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ELEC (00017427)., ❑ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- PERMIT APPLICATION pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensa CITYICOMMUNITYISTATEIZIP LA QUINTA GA 922230000 lion Laws of California. Count v of Riverside Department of Building and Safety Date Applicant 4080 Lemon Sl. 2nd Floor Riverside. CA 92501 Ph: 787.6146 135 N. Alessandro Rd. Rm. 203 Banning. CA 92220 Ph: 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. Am. 310 160 N. Broadway Indio. CA 92201 Blythe. CA 92225 Ph: 342.8271 Ph: 9222670 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. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ., ❑ 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- �y ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensa CITYICOMMUNITYISTATEIZIP LA QUINTA GA 922230000 lion 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, alter makinglhis Certificate olExemption, 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) at Division 3 of the Business and Professions Code) or that he is ex- eanpt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- 01 hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will Taft subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).): be made in connection with work authorized by this permit. and that no building structure. 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, ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the Title 8. C.A.C.). "' structure is not intended or offered lar sale (Sec. 7044. Business and Professions Code: The Contractor's License ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of In - 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. dustrial Safely. as noted above. unless such person has a permit to do such work from the division. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov[]Division of Industrial Safety Permit No. 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 contractor(s) licensed pursuant to the Con- tractor's License Law.) ']I am exempt under Sec. . B.& P.C. (Attach Certificate). r Date Owner r 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.). ❑Certilied copy is hereby furnished. ❑Certified copy is filed with the County Building Inspection Department or County Department APPLICANT NAME If, F, MI) ADDRESS 52426 AVE MENDOZA CITYICOMMUN ITYISTATEIZIP LA QUINTA CA 922530000 JOB -SITE ADDRESS/SPACE 426 MENDOZA AVE1'i V CITYICOMMUNITYISTATEIZIP LA QUINTA GA 922230000 BOK 77312! PAG N0015 TWN RNG 0001 SE 00 S TRACT 000000011 MOD SB TRACT NAME SCV LAO 011, OLK-101 LOTS 1506 NER NAME LF,M ONE pAITCL7tN,F CONTRACTOR -FIRM NAME LICNC N ADDRESS ' CITYICOM M UNITYISTATEIZIP PHONE N BLDG EC FI A AT ARC/ENG FIRM NAME LICNCfi ADDRESS CITYICOMMUN ITYISTATEIZI P PLAN N PLANS EXAMINER APPROVE DATE USE OF PERMIT OF SERVICEBIL CHANGE13 �1 R1 ZON ''' V20 n !l05 6t (�1� 4SSBS{/J yggn QRlo (F D�ND ZONE ORD N LOT SZ _ TOTAL FEE END O 0SW 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 stale that the information given is correct.. I agree to comply with all stale 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 for this permit for the purpose of making inspections. rp Signature of Applicant or Agent ! Date Print Applicant/Agent Name APPLIPRMT M 00617427 PS DATE EP 04/24/6- 26974 � � � A tr/jIl ELECTRICAL. FEE $13.00 _ TOTAL FEE CA CK)( NC I C(QUI�JTER ,B,(I/f�/, 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 EL.E.CTRICAL. FEE: COMPUTATIONS * Permit Fee (if applicable) FEE: SWIMMING POOL—Privatet N Commarcialt N Service Change R/Cs R FEES FORM 284208 (11.81) . INSPECTOR $3.00 $10,00 NO. OPERATION GATE INSPECTOR NO. OPERATION DATE INSP [tTr?R� 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 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. E] 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 ELECTRICAL APPROVALS PSL a P/ 26 Power Pole 27 Conduit 28 Service Entrance ' 29 Wiring 29A Grounding Wire 29B Bonding I AO 30 Fixtures 31 Service 32 Final STREET NAME DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE OFFICE DATE TIME } 3 PERMIT NUMBER INSPECTION REQUESTED ADDRESS I SPACE NO. FOR: S 2 I A.M. OWNER COMMUNITY BUILDING REMARKS: PLUMBING I ELECTRICAL i MECHANICAL OWNER/CONTRACTOR TEL.NO. _ P.A. A a TUES WED QTHUR FRI APPLICANT NAME (L, F, MI) AITCHISON. r ADDRESS ' ST�46 AVS. MENDOZA GCA Qi 4IZ1 TTA IP CA 922530000 JQp.,B,jI4.CESSISPACE AVE MENDOZ922530000' Ay pip /y /� CL�CO MIGIv �TWIP {,� A 7 i v'F V V V0 BOK 77,E PAAGi '7 PRC OO7 C 0 TW N RNG 000 SE 0Q S TRACTT O15 O100000 1 WO Ido SB TRACT NAME SCV LAO 411, OLK-101 LOTS 15616 A INdA �JW m, F PHONE# CONTRACTOR•FIRM NAME LICNC # ADDRESS CITYICOM MUN ITYISTATEIZIP PHONE# BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC # ADDRESS CITYICOMMUNITYISTATEIZIP PLAN # PLANS EXAMINER APPROVE DATE USE OF PERMIT CHANGE OF SERVICE BL 0 i RZ1N 0°20 OgT) Osa , 0l 0 UD ZONE ORD # LOT SZ END 0 OS6EE ..� APPLICA'TI'ON FOR ELECTRICAL PERMIT } T N X, I SA .id A P P L I C A TC 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 & 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 IDA Fireplace T.O. P' 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) iling (Blown) TCL al _ PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewoge.Disposal, 20 Sewer 21 Water Heater 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 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME