATEIZIP
PHONE # BLD71NSPEC R FIN L DATE
L6�
✓
ARCIENG FIRM NAME LICNC d
ADDRESS 09 ,
1 CITYICOMMUNITYISTATEIZIP
r PLAN If PLANS EXAMINER
USE OF PERMIT
46)(65 WOOD FENCE;
�o R N 0" 0U� 01 0
' ZONE ORD p LOT SZ
''
, a
,L
6)(45 WOOD FENCE
e.
I
q1 ti i
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 authorite,a-representative of the County of Riverside. Department of Building and Safety
to enter upon the properly for/which II have applied for this permit for the purpose of making inspections.
Xr�'f7r" f •� r� ��
Signature of Applicant or Agent Date
_ Print Applicant/Agent Name ' _
APPLIPRMT If PS DATE
0
J6X65 WOOD FENCE $15.00 1
j TOTAL
/ FEE
§1DE� CAX CK NC COUN%ER Bd ' COUNTER L.U.T.
U " /. &/J
P. F. R M I T FOR 6X65 WOOD FENCE
TO1*AL PERMIT CUSS' 18 $15.00
r
.FORM 284•208 (11.81) INSPECTOR s
15,001
$15.00
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 & 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. C3
43
Final
WA
Fireplace T.O.
OP'N
NO.
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
R
Value
7A Walls (Botts)
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 ^
r
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
r•
P)
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME