AR (00020127)PERMIT APPLICATION
County of Riverside
Department at Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Am. 203 880 N. Slate Street
227 North "0" sheet 46209 Oasis St. Rm. 310 160 :'r' Madway
Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343
Perris. CA 92370 Indio. CA 92201 ' Blythe. CA 92225
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, it work has beer suspended or abandoned for a period of 180 days.
❑
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-r
LICENSES CONTRACTORS DECLARATION: I hereby affirm that 1 licensed under provisions of f 9 (commend-
pleled it The permit is for one hundred ($100) or less. I certify that in the performance of The work for which this
ing with Section 7000) of Division 3 0l the Business and Professions Code, and my license is in full
ull foor rce and elfebl.
permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
S
lion Laws of California.
❑
Date Applicant
OWNER -BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractor's License Law lot the
NOTICE TO APPLICANT: It, after makingthis Cerlilicate 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.
struct. alter, improve. demolish, or repair any structure, prior to its issuance, also requires The applicant for such
PHONE N
permit to life 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-
❑I 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 [his permit. and that no building structure. scaffolding, falsework.
FINA DATE
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 properly, 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
❑ As owner -builder, I will not employ anyone to do work which would require from the Division In
Law does not apply to an owner of properly who builds or improves thereon, and who does such workhimself or
a permit of -
duslrial Salety. 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: ll, however,
BL
01
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
❑ Division of Industrial Safely Permit No.
ing that he did not build or improve for the purpose of safe.)
SSB
as
❑l, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby allirm 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 properly 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-
Lender's Name
tractor's License Law.)
Lender's Address
01 am exempt under Sec.' B.& P.C. (Attach Cerlilicate).
END
1 10000
bate Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cerlificate of consent to sell -insure, ora
certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
❑Certilied copy is tiled with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, MI)
SANTIAGO, MAUARL44-
ADDRESS
51592 AVE tMIRU_„_ UA •1,.., / � �
LAO1QUINTAZIP CA _,92:�P30000
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L1°°Q�7 T�f, CA 7t2.•L2.530000
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TRACT NAME
SCAV LA QUINTA 012, BLK-110
OWNER NAMEL, I
SANTIAGO, N44424.Cr:,..
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CONTRACTOR -FIRM NAME
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ADDRESS
CITYICOMMUN ITYISTATEIZIP
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FINA DATE
ARC/ENG FIRM NAME
LICNC N
ADDRESS
CITYICOM MUNITYISTATEIZIP
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PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
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END
1 10000
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that the Information given Is correct. I agree to comply with all state 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 properly for which I have applied for this permit for the purpose of making inspections.
v
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLIPRMT N
00020127
CONSTRUCTION
PS DATE
P 06/14/82
FEE
35012
$16,00
ADD P/C FEE
$10.40
SMI FEE
$0.06
q
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ti
i
% TOTAL
FEE '
$26f,16
CA
CK
NC I
COUNTER B.I.
COUNTER L.U.T.
STRUCTURAL ( BUILDING > P E R M I T
TOTAL PERMIT COST IS $26.46 `
CONSTRUCTION ESTIMATE (NOTE: Not to be used as property valuation)
Description FCC Group Type Sq Ft Rete Valuation
PRIMARY MISC h4 M 85 $10.00 $850
Construction Fee based on Total Actual Valuation of $850 i ss $16.00
SMI PEE
AAD P/C FES:
FORM 284-208(11.81) iNSRECTOR
$0.06
$10,40
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System ,,i
2
Ftgs 8 Frms
34 Plenums 8 Ducts
2A
Slab Grade
35 Furnace Comport.
3
Steel s
36 Inlets 8 Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
u
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.
OP'N
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
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
1,
P)
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding_ Wire-
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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,AFFLII:AN I NAMt (L, F, MI)
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CONTRACTOR -FIRM NAME -
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ADDRESS -
CITY,COMMUN ITYISTATEIZIP - -
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME -
LICNC #
ADDRESS -
CITYICOMMUNITYISTATEIZIP '
•
PLAN #
PLANS EXAMINER.
APPROVE DATE
USE OF PERMIT•
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END
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APPLICATION FOR . Sr`1 RUCTUR.AL PERMT .
T H I. S. I S ..A N.' A P• P L. I C A - T, 1 0 N Ci 0 0 Y
"I'.
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 & 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. 0.
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
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding. -Wire-_
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME