SATT (00019093)77621 Los Arboles Dr
00019093
CA CK NC COUNTER B.I. COUNTER L.U.T.
71 TT
APPLICATION FOR STRUCTURAL PLAN REVIEW
X.
' T H x$ I S A N -A P P L I C A T I 0 N O N L Y
'Yo6 must see the fallowing Depapvmenvs (if listed) for concurrence BEFORE
3C' +rMl can be isssued i
Descrt i ors ...» _ .- .. .. ------_--------- ... a . ,....M .. _ , Do I to Sege ..-
HOLD-POAD, H ALTH w..AAD USE
FORM 284-208111.81) I NSPEC 0R
ADDRESS.y
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X I8®
} NCMUFA TF1IZ IP
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AA
C . " 122" 17 ®V
qVgfjRESS/SPACE LO AR BOL IG.S
TYCO a fA IT€IZIP CA922530000
BOK
631
PAG
380
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02
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3
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TRACT NAM QE
ry
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atp Fr Eit HOWER DR
4TyY
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L`OGOt 4llt`dTl.TAIZIP CA 922530000
111`4 ' 564-1 31 tJ
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC N
ADDRESS
CITY/COMM UNITYISTATEIZIP
PLAN 9
PLANS EXAMINER
APPROVE DATE
U{SE yOF P7E`RMryIT {s t ATT
q{ y w
166NAO- DWI..0 Q A ! T GAR
A)131.
001.
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END
0 VS® b
vVVY409 A 05/20W ' 7
I
1
4
TOTAL .
FEE
CA CK NC COUNTER B.I. COUNTER L.U.T.
71 TT
APPLICATION FOR STRUCTURAL PLAN REVIEW
X.
' T H x$ I S A N -A P P L I C A T I 0 N O N L Y
'Yo6 must see the fallowing Depapvmenvs (if listed) for concurrence BEFORE
3C' +rMl can be isssued i
Descrt i ors ...» _ .- .. .. ------_--------- ... a . ,....M .. _ , Do I to Sege ..-
HOLD-POAD, H ALTH w..AAD USE
FORM 284-208111.81) I NSPEC 0R
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 & 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. E]
43
Final
IDA
Fireplace T.O. ❑
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
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
.{ t
STREET NAME
AUbcr,.T"ti'bi r
SOW 700
a /coM u / , r /zIP
EIA76ir� ,� CA ?22530000
JQB„SITEffRESS/SPACE LOS ARRfOOpLES
+yam (� n ,{y n
ET1�(COMMIZIP 'I� A 722530 0 0 0
BO{{KJJjjPAG
631
0
PRC
0CW
C
3
TWN
UOOf1
RNG
SE
00
S
M496 I&B5
1
15"11
1 SB
CA
NAME
�TRACT
A�ER
VNqn
PHONEqgMIN7
j�pyR
1
�u
�C.fy�p�
�•ly t
x9153672
gJ{J�E[$�q ��^�Wj pv�i �R.
WM-1 Ei-SENWOWER DR
WIC041TIzW A ZIP Cf'! 922530000
7NV a5 LG7N M 1 � 1 5
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC 0
ADDRESS
i.
CITY/COM MUN ITY/STATE/ZI P
PLAN 0
PLANS EXAMINER
APPROVE DATE
MARlDWU 8 ATT CAR (P-1 A)
uo
R gN
FSB'
B� ()
1 0 V
[�
Ub
„ l b
U
ND
ZONE ORD O
LOT�jSZ
END
0 0 BIDE
ffW(PTTo o 9;z0 � y 2 5 8 6 6
TOTAL .
FEE
CA
CK
NC
I COUNTER B.I.
COUNTER L.U.T.
_ - --•'"
APPLICATION k'09 STRUCTURAL PERMXT
T H I S i s A N A P P L I C A T 1 0 N O N L. Y
r
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Bock
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.
OWN
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 (Botts)
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
PERMfT APPLICATION
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 "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: 658.4464 Ph: 657.3898 Ph: 342.8271 Ph: 922.2670
This permit becomes void it work not commenced within 180 days from dale of issuance. OR, it work has beer suspended or abandoned for a period of 180 days.
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(comment- pleted if the permit is lot 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 lull force and effect. Permit issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
tion Laws of California.
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 Prolessions 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 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 ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
j Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If. however.
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
ing that he did not build or improve for the purpose of sale.)
❑I, as Owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
builds or improves thereon, and who contracts for such projects with a conlractor(s) licensed pursuant to the Con-
tractor's License Law.)
❑I am exempt under ec. . BA P.C. (Atlach Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800, Lab. C.).
[]Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County Department.
T91\Idt'�AM4t s.f /S 1
' PNB 780
f,1TACO'i>01Td-P4'i zIP CA 922530000
I5RESS/SPACE LU %$ AXUULhb
IVIFT449611
f v�3
TWN
S
a.�
SB
TRACT NAME
NR )HONE
X
fPi 1-EISEMHE)WER DR
k'ACOWtJ.Q4MtJAfqJZIP CA V >R..•
8 M" BLDG.
INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC X
ADDRESS
CITYICOMMUNITYISTATE/ZIP
PLAN X P EXAM R APPR E DgTTTE
UILONWr- *4 i 7/
180
R 'N
FSB
1 0 #J
CtK
` $)
I COU TER W.I.
.. ZONE ORD X
LOT SZ
END
uale 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 lorlhwith 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 leel 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. scalfolding, falsework,
or demolition or dismantling Ihereol. will be more than thirty-six (36) [eel high. (Chap. 3.2. Grp 2. Art 2. Sec 341.
Title 8. C.A.C.).
❑As 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 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 formation given is correct. I agree to comply with all state laws and county ordinances relating to
building uction, and authodzesepresentative of the County of Riverside. Department of Building and Safety
to enter on he grope dy-1 r w ich I have applied for this permit for the purpose of making inspections.
X fir—
Signature of Applicant or Agent Date v
Print Applicant/Agent Name
V VIU AT( 09 CXR
otJO
'32
TOTAL
FEE
d r :
CA
CtK
NC
I COU TER W.I.
COUNTER L.U.T.
L-- __ . I. V %
PERMIT FOR STRUCTURAL PLAN REVIEW 1 258321
TOTAL PERMIT COST IS $169.32
CONSTRUCTION.ESTIMATE (NOTEt Not to be used as prop rty valuation)
Description FCC Group Typ e HiQ �t Rate Valuations
PRIMARY DWL.G 100 K_3 W69D 14401 $27.60 $40875
SECNDRY PRIGAR 436 M--1 WOOD 448 $9.10 $4076
Est Plait Rey Fee based on Tota. Estimated Val'tn of $44951 it i $169.32
!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
Figs 8 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. C]
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 (Botts)
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