00013161 (SFD)" County of Riverside
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Department.Y Building and Safety ; y
- 4080 Lemon St. 2nd Flo> 135 N. Alessandro Rd. Rm. 203 860 N. Slate Street � _ • _ 227 North "D Street �` /z + i 46-209 Oasis St. Rm. 310 • .160 N. Broadway. _
` Riverside.';},. 92501 Banning, CA 92220 ;r Hemet. CA 92343 Perris. CA 92370 ,•. 1z ' Indio, CA 92201' ..Blythe, CA 9e225
YY •-r
Ph 787-6146 .-. -Ph: 849.7312 Ph: 658.44CA Ph: 657-3898 ,r 'h.�a t;Ph: 342-8271 ; - Y' • ., Ph: 922.2670
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> , -This permit becomes void it work not commenced within 160 nays 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 lot one hundred (5100) or less. ,I certify that in the performance of the work for which This permit is issued. I
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. '
License Class Lic. Number
- - DateApplicant
Date Contractor NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should become subject to.the Workers' �1
.OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from 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 five (5) or more feet in depth into which a person is required to descend, will be
with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or i
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil demolition or dismantling thereof, 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 five hundred dollars (5500).): C.A.C.)
I, as owner of the`property, or my employees with wages as (heir sole compensation, will do the work, and the Q As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law Sarety, as noted above, unless such person has a Dermic 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 offered 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.). CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. Q.
I, as owner of=the property, am exclusively contracting with licensed contractors to construct the project (Sec7044, Lender's Name
.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 contractor(s) licensed pursuant to the Contractors Lender's Address _
!License Law.). ., • I certify that I have read this application and state that the above information is correct. I agree to comply: with all
0 I.am exempt under Sec. r- . B. 8 P.C. (Attach Certificate): city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
r F • this county to enter upon the above-mentioned property for inspection purposes. j•I t
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. C.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
information given is correct. I agree to comply with all state laws and county ordinances relating to building con- '.
Policy No. - Company struction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon '
' Q Certified copy is hereby furnished. ; the property for which.) have applied for this permit for the purpose of making inspections. _
Signature of Applicant or Agent 'p Dales
Q!Certi!ied coot is filed with'the County Building Inspection Department'or County Department.
Applicant r`, i Print Applicant/Agent Name .y - • "t
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t CITY�//CyIOMMMUNNIITeY./STaAATF//ZIPvCA -:10410- 6046
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JOB_SSnIITE TTAD�DDR«EgSS/SPACE )1 gp01 pip
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L.f�MU�� j�;� i A. ' MPT ' 9.295,704013 '.
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TRACT NAME
OWN_ R ON.
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,CONTRACTOR-FIRM NAME 4
s
ADDRESS
i CITY/COMMUNITY/STATE/ZIP
.PHONE p { LICNC If
ARC/ENG FIRM NAME
1 r!� .R XCK TSL#SHIMF9 9096
ADDRESS.- - 11
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-0`218 2 9
ct�aTt�ix� p:�6it"f•�ji'dyt� p�`$C��■TEK 3 ,i�t�$-10 p�tif� .a s1pCoWti v�{<�jQ�tq p �,wj „y
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8¢¢.'�1�Wj1i��7L "�' .6'..0 :p li ' �tN�1. �1 y�ty.. ti -v $ iyV 6� 6 q,+Fi�• ` _ ;ahC�
d [ d+ °iD�f.a :f�-I Y4.I,d®>S7 �'� � �' '
T '490 'R'46V POO- ba-sred on 70-t-Al ftti. 04te'd V. al..." n of $4240- is1
FORM 284?20B 12/81).x''^ • ` y _.
y
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
�n
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
10A
Fireplace T. 0.
❑
°o
ADDITIONAL INFORMATION
-
'Q
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Bans) — –
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
P/l
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
A.
j
A
r[nllul Nrr LILNIlUN
Countv of Riverside
Department of Building and Safety
+ '
"0"
Cemo* St{ 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street
227 North Street 46209 Oasis St. Rm. 310 160 N. Broadway
P erside, CA 92501 Banning, CA 92220 Hemet, CA 92343
Perris. CA 92370 Indio, CA 92201 Blythe, CA 92225 t
PI ;;717-6146 Ph: 849-7312 Ph: 6564464
�F
Ph: 657-3898 Ph: 342-8271. Ph: 922-2670
PING BE S
LOT
TRACT«+�� ''il
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Thi ermit 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. - r,
'borr'
LICENSE TRACTOGGDECLARATION: 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 feted it the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permR is issued. I
•
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
License Class Lic. Number
Date Applicant 4J -
Date Contractor
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the lolfowing
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
E] 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 of the Business and Professions Code) or that he is exempt therefrom and the basis for
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or -
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, 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 five hundred dollars ($500).):
C.A.C.)
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the '
l{��1 As owner builder. I will not employ anyone to do work which would require a permit from the Division of Industrial
Rarery• as noted above, unless such person has a permit to do such work from that division.
structure is not intended or offered for sale (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 does such work himself or through
❑ Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered 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
ZONE ORD n
build or improve .for the purpose of sale.). ,
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.).
I,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name
usineas 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 Contractor's
Lender's Address
License Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
I 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 COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
Policy No. Company
information given is correct. I agree to comply with all state laws and county ordinances relating to building con.
Certified copy is hereby furnished.
struction. 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.
Certified copy is filed with' the County Building Inspection Department or County Department.
Signature of.Applicant or Agent Date
Date Applicant
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) '
RICK TSUSHIMA
ADDRESS- -
36N MARENGO
CITY/COMMUNITY/STATE/ZIP - -
PASADENA CA 911010004
-
JOB SITE ADDRESS/SPACE
49Qi 3 AVE MONTERD
CITY/COMMUNITY/STATE/ZIP ..
LA QUINTA CA 922530000
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TRACT NAME '
OWNER NAME (L, F, MI)
YOUNGII, RODER'i
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
CA IM0090110(l
PHONE 4
.
LICNC N
ARC/ENG FIRM NAME +
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE fl
LICNC n
USE OF PERMIT '
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RSB
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END
SIDE
DATE 021825 ^ ^
APPL/PRMT p=V1,
P L 8 L
- '
\ i
ASSESSOR COPY TOTAL
FEE
1-0218251
APPLICATION FOR STRUCTURAL PLAN REVIEW
T.WI3 IS AN APPLIC-AT10N QNLY
You most see the fallowing Departments (if listed) for concurrence BEFORE
a Perm -it can be issued t
� _ ....�. Des rip t i o -P i t bee.
HOLD- LiPo
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APPL�Ir�C:ANT NAME (L, F, MgI), '
�. ADDRESS`y-{
M '�Kl tY '�p9 tifyi�F7l�i� .
CITY/COMMUNITY/STATE/ZIP
�. JOB.SITE ADDRESS/SPACE I'
AVE 't4GHTFUtO
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rt OWN1��#a�F: MII��#3��•i 1�k"�� �#Fo�
l?f7'1�9i
i jCONTRACTOR-FIRM NAME.,
ADDRESS
'• .CITY/COMMUNITY/STATE/ZIP
>. PHONE 8
'
LICNC N'.
1A
ARE/ENG FIRM NAME'•• �•,k 1
`,ADDRESS
4 -CITY/COMMUNITY/STATE/ZIP
,L PHONE p
LICNC
P(EERMIT r
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SIDE '
66.6
APPUPRMT pPa s DATE _p ® /'� � lyJ(^ /1• ("
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TOTAL
FEE
NSPECTOR S COPY
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FORM 28d.20S (281) .• 1 .. 1. I r .l . .. •5= ii + s
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
10A
Fireplace T. 0.
°o
_
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
.--
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
STREET NAME