PLAN CHANGE (00008780)77670 Los Arboles Dr
00008780
. rcnmiv nr-r-LI mnun
County of Riverside
Department of Building and Safety
4060 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Stale Street t
227 North "0" Street 46.209 Oasis S1. Rm. 310 160 N'Broadway
Riverside. CA 92501 Banning, CA 92220 Hemet, CA 92343 •t'"
Perris, CA 92370 Indio. CA 92201 Blythe. CA 92225 f
Ph: 787-6146 Ph: 849-7312 Ph: 658.4464
Ph: 657-3898 Ph: 342.8271 Ph: 922-2670
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
•. with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit is issued. I
,,,. •'4
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
.'License
• License Class Lic. Number
Date Applicant
a Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
"OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt train the Contractor's License Law for the following
Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct. alter,
deemed revoked.
improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
,. signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing-
❑ I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be
.with Section 7000) of Division 3 0l the Business and Professions Code) or that he is exempt therefrom and the basis for
1 the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
made in connection with work authorized by this permit. and that no building structure, scaffolding, falsework, or
demolition or dismantling thereat. will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec 341, Title 8.
penalty of not more than live hundred dollars ($500).):
C.A.C.)
1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the❑
As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
-s ructure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
Safety. as noted above, unless such person has a permit to do such work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or altered for sale. Il, however, the building or
Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
-"build or improve for the purpose of sale.).
affirm that there is a construction lending agency for the performance of
CONSTRUCTION LENDING AGENCY: I the work for which this permit is issued (Shereby ec. 3097, Civ. C.).
PsiI, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name
ness 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 contractor(s) licensed pursuant to the Contractors
Lender's Address
License Law.). k
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
1 am exempt under Sec. - . B. 8 P.C. (Attach Certificate)_
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
. Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. or a
Signature of Applicant or Agent Date
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Q.
CERTIFICATE OF COMP IANCE AND'AUTHORIZATO)N OF ENTRY: I certify I have read this application and state that the
z Policy No. Company
nformation'diven isrrect. I agieg1to comply with all state laws and county ordinances relating to building con-
slruction,!and Outhor' e a represehtalive'of the County of Riverside. Department of Building and Safety to enter upon
Certified is furnished.
me propeHyll o whi 11.have applied this&armlt`forthe•puxppSaaLmaking inspections.
{r - copy hereby
Rn Certified copy is tiled with the County Building Inspection Department or County Department.
Si Lure of Applicant or A gent Date
Date Applicant
lJ
1 -:Pr, t#A"pplicant/Agent Name
APPLICANT NAME (L. F. MI)" -- _ •_ - _---_r -_ - - _-
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ADDRESS
CITY/COMMUNITY/STATE/ZIP
LA QUINTA CA 922530000
JOB SITE
+ADDRESS/SPACE M p y
CITY/COMMUNITY/STATE/ZIP
LA t UINTA CA 9421..2 30000
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TRACT NAME
.OWNER NAME (L, F, MI)
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CONTRACTOR -FIRM NAME
ADDRESS
CITY /COMMUNITY /STA T E/Z I P
. PHONE 4
LICNC 4
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE q
LICNC 4
'USE OF PERMIT
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END
SIDE
P C A M 17 FOR PLAW CHAI NGe
TOTAL-•PtRM1 COSY 19
s PLAN. CHANGE,
FORM 284-208 (2/81)
$45. . 0 0
TOTAFEE` -t A*g1r►1,
101110003
$4! . 00
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1.
Set'Back
33
Ventilation System
2
Ftgs & 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
10A
Fireplace T. 0.
°o
_. .__ .
ADDITIONAL INFORMATION
_.. .. ..... .._ ... _ '..-. '• _ __..._ .-_ . _ .. _ .. _ ..
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal lath
12A Drywall
13 Finish Grade .ti .. " - -•• - _' ..- ._ _ _ _ _ ...
INSULATION Thick „RSI
Value
7A Walls (Bans)
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
APPLICANT NAME (L. F. MI)
ANAMEM.1
ARADLES
CITY/COMMUNITY/STATE/ZIP
LA' QUINVA C -A ggt afaco
JOBB] SITE ADDRESS/SPACE
l
'CITY/COMMUNITY/STATE/ZIP
C- ami
fNT9,225-30004
BOK
PAG PRC
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TRACT
LOT
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,TRACT NAME
OWNER NAME (L, F, MI) _
ANDIENY.
CONTRACTOR -FIRM NAME
ADDRESS
C I TT!COMM U N ITY/STATE/ZI P
PHONE #
LICNC #
ARC/ENG FIRM NAME
J
ADDRESS
S
CITY/COMMUNITY/STATE/ZIP
PHONE q j
3
LICNC N
USE OF PERMITt
BLZON
0 p
621
1
FSB
SSB SSB
00 00
RSB
60
OFC
114
ZONE ORD #
LOT SZ
END
SIDE
APPL/PRMT a PS DATE 011182
t
PLAN CHANGE
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° TOTAL .
FEE '
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APPLICATION TOR PLAN 'CHANGE /
'r aY act pan+ A P—P L 1 C A T10 o N L
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
Slob 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
Gnroge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O.
°o
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
FLUMBING 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
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30. Fixtures
31 Service
32 Final
t STREET NAME