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00016742 (SFD)❑ 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 full 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- slrucl. alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant lot 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 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 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. 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.) ❑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 contracto((s) licensed pursuant to the Con- tractor's License Law.) 01 am exempt under Sec. && P.C. (Attach Certificate). Dale Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm 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 filed with the County Building Inspection Department or County .Department. P6tl. PAT, ANb(hkMI) tW` Vs 1630 PERMIT APPLICATION M8,P1-E?AWRESSISPACE AVE MONTEZUMA LrCW+friflZIPCA 922570000 ID/9 County of Riverside Department of Building and Safety n3 4080 Lemon St. 2nd Floor Riverside. CA 92501 Ph: 787.6146 135 N. Alessandro Rd. Rm. 203 Banning. CA 92220 Pm 849.7312 880 N. Slate Street 227 North "D" Street Hemet. CA 92343 Perris. CA 92370 Ph 658.4464 Ph. 657-3898 46.209 Oasis St, Rm 310 160 N. Broadway India. CA 92201 Blythe. CA 92225 Ph. 342.8271 Ph. 922.2670 This permit becomes void if work not commenced within 180 days tram date of issuance. OR. it work has beer suspeVeff or abandoi*d for a period of 180 days. 0000 02!1 ❑ 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 full 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- slrucl. alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant lot 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 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 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. 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.) ❑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 contracto((s) licensed pursuant to the Con- tractor's License Law.) 01 am exempt under Sec. && P.C. (Attach Certificate). Dale Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm 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 filed with the County Building Inspection Department or County .Department. P6tl. PAT, ANb(hkMI) tW` Vs 1630 • ITnfI CrrUV MA1!R`T CA 922_'600000 M8,P1-E?AWRESSISPACE AVE MONTEZUMA LrCW+friflZIPCA 922570000 ID/9 m n3 TWIN 0VU0 610 S 0000 02!1 0°IP1 SB CA ,%VAtAO *19, BLK-196 F i` it ME (Ijrj MN PHONE p MyM"IJW NFt3RN Li7'�.ir6436 Oaks 1638 T"IAIL"U'J7G.Jr,IRP CA 92: 600000 7`14-560 —1040 BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC M ADDRESS CITYICOMMUN ITYISTATEIZI P PLAN M P S XAM ER APPROVE DATE t36EY3FPERMI6 ATT GARAGE JH g�{ I R JON WOO 10ft 1005 J0 VW I T10 ZONE ORD N LOT SZ V #Nii V 1 ODE 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- tion Laws of California. Date _ _ ____ Applicant NOTICE TO APPLICANT: II, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Cade. 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 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. 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.). 0 A 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 Safely Permit No. ___ _ _ _ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor. mance OI 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 buildingl�pppp;,(ruction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter �Tip property for which IIhha� applied for this permit for the purpose of making inspections. Sj)gnlure of Applicant or Agent Date Print Applicant/Agent Name IAU URi T8174F7.. CU 04/G. 10/t�7 L:-� 721 ESTIMATED PLAN REV NEE TOTAL FEE CA CI NC COUNTER B..� i COUNTER L.U.T. f PERMIT FOR STRUCTURAL PLAN RLVICW TOTAL PERMIT COST IS $151,77 CONSTRUCTION ESTIMATE. (NOTEt Not to be used as property valuation) Description FCC Group Typ e Sq Ft RateValuation DWLG 101 R-3 V -W 1211 $27,60 $33423 SECNDRY AIRCON 900 R-3 R 1211 $2.20 $2664 SECNiDRY PRIGAR 436 M WD 320 $11 to Est Plain Rev Fear based on Total Estimated Val'in of $38§99 is) $151.77 61:?Z- FORM 284.208(11.81) INSPECTOR NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS I Set Back 33 Ventilation System 2 Figs & 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 'V. 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial blood 10 Fireplace P. L. 0 43 Final IDA Fireplace T.O. 0 NO _ . 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 (Botts) 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 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 APPLICANT NAME (L, F, MI) HORN. DAN ADDRESS q BOX 638 CITY/COMM UNITYISTATE/ZIP PALM i7ES :RT UA 922600000 JOB SITE ADDRESS/SPACE 537910 AVE MONTEZUMA CITY/COMM UN ITY/STATE/ZIP ' L.A QL INTA CA 922530000 BOK 774 PAG 191 PRC 003 C 5 TWN RNG 000 SE as S TRACT LOTMOD oaanaa 00 TOTAL` . FEE Oil SB ' TRACT NAME S, CV L.AQ *19, ELK -196 OWNER NAME (L,F,MI) N , PHONE # yyHORN, DANAVON NAME g�lCppl}}i�� �(.yy ppX,�)��XN p�p,� U. L1�:7. �tii6 ADDRESS BOX 1638 CITY/COMMUNITY/STATE/ZIP PALM DL '6 CA �.2600000 PHONE# 7a 4-568-1048 ' BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC # ADDRESS CITY/COMMUNITY/STATE/ZIP PLAN # PLANS EXAMINER APPROVE DATE USE OF PERMIT 1/WLG & ATT GARAGE - BL20N na R1 FSB Qin' SSB A0 SSB a05 RSB a0 OFC . IND ZONE ORD p LOT SZ END SIDE 0050 0100 APPLIPRMT p PS DATE 1 A 00016742 �B 26714 6 7 a�r�a�t�� 1/d/ I LJa{fl TOTAL` . FEE CA CK I NC COUNTER 8.1. COUNTER L.U.T. APPLICATIUN F OR STRUC URAL. PLAN REVIEW T H 1 8 1 r A N A P P L a C A T T U N 0 N L Y FORM 284208(11.81) NVECTOR 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. E3 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,(Bptts) 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 APPLICANT NAME JL, F, MI) HORN DAN ADDRESS BOX 108 CITYICOMMUNITYISTATEIZIP PALM DESERT CA 922600000 levood, RESSISPACE AMIE MONTEZUMA j� f'1 CIITYICOMMUNITYISTATEIZIP ' LA QUINTA CA 922530000 BOK 74 PAG, 1.41 003 C � TWN RNG aaa SE as S TRACT • LOTMO 000000 0021 OD Ulf SB TRACT NAME SSV LAA 419j, BK—1 I 6 O;�W�(L. N �MAN HONE q A'WORN 7 rti4^vWNgO ADDRESS BUX 1438 . PALMUNDESE tT CA 922600000 Yl•IE,(-5 l 8— 1 0 48-1 i BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC # ADDRESS CITYICOM M UN ITYISTATEIZI P h PLAN # N PLANS EXAMINER APPROVE DATE USE OF PERMIT VWLG & ATT GAR -AGE, Ba'a R fN { UF�BO VSVx gry 6sh n OlItl hD ZONEORDM LOT SZ TOTAL . FEE ' 0 dl to V �f fS6Db � NC: COUNTER B.I. COUNTER L.U.T. , T H I S FORM 284208 j11-81) INSPECTOR APPLIPRMPs T B . DATE 3110016 039 j^ t TOTAL . FEE ' CA CK NC: COUNTER B.I. COUNTER L.U.T. , APPLICATION FOR STRUCTURAL PERI' IT 1 6 A N A R P L x C A T 1 0 N 0 N L Y 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 Froming 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