00018122 (BLDG)PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Lemon 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: 558.4464 Ph: 657.3898 Ph: 342.8271 Ph: 9222670
This permit becomes void if work not commenced within 180 days Irom date of issuance. OR, it work has beer suspended or abandoned for a period 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.
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 Professions 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 Iherelrom 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 five 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 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. II, 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-
tractor's License Law.)
01 am exempt under Sec. BA P.C. (Attach Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of Workers' Compensation Insurance, or a certified copy thereof (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)
HORN, DAN
ADDRESS
53776AVE uONTEry MA
C`ITYIICOMpM�UNIITTYIIS,TyA�TEEIIZIP Ch 922
tt0„
JOB SITEADDRESSISPACE
53776 AVE MOT EZJMA
CI TYICOM M UN ITYISTATEIZI P
LA QUINTA CA 942530000
BOK
774
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TRACT NAME
SCV LAO #19, ELK -196
OWNER NAME (L,F,MI)
-HORN, , DAN
PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOM MUN ITYISTATEIZIP
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITYICOM MUNITYISTATEIZIP
PLAN #.3 — <
PLANS AhyN�R „
�Y
AP 9V ®E`—S
S
USE OF PERMIT
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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. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-,
lion Laws of California.
Date Applicant
NOTICE TO APPLICANT: 11, after 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
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 buildingstructure. scaffolding, lalsework.
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.).
0 A owner -builder, I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Salely. 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 Safely
to enter upon;lh` roperly for which I have applied lot this permit for the purpose of making inspections.
"•St Ba(uyL�61 Appi of -Agent Date
Print Applicant/Agent Name
APPLIPRMT p PS DATE
00018122 CG 1/82 34742 4Id2
GRADING PLAN REVIEW FEE $15.00
TOTAL .
FEE
$15 0 v
CA
CK
X
NC
I COUNTER B.I..COUNTER
11 e—
L.U.T.
PERMIT FOR GRADING PLAN REVIEW
TOTAL PERMIT COST :IS $1510.0
0 of tots) 0 CU YDS -Cut: 0 F';i ll s 130 Total Moved f 130
Cradincl Plan Review Fee (hased on cubic. yds Cut and Filled) isi $15,00
FORM 284.208(11-81) IN_--DECTOR
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
Inleis 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. E)
NO
_ _` '_
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
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A. Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
APPLICANT NAME (L. T. MI)
l4likti, I)AN
ADDRESS
53776 AVE MONTEZUMA
CITYICOMMUNiTY/STATE/ZIP
,LA QUINTA CV 929530000
JOB SITE ADDRESsISPACE
53776 ' AVE MONTEZUMA
CITYICOMMUNITYISTATEIZIP'
QUINTA CAS225'30000
BOK
,774
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CA I
TRACT NAME
SCV LAO 019B.LK--,196
OWNER NAME IL,
�HORN, VAN
PHONEM
CONTRACTOR -FIRM NAME
LICNC 0
ADDRESS
CITY/COMMUNITY/STATEIZIP
PHONE#
INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITY/COMMUNITYISTATEIZIP
PLAN #
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
GRADING
BLZ0
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SIDE
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APPLIPRIVIT #s DATE
00018122 lxpc105/1 1/82 34737
TOTAL
FEEg
CA I
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INC
I COUNTER B.I. --17
LINTER C. U ')
APPLICATION FOR GRADING PLAN REVIEW
lll' H I S I S A N A P P L I C A 7 1 Cl N
FORM 284-208 (11.81) INSPECTOR
Cl N L Y'
1 3.47371
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. 0
43
Final
10A
Fireplace T. 0. C3
No
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Botts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 1 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' 7�
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
APPS xA rari rOGRAD :xNPERMIT
H S T a A M A P ,P LT A 't M U N L. Y
.n
FORM 284.208 (11.81( i I V..7PECTOR
'4DP5s?6 AVE MONTEIZUMA
r
Flrb`4CO u. TV`A/ZIPGA 922530000
Ueppt,A8RESSISPACE- _-- — .A. VE M(aNTEZUMA
zIP GA 922530000'¢N�
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oof 11
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PftY 1E (L'jVoVN
PHONE N
CONTRACTOR -FIRM NAME
LICNC N
ADDRESS
GITYICOM MUN ITYISTATEIZIP
PHONE N
BLDG.JNSPECTOR
FINAL DATE _t s
ARCIENG.FIRM NAME
LICNC N
ADDRESS
CITYICOMMUNITYISTATEIZIP
# ..a
PLANS EXAMINER
APPROVE DATE
ptPLAN
'!G&J (I')TRVN
•ry
900
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APPS xA rari rOGRAD :xNPERMIT
H S T a A M A P ,P LT A 't M U N L. Y
.n
FORM 284.208 (11.81( i I V..7PECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & 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.
FI
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
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