ELEC (6385)PERMIT APPLICATION
N4 Count of Riverside A�
Department .1 Building
and Safety
4080 Lemon St. 2nd Floor 135 N. Alessa,rdfo',Rd. R.. 203 B80 N. State Street
liversklit: CA 92501 Banning, CA 92220 Hemet. CA
227 North -D- Street 46.209 Oasis St. Rm. 310 160 N. Br4,ay-
92343
Ph. -4464
'.7 6J46 Ph: 849 7312 Ph: 658
Perris. CA 92370 Indio. CA 92201 elylhe. CA 922,15
Ph: 657 -3898 Ph: 342.8271 Ph: 922.2670
This permit becomes void it work nor commenced wilhin 180 days Iron date of issuance. OR. it work has beer suspended
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of abandbned for a period of 180 days,
CERTIFICATE OF EXEMPTION� FROM, WORKERS' COMPENSATION INSURANCE: This section need not be om-'
C
E,�'Ll I -`LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comment.
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Cleted it the permit is for one hundred ($100) or less. I certify that in the perfortnance of the work for which this-
is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
g with Section -7000) of Division 3 of the Business and Professions Code. and my license is in full force and elect. - •permit
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tion Laws of California.
-n
Date Applicant
i.
OWNER -BUILDER -DECLARATION: I hereby allimn that I am exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: 11, alter makingthis Certificate of Exemption, you should become subject lothe 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.
'ilrucl, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such
4 eh�
permit to lite 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-
01 hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend. will
empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
!nit subjects the applicant (o,a civil penally of. not more than five hunderd dollars ($500).)::
be made in connection with work authorized by this Permit. and (hat no building.struclure. scallolding, falsework.
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or demolition or dismantling thereof, will be more than .thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 34 1.
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
S is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
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C3 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of In-:
does not apply to an owner of property who builds or improves thereon, and who does such work himself -or
dustrial Salely..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 for sale. 11 [towever.
building improvement is
ED Division of Industrial Safety Permit No.
;he or sold within one of completion, the owner -builder will have the burden of prov:
'yring that he did not build or improve for.(he purpose of sale.)
OWNER NAME (L,F,M`
,01� 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 loir the perfor-
�' 4WO'44,' Business and Professions Code: The Contractor's License Law does not apply to an owner of property 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-
Lenders Name
Kractors License Law.)
r" .
Lender's Address
;tnl am exempt under Sec. B.& P.C. (Attach Certificate).
—Owner--..-
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: f certify I have read this application and state
that the information given is correct. I agree to comply with all stale laws and county ordinances relating to
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell,insure, ora
building construction, and authorize a representative of the County of Riverside, Department of Building and Safety.
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Certificate Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
to enter upon the properly for which I have applied for this permit for the purpose of making inspections.
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:¢+013erfified copy is hereby furnished. Vis,X
J , _ "� "' _ � _^ Ila,*,—
,[]Certified copy is filed with the County Building Inspecti6n,Department or County —Department.
SiUhalure of.Applicdni or Agefit Date
Print Applicant/Agent Name
APPLICANT NAME ( F. MI)
I- K?_ / " " 1
APPLIPRIAT # PS DATE
5;! 40128
'ADDRESS
Kn
CITY/COMMUNITY/STATE/ZIP
JOB SITE
PHONE#
BLDG-LNSPECTOR
SEES-
CITYICOMMUKITY/STATEZIP
40ILk-3
ARC/ENG FIRM NAME
BOK
PAG'PRC
C
LICNCY.
FIND
SE
ADDRESS
q9 4-A
4 eh�
lla
'PITYICOMMUNITYISTATEIZIP
.
TRACT LOT
PLAN #
rPLANS EXAMINER
MOD
SB
I,
TRACT NAME
OWNER NAME (L,F,M`
ONE N
CONTRACTOR -FIRM NAME
LICNC N
_AE')CRESS
PHONE#
BLDG-LNSPECTOR
NAL DATE
40ILk-3
ARC/ENG FIRM NAME
LICNCY.
ADDRESS
.000Z
of
'PITYICOMMUNITYISTATEIZIP
PLAN #
rPLANS EXAMINER
APPROVE DATE
I,
USE OF PERMIT
FBL, ZOi4— FSB SSB SSB RSB &C
ZONE ORD If
LOT SZ END SIDE CA CK
.i
TOTAL
FEE 0
COUNTER BXCOUNTER L.U:T.
01 `0
V
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74
CANARY -FILE, PINK -APPLICANT
Ownero. - Architect -- _ Contractor--_ -
g rQv_,& S Ac1dress___— Address-------
Address
City,—��ESx_yQ7 city-- City----
Phone�'�//� sO Phone _ Phone— -------.-
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
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paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
3
shall riot make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W
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without an encroachment permit.
NOW, therefore, it is agreed that I (we) will not oF36py said property and will not cause said property to be occupied until I (we) have
complied with all laws of the County of Riverside and the State of California governing said property.
DATE ___-_—_— SIGN-ATJRE OF OWNER AND/OR AGENT�-
Approval by Signature from the Foliowing Department3-Lkted Below
Must Be Obtained Prior to the Issuing '6:-i- Construction Permit.
I SPACE NO.
JOB 7_9(�S 0C.LCXX USE OF STRUCTURE
ADDRESS
�0��� SINGLE FAMILY � DUPLEX
Z
LEGAL DESCRI TION 0 RO RTY AGRIC.
ARTMENTS t_1
-®-- - '
0 Q
COMMERCIAL ® INDUSTRIAL LJ
'^
COMMUNITY ALTERATIONS n
ONO.
Z
OF SUBMITTED PLANS --- USE OF PERMIT
Q
CASE NO.
44-
O
Z
NO. OF PARKING SPACES REQUIRED -- 0. OF BUILDINGS NOW EXISTING -
94
ZONE SETBACKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
y
SETBACKDIN NCE N OF FEET REQUIRED ON TREET
DATESIGNATURE OF LAND USE OFFICI --
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET --
H
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ -STREET
F
ot:
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
°C
DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
WSEWAGE
DISPOSAL
S
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
H' FLOOD CONTROL
F ,
W AIR POLLUTION
W DIV OF HWY
0 YOUR PROPERTY MAY BE SUBJECT TO
a —
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74
CANARY -FILE, PINK -APPLICANT
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
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. C]
No
f
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/
0
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire �( f%
�T
29B Bonding
30 Fixtures
31 Service ✓
32 Final
STREET NAME