00016875 (BLCK)'PERMIT APPLICATION
f : County of
Riverside:
Department ol4juilding
and Safety
- 4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd. Am. 203 880 N. State Street' t
227 North "D" Street 46209 Oasis SI. 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: 8497312 - Ph: 6584464
Ph: 657.3898 Ph: 342.8271 Ph: 9222670
This permit becomes void if work not commenced within 180 days Irom dale of issuance. OR, it work has Deersuspendedor
abandoned Ior a period of 180 days.
FINALDATE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (comment
pleted if the permit is for one hundred ($100) or less. I certify that in the perlormance 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-
tion Laws of California.
CITYICOMMUNITYISTATEIZIP
Dale Applicant
_OWNER•BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for (he
NOTICE TO APPLICANT: If, afler making this 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.
strucl, 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
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-
Of hereby certify that no excavation five (5) or more feel 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-
mit 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) feel high. (Chap. 3.2, Grp 2. Ar( 2. Sec 341,
❑ 1, 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 for sale (Sec. 7044, Business and Professions Code: The Contractor's License
E) 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
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. If, however.
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 (SIC.
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 property who
mance of he work for which this permit is issued (Sec. 3097. Civ. C.).
builds or improves (hereon, 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
❑1 am exempt under Sec. . B.8 P.C. (Attach Cerlilicale).
` Date Owner
CERTIFICATE OF, COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
that the informatio9l is correct. I agree t0 Comply laws
. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
given with all slate and county ordinances relating to
building construction, add authorize a representative of the County of Riverside. Department of Building and Safely
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
to enter upon the propert ,w.p.
�orhich I have applied for this permit for the purpose of makinginspections.
» s _�Y
1 ! 77
Y r, Sf�y .• cFT/r� i
❑Certified copy is filed with the County Building Inspection Department or County Department.
Sighalur'e of Applicant' of Agent b W Date
Print Applicant/Aoenl Name
APPLICANT NAME (L, F, MI)
YOUNG, ROBERT, REED LAUREN
ADDRESS-
y45'8j�A4�3 Ir y� TgpA�VE �9� NT5ROCITY! ryry & n j�
L AICO'l 4lNAi� i 'A CA
CA 92253000 7
J4OtQ>SI�EyAp�RESSISPACE AVE MONTERO
aCI7YIC0(�[.�Uj•()JYpLSrAIZIP CA 9225Z0000'
4BOK I PAI
I �P'7RC C TWN PING BE S
1617 441 p02 3 0000 00
w
691:448 D609 60T1 I SB
UDF49E3L,F )V Btm' ! REED 7f:
M
iPl.J li py tY
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP
'
PHONE# -
BLDG. INSPECTOR
FINALDATE
ARC/ENG FIRM NAME
LICNC It
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN # PLANS EXAMINER
I APPROVE DATE
ADD 641 SQ. FT. RE. WALL.
00 R2' O S .Dir n1 020 ND
ZONE ORD If LOT SZ END SIDE
PfP6598 0000
APPLIPRMT It
01
IADD 641 SQ. FT. RE. $22.00 1
ICA Ick INC ICOUNTER
P.E. R M x T FOR ADD 441 ate. FT. RE.
TOTAL PERM -IT COST IS - $22.00
AICD .641 SN. FT. RE.
r
FORM 284.208 (11.81) INSPECTOR
TOTAFEEL Qti� LA . 0 0
COUNTER L.U.T. ren
F
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
i
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. E]
43
Final
10A
Fireplace T.O. 0
FI
ADDITIONAL INFORMATION I
t
~
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
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
APPLICANT NAME (L, F. MI)
,
r ROBERT,
LAUREN'
U
CITYICOMMUNITYISTATEIZIP
-
CA
I CK
NC
COUNTER B.I. _ -
COUNTER L.U.T.- '
• I'C
rpq
n
JOB SITE ADDRESSISPACE
-
✓f^J
1
E 0
CITYICOMMUNITYISTATEIZIP
QUINTA,.
CA
922530000
BOK PAG
-PRC
_
TWN
SE
S
t _
�F
no
TRACT
LOT
OD
SB
00348
0009
oMiq
TRACT NAME
NAME (L,F,MI)
-
-
PyH�ON EE #
oOfWNER
9
:..CONTRACTOR -FIRM NAME
LICNC p
"ADDRESS
` ;CITYICOMMUN ITY/STATE/ZIP
"
PHONEp
BLDG. INSPECTOR-
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CIT MUNITY/STATE/ZI P
-
YICOM
PLAN p
PLANS EXAMINER
APPROVE DATE . '
USE OF PERMIT
AI Q
IrT
MAI
I
It BLy;� ZON.
FSB,
SSB
SSB
i RSB
OFC
n
n� $ t�a.5
o20
IND
+r Y; ZONEORDp
COT SZ
END
SIDE
4:. .Ct
1?s l5�
,
100-00
APPLIPRe T p PS 'DATE 7 ^
2.6
TOTAL .
FEE
CA
I CK
NC
COUNTER B.I. _ -
COUNTER L.U.T.- '
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 6 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.O. 0
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)
12C Ceiling (Blown)
14 Finel
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
P/
r r1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME