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PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITYICOMMUN ITYISTATEIZI P
PLAN #
PLANS EXAMINER
APPROVE DATE
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APPLICATION FOR GRADING. PERMIT
?, T H"T 8 1 5 A i4 A P P L I C A T ! 0 N
FORM 284208 (11.81( 1 NSPECTOR
0 Al L 'Y
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
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.O. 0
FI
ADDITIONAL INFORMATION
r'
_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
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
P/L
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
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: 658.4464
Ph: 657.3898 Ph: 342-8271 Ph: 9222670
This permit becomes void it work not commenced within 180 days from date of issuance. OR, it work has beer suspended
or abandoned far a period of 180 days. -
p
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter9 (wmmenc-
pleted if the permit is for one hundred (8100) or less. I certify [hat 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 full force and effect.
permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
TRACT LOT
000000 Oq�A
tion Laws of California.
❑
Date Applicant
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: II. after making this 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
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to con-
deemed revoked.
slrucl, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such
CONTRACTOR -FIRM NAME
permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will
empl 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 (8500).):
be made in connection with work authorized by this permit. and that no building structure. scaffolding, falsework,
❑ I,
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 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
❑ As owner -builder. I will not employ anyone to do work which would require a from the Division In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
permit of
dustrial Safety, as noted above. unless such person has a permit to do such work from the division,
through his own employees. provided that such improvements are not intended or offered for sale. II, however,
USE OF PERMIT
GRADING
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
❑Division of Industrial Safety Permit No.
ing that he did not build or improve for the purpose of sale.)
SSB
00S
❑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 lot 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 lot which this permit is issued (Sec. 3097. Civ. C.).
builds or improves thereon, and who contracts lot such projects with a contractor(s) licensed pursuant to the Con-
Lender's Name
tractor's License Law.)
Lender's Address
❑l am exempt under Sec. . B.8 P.C. (Attach Certificate).
Date Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certilicate of consent to sell -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 1l., F, MI)
wngm, DAN
ADDRESS '
:3790 AVE MONTEZUMA
CITY/COMMUNITYISTATEIZI P
LA QUXNTA CA 922530000
JOB SITEAD„RESSISPACE 3790 AVE MONTEZU �1A
CITY/COMMON ITYISTATE/ZIP
LA QUINTA CA 922530000
BOK
774
PAG
141
PRC
a0:A
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5
TWN
RNG
600
SE
00
S
TRACT LOT
000000 Oq�A
MOD
02�
SB
TRACT NAME
SCV LAW 419 BLK. 196
OWNER -HORN, (L,F,MI) N
PHONE p
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOM MUN ITYISTATEIZI P
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC #
ADDRESS
CITY /COM M UN ITY/STATEIZI P
PLAN If � 0 �v
PLA S E
APP�pVE DATE
USE OF PERMIT
GRADING
BL
as
ZON
RI
FSB
020
SSB
00S
$SB
n0
RSB
010
OFC
INu
ZONE ORD If
LOT SZ
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0050
SIDE
0100
a t e In ormatton 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 enter upoh•the property lot which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLIPRMT If
GRADING
PSI DATE
PLAN REVIEW FEE
34739 73ry
$101 00
TOTAL .
FEE
$15.00
CA
CK,X
I�
NC
I COUNTERr8.1. ✓'
t
COUNTER L.U.T.
PERMIT FON GRADING PLAN REVIEW
TOTAL PF::RMIT COST IS $15,00
0 of Lots, 0 CU YDS -Cuts 0 Fill: 148 Total Moved t 148
Grading Plan Review Fey* (based on cubic Spids Cut and Filled) ist $1115,00
FORM 284208(11.81) INSPECTOR
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 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. C]
43
Final
IDA
Fireplace T.O. 0
FI
r
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
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 '�c ._
Tank Pit L.Line
•
REAR OF PROPERTY LINE
PSL P/
ELECTRICAL APPROVALS
26 Power Pole
27Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
APPLICANT NAME (L, F. MI) I
HORN, • DAN
ADDRESS
53/70 AVE MONTZUMA
CITY/COMMUNIITYISTATEIZIP
LA QUNrA CA922530000 2253nM00
JOB SITE �ADDRESS/SPACE AVE
gpM �y �q p
53 70 AVPs MON EZUMA
CITYICOMMUNITTYISTAATEIIZIP '
/�y j� y�
LA ®OXN 1 A CA 92253 7060
BOK
PAG
P/RRC/�
C
TWN
SE
S
741141
i
0013
(w�
IL
(RAN (G� �y
000
(�
00
TRACT LOT
MODSB
000080 0021
I
TOTAL .
FEE \
1
019
CA
CK
TRACT NAME
SCV LAA 049, BLK -196
OWNER NAM, (L, F,MI) N
HORN
PHONE p
CONTRACTOR-FIRM NAME
LICNC N
ADDRESS
1
CITYICOMMUNITYISTATEIZI P
PHONEN
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC N
ADDRESS
CITYICOM MUNITYISTATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
GRADING
Boo .
RI -
020
A05
005
010
•
&D
ZONE ORD N
LOT SZ
rtEN�DD!! n
�{/ wl 0
tt** y4SIDE(�
Y i 0 0
APPLIPRMT #r p �xJA
34735
TOTAL .
FEE \
CA
CK
NC
COUNTER B.I.
COUNTER L.U;T.
,
APPLICATION FOR'.G62F1DING PLAN REVIEW
T H T 8 x s A H A P P L I C A T x 0 N O N L. Y
FORM 284.208 (11.81) I N$PECTOR
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.
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 s 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