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39943 (SIGN)PERMIT APPLICATION Count V of Riverside _ Department of Building and Safety. +� 4080 Lemon SI. 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: 922.2670 k This permit becomes void if work not commenced within 180 days Irom date of issuance. OR, if work has beer suspended or abandoned for a period of 180 days. A tF] Y LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- IY 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 alfirm that I am exempt from the Contractor's License Law for the Iifollowing reason (Sec. 7031.5. Business and Professions Cade: 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 life 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 - mil subjects the applicant to a civil penalty of not more than live. hunderd dollars ($500).):- 1 0 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 ,t Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or •v 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- r., r ing Ihal,he did not build or improve for the purpose of sale.) ;Y❑I, as owner of the property, am exclusively contracting with licensed contractors IO construct the project (Sec. 044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who i' builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con - V tractor's License Law.) I' ❑1 am exempt under Sec. . B.& P.C. (Attach Cerlilicate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby.alfirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a cerlilied copy thereof (Sec. 3800. Lab. C.). ❑Certilied copy is hereby furnished. ❑Certified copy is tiled with the County Building Inspection Department or County Department. 9;M 0i. APPLICANT NAME (LL, F, MI) �+y �, , O a'd0MM 040411 ADDRESS {,` 711 Y M CITYICOMMUN ITYISTATEIZIP' ixtario 9't fa A JOB SITE ADDRESS/SPACEit yy�� y. ~ 77985 Ave utq== C. IT,Y'ICOMMMUNITYISTATE7ZIP 4 raOil in CA 9? -25/ BOK PA��G))�� ,,yyP��RC ' V C a TWN RNG BE S TRACTyp� LOT dt# WV 014 1 MOD SB C� TRACT NAME � ). OWNER NAME (L,F,M*I)�� M BIWk PHONE It CONTRACTOR -FIRM NAME LICNC p ADDRESS . CITYICOMMUNITYISTATEIZIP PHONE p BLDg.JNSPECTOR FI L D XE � ARC/ENG FIRM NAME LICNC p ADDRESS CITYICOMMUN ITYISTATEIZIP PLAN p PLANS EXAMINER APPROVE DATE USE OF PERMIT " Roiniamation Fee E�) BL, I I ZON CPS FSB SSB SSB RSB 0 raw t ZONE ORD p LOT SZ END SIDE D FORM 284.208(11.81) INSPECTOR 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 cerlify 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: ll. after makingthis Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code. you must lorlhwith 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, 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 B. C.A.C.). OAS Owner -builder. I will not employ anyone to do work which would require a permit from the Division o1 In-' dustrial Safety, 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 Safety to enter upon the property for which I have applied fowhis permit Idr he purpose of making inspections. ./tom— ....� � !w/��,•,.i'L`s/ 'ti. `—Sfgnalure of Applicant or Agent Date Print Applicant/Agent Name APPLIPRMT p PS DATE 3 9 � /I /1 TOTAL FEE t �r C� CK NC COUNTER B.I. COUNTER �LrUi.TP NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 8-6-82— 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. 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 (Batts) 12C Ceiling (Blown) 14 Final 6 8 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 ELECTRICAL APPROVALS PSL 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, F, MI) ' KON CQ ADDRESS ;103 w MAIN U�NIITY//STATEIZIP CITYIC�O+M MpI ONTARIO CA 91I630000 P' f�6 1-'Y9 9WA�DRESS/SPACE AVE MONTEZUMA CITVICOOMI�.JMUNITY/STATEIZIP LA- QUINTA CA 922530000 BOK 7731104 PAG PRC 013 C 2 TWN ,R+NpG �k V V V lS�En o o S TRACT LOT 000000 ()00101 MOD IS. TRACT NAME y �y"i� �. Q *14p 1 4 p P � K -1 v��+ r4 11� qVn L3F.EWN (L.VL OIL,MI LII PHONEp CONTRACTOR -FIRM NAME LICNC N ADDRESS ' CITY/COMMON ITYISTATEIZIP PHONE pBLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME °, LICNCN ADDRESS " CITYICOMMUNITYISTATEIZIP S PLAN q PLANS EXAMINER APPROVE DATE USEnO1F'PE MMIT p p OLI 9.00 ` FSB QWU IOU' VBV Q458 F�1D 1SIDE u«'_G�.i3 ' ZONEOR LOT SZ END 000 APPLICATION FOR STRUCTURAL PERMIT 'T M I s 1 5 A N A P P L I C A T I C N U N L Y FORM 284.208(1181) INSPECTOR NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECT BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Figs 8 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 IDA Fireplace T.O. P' ADDITIONAL INFORMATION 1 t 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 P/L REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/L 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET