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00018913 (ELEC)❑ 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 Chapter 9 (commenc- pleted it the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this PERMIT APPLICATION permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensa- trIT�COAQDy1�1�1ra"IQTAZIP CA tion Laws of California. County of Riverside 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 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 Department OT Building and Safety deemed revoked. 4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North -D- Street 46.209 Oasis 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: 849.7312 Ph: 6584464 Ph: 657.3898 Ph: 342.8271 Ph: 922-2670 This permit becomes void it work nor commenced within 180 days from date of issuance. OR. it work has beer suspended or abandoned for a period of 180 days. ❑Division of industrial Safety Permit No. ❑ 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 Chapter 9 (commenc- pleted it the permit is for one hundred ($100) or less. I certify that 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- trIT�COAQDy1�1�1ra"IQTAZIP CA 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 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 following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con- deemed revoked. struct, alter, improve. demolish. or repair any structure, prior to its issuance, also requires the applicant for such S 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- ❑I hereby certify excavation five (5) or more feet in depth into which person is required to descend, will. 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).): do with n made to connection with work authorized by This permil, and that no building structure. SGrp Art Q I, the or or demolition or dismantling thereof. will be more than Thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341, 2. . Sec 41, Title B. C.A.C. as owner of 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 from Division Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or would require a permit the of In - 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 lot sale. II, however. the building or improvement is sold within one year of completion, the owner -builder will have the burden of ploy- ❑Division of industrial Safety Permit No. Ing that he did not build or improve lot the purpose of sale.) FINAL DATE c ❑l, 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 for the perfor- 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who mance of the work for which this permit is issued (Sec. 3097. Civ. C.). builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- Lender's Name tractor's License Law.) Lender's Address pl am exempt under Sec. . B.8 P.C. (Attach Certilicate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a certilicale of Workers' Compensation Insurance, or a certified copy thereol (Sec. 3800. Lab. C.). OCerlified copy is hereby furnished. QCertified copy is filed with the County Building Inspection Department or County Department. APPLICANT NAME (L, F, MO CARROLL SERV STAT MAINTENANCE '9VI"o' W STATE ST QA'J,�i1,WydTATEIZIP CA 917610000 �e6T HH �+QQ(RESSISPACE JGj A er AVE MONTEZUM AVE 69225300001_1 ►4 trIT�COAQDy1�1�1ra"IQTAZIP CA 'W3 if b^f P'13 K. V W� 0 S ]AdTa 000 `oT0 01 �,Q{]TWN V x1 SB 1 S 6T V..'&lLUbLD g OIL CO PHONE# CONTRACTOR -FIRM NAME LICNC # ADDRESS CITYICOM MUNITYISTATEIZIP PHONE# BLDG.INSPECTOR FINAL DATE c ARCIENG FIRM NAME LICNC N ADDRESS CITYICOM MUNITYISTATEIZIP PLAN If PLANSq�EXAMINER APPROVE DATE �j ry ry� 'I H,�{t"'bONS 1 SERVICE r� Bb a c * FSB 00 16W aOb YWn CU arC! LOT SZ ENDaO$JD€, CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the information given is cor(ect. I agree to comply with all state laws and county ordinances relating to building construction, ar�yauthorize a representative of the County of Riverside. Department of Building and Safety to enter upon,# rlp� for which I have Applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name APPLIPRMT p S ""DATE EPaa!e!/E0001891 27017 On ELECTRICAL FEE $13.00 TOTAL CAx CK NC COONit COUNTER L.U.T. E L E C T R I C A L P E R M I T TOTAL PERMIT COST IS $13,00 ELECTRICAL FEE: COMPUTATIONS * Permit Fee (if applicable) F'EEs TEMP SVC•-Temp/Constr SoctY Temp Use PrmtiN Add'1 Pole+ c 0 FEEj FORM 284.208111.81) INSPECTOR $3.00 $10.00 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL' APPROVALS 1 Set Back 33 Ventilation System 2 Figs & Frms 34 Plenums 8 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. E] 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) 128 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 Heiner 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 s_ �� _� 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding WireSZ _ 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME APPLICANT NAME )L, F, MI) CARROLL SERV -STAT MA-INTENANCE aW6- W STATE ST C6I,�',C�jv1�a1�`OTATE/ZIP CA .917610000 91 761 0 0 0 0 1 u \ u AES�SjjISPACE y(�j��T€((�j' V 1CP t7 AVE MO�a,TEZUMA AK. 9 VY40M6, t:J fWfAE IP 0 000 9' 3 PTb4 T13 Cr TWN 6bo UO Is TaAYO 0 0 0 LOTO 0 9 `iii 1 I SB 915TVM 0 1� 4 �y �q �n 19t�.E U LtLELD,,, OIL C0 JPHONEN CONTRACTOR -FIRM NAME LICNC # ADDRESS CITY/COMMUN ITYISTATEIZI P PHONEN BLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNC # ADDRESS CITYICOM M UNITY/STATEIZIP PLAN p PLANS EXAMINER APPROVE DATE USE OF P RMIT fleg bONST SERVICE '60 Cf�i7 FSB Ott n t' 0170 Sat U Ott - ry� UD ✓' kw�N� �N LOT SZ END 0 osob APPIL 000T6913 0.5 2, ; TOTAL . FEE CA. - CK I NC COUNTER B.I. COUNTER L.U.T. APFLICA" ION fOR E LE CTll.bli AL PERMIT 1 2,70 T' -H'1 S I S A N A P P L.1 C A T T O N O N L `d r .4 v. FORM 284'.208(11.81) !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 & 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.O. 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