00016747 (SFD)APPLICANT NAME (L, F, MI)
MORN, JAN`
ADDRESS
BOX 1638 ,
CITYICOMMUNITYISTA EIZIP
PALM X3t«3�RT CA 922600000
-611I��gRESSI'7SSPPACE AVE MONTEZUMA
C 11COl1L�,��WAIZIP CA 922Z�.70000
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INSPECTOR
FINAL DATE
AAROIEaf NNG FIRM NAME
LICNC p
ADDRESS
CITYICOM M UNITYISTATEIZIP
PLAN p
PLANS EXAMINER
APPROVE DATE
US OF PFiRMI � ` ,
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APPL0 1 p PS DATE n w
000147 ix*04"O1E3 265
I/ I
TOTAL .
FEE
CA CK NC I COUNTER B.I. COUNTER L.U.T.
APPLICATION FOR STRUCTURAL, PLAN REVIEW
I s A .N A P. P t... I is A T I C N 0 N L Y
x
FORM 284.208 (11.81) 1 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
1 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.
OP•N
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 (Betts)
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
P/L P/
z'
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
i1 �1'i, 1'i NAM Ut9Ft I)
DOW 1 63$
¢'-'7-44°"UNfbT�r3SEljkPT CA 922600000
04!,$ r.AggRESSISPACE AVL MUNIL4UMA
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,9104— 8-1048_ BLDG.
INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC q
ADDRESS
,CITYICOMMUNITYISTATEIZIP -.
PLAN # PLANS
EXAMINER
APPROVE DATE
MIj l tjq !a °
y
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'� S�D9
li R�11F dTi ! 'Y i Ap 'Q 4! i A C"� �T i� 2•
25918
A,
f
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TOTAL .
FEE
CA
CK
NC
COUNTER B.I.
COUNTER L.U.T.
p1 259
AI PLICATION FOR 'STRUCTURAL -DER 1U
.j;
.4 IN. r
.t
• ,a
FORM 284.208(11-81) INSPECTOR
r
t
9:
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 6 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.O.
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 i
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
2913 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
PERMIT TPPLICATION
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 "0" Street 46.209 Oasts St. 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' 8497312 Ph. 658.4464 Ph: 657.3898 Ph.. 342-8271 Ph: 922.2670
This permit becomes void it work not commenced within 180 days from date of issuance. OR, d work has beer suspended or abanifnned for a period of 180 days.
7
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter ( comment
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect
11
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot 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 therefrom and the basis lot 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 Conlraclor'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 altered 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.)
❑l, 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.
B.8 P.C. (Attach Certificate).
WORKERS' COMPENSATION DECLARATION: I hereby allirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
❑Certified copy is hereby furnished.
❑Cerlified copy is tiled with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, Nut
HORN, DAN
=S 163Q
FHi°�iD�1i:�a PT CA 922600000
Idl;%Qi; IIIAURESS/SPACE AVE MONTEZUMA
F"4 °O%i Y9 T(pplZplP CA 922q�iry3n00g00
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FCC Group
Type
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SB
CA
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P.MiR V411E(L:FMll,
PHONE N
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LWJURA 36
RB 16.313
P I PUM ULFRER i CA 922600000
1" —51,G7 404011 8—
71"V-568-1048
F V is
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC N
ADDRESS
CITYICOMMUNITVISTATEIZI P
PLANK
P EXA I R
APPROVE DATE
AM ATT GARAGE
aO I
R VN
0�.S�D
0 P� 1
0 f�
0185
of
IRSi>
is: 91.,1.77
ZONEORDN
LOTSZ
0 V:f0 101095
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted it 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-
tion Laws of California.
Date _- Applicant
NOTICE TO APPLICANT: If. 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
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Of hereby certify That no excavation live (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, falsework.
or demolition or dismantling thereof. will be more than thirty-six (36) feel high. (Chap. 3.2. Grp 2. Art 2. Sec 341.
Title 8. C.A.C.).
0 A owner -builder. 1 will not employ anyone to do work which would require a permit from the Division of In-
dustriat Safely. 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 lot 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 en le n the property for w I ave applied for this permit for the purpo of making inspections.
X -Z( -232—
ignature of ApplirnT or Agent ' Date
Print Applicant/Agent Name
APPLIPRMT NPS A
00U16747 C 04/2'f7b 6 7.,x,0
ESTIMATED PLAN REV FLS .
TOTAL,
PERMIT COST
IS
$1:1.77
CONSTRUCTION
ESTIMATE (NOTE:
Not to
be used as
property
Y
Description
FCC Group
Type
TOTAL
FEE
$
CA
C%
NC
COUNTER B.I.
COUNTER L.U.T.
V'
?P( 47S PERMIT FOR STRUCTURAL PLAN REVIEW
FORM 284.208(11.81) INSPECTOR
TOTAL,
PERMIT COST
IS
$1:1.77
CONSTRUCTION
ESTIMATE (NOTE:
Not to
be used as
property
valuation)
Description
FCC Group
Type
Sq rt
Mate
Valuation
PRIMARY
DWLG
101 Rw3
V_
1211
$27.60
$33423
SECNDRY
AIRGON
900 R--3
R
1211
$2.20
$2664
SECNDRY
PR IGAR
436 M
WD
320
$9.10
$291
Est flan
Rev Fee based
on Total. Estimated Val'tn
of
$38994?
is: 91.,1.77
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 3 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
ompressor6
Compressor-
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
M
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T. 0.
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
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