SFD (00019632)PERMIT APPLICATION
County of Riverside
Department of Building and Safety
A 4080 Lemon St. 2ndy IM 135 N. Alessandro Rd. Rm 203 880 N. Slate Sheet
227 North "0' Street 46209 Oasis St Rm. 310 160 N. Broadway
i Riverside, CA 92501 Banron9. CA 92220 Hemet. CA 92343
Perris, CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787.6146 Ph 849-73121 Ph. 658.4464
Ph 6573898 Ph 342.8271 Ph 922.2670
This permit becomep void it work rel comm.Rited within 180 days from date of issuance. OR, 4 work has beer suspended or abandoned for a period of 180 days
❑ 14
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby allmn that I am licensed under provisions of Chapter 9 (Comment-
pleted it the permit is for one hundred (5100) or less. I certify that in the performance of the work for which this
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
S
tion Laws of California.
❑
Date ---- -------Applicant --------
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the
NOTICE TO APPLICANT: If, alter 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.
struct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
PHONE N
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-
01 hereby certify that no excavation five (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-
mit subjects the applicant to a civil penalty of not more than five huntlerd dollars ($500).):
be made in connection with work authorized by this permit, and that no building structure. scaffolding, lalsework,
FINAL DATE
or demolition or dismantling thereof, will be more than thirty - six (36) feet high. (Chap. 3.2, Grp 2, Art 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
❑ As owner -builder. I will not employ anyone to do work which would require a from the Division of In -
Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or
permit
dustrial Safely. 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. If, however,
ED Industrial
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
Division of Safely 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 conslrucl 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.)
01 am exempt under Sec. && P.C. (Attach Certificate).
Dale Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County _Department.
ISAPLlff&ME,L FATR ICK T
T4,001 GREINWAY
@1T11fiit"W YBLATFiT SPRINGS CA 922400000
v1`661RESSISPACE AVE NAVARRO
r�TrAZIP CA 9225300'y000
L`73lMWTW41TE
pGTYLcor�Na
1
valuation)
Rate Valuation
$27.60 $37536
•2,20 $2c9992
$9 , 10 $4i 4?
0
2
TWIN
of
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00
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ATO a 0 0 I l,pT4q
0 G
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SB
CA
WMIE LQ UNIT 12 BILK 111
QY/LIERHMMi VIII #IIP ATRj ICK T
W
PHONE N
CONTRACTOR -FIRM NAME
LICNC N
ADDRESS
CITYICOM MUNITYISTATEIZIP
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC N
ADDRESS
CITYICOM MUNITYISTATEIZI P
PLAN N S E I AP ROVE DATE
1� P &P 9 -SL
P
IV P�RMI ATT W7014!'{GE
d 1
8491
On
1 0sm 1
0VB3 IOU's
I 1
110
ZONEORDN
LOTSZ
N6
00
fl�30
CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the perfor-
mance of the work lot 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 state
That the information given is correct. I agree t0 comply with all lot¢ laws and county ordinances retailing to
building construction, and authorize a `epre!ylahve of the.County7 Riverside. Department of Building and Safety
to enter upon the properly for v✓hic�t fi e applied f?1, is p Oa for the purpose of making inspections.
Signature of Applicant or Age , ' Date
Print Applicant/Agent Name
0 w"IT9632 cp9b. 1 06/0 —IS2 1 3,12
ESTIMATED PLAN REV FEE "
E8TIMtATE
escr ption
OsWyF1.OM�ry�
ANCON
��110�R
(NOT f:
PSC
101
lot
Nit to
firroup
R-3
R-3
M-1
be used as
Type
W69D
R
WOOD
prop rty
4q Pt
1360
1360
436
valuation)
Rate Valuation
$27.60 $37536
•2,20 $2c9992
$9 , 10 $4i 4?
Est Plan Rev
Fee based
on Total Esti"afted Val'tn
of
$45294
ia: $172.25
TOTAL
FEE
,
CA
CKX
INC
COUNTER B.I. -�
COUNTER L.U.T.
PERMIT FOR 8TRUCTURAL PLAN REVIEW
TOTAL PERMIT COST I6 $172.25
CONSTRUCTION
PR ARY
Of DRY
E8TIMtATE
escr ption
OsWyF1.OM�ry�
ANCON
��110�R
(NOT f:
PSC
101
lot
Nit to
firroup
R-3
R-3
M-1
be used as
Type
W69D
R
WOOD
prop rty
4q Pt
1360
1360
436
valuation)
Rate Valuation
$27.60 $37536
•2,20 $2c9992
$9 , 10 $4i 4?
Est Plan Rev
Fee based
on Total Esti"afted Val'tn
of
$45294
ia: $172.25
FORM 284-208(11.81) INSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
` 2
Ftgs &.Frets
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
G7out 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.
FI
ADDITIONAL INFORMATION
r
-
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
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
P/L
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
t 4
PERMIT APPLICATION
Couniv of Riverside
tIV. Departmept of Building and Safely
4080 Lemon SI. 2nd floor 135 N. Alessandro Rd, Rm. 203 880 N. Slate Street
227 North "D" Street 46.209 Oasis 51. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning, CA 92220 Hemel, CA 92343
Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787.6146 + Ph: 8494312 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.
,,+ �.
r
❑
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTOfiS1iTECLARATION: thereby affirm that I am licensed under provisions of Chapter 9 (comment-
pleted it the permit is for one hundred ($100) or less. I certify that in the performance of the work lot which this I
permit is issued. J shall not employ any person in any manner so as to become subject to the Workers; Compensa-
Ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
i
tion Laws of California.
❑
I,,,Yale t • f '. i Applicant
`
i . ` i
OWNER BUILDER DECLARATION: thereby affirm that I ant exempt Irk the Contractors License Law for the
oNOTICE TO APPLICANT: II, alter making this Certificate of Exemption, you should become subject 10 the Workers'-�-
following reason (See. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
siruci, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant lot such.:
p�a2[.:Ejf}irytA�yl�y(E
TY'A 1 411Y yMl)PATRICK 1,
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-
❑I hereby certify than no exwovataul five (5) or more leer in depth into which 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-
made in connection with n
�eouthorized by This permit. and that building structure. scaffolding,
mit subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).):
If., [e
or demolition or dismantling nhel'Bof, will be more than thirty-six (36) feel high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
or . Sec 41.
❑ 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 ollered for sale (Sec. 7044, Business and Professions Code: The Contractor's LicenseM
❑ 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 for sale. II, however.
the building or improvement is sold wit liin'one year of completion, the owner -builder will have the burden of prov-
_
C] Division of Industrial Safety Permit No.
ing that he did not build or improve for the purpose of sale.)
COUNTER B.I. ;,
7
1
❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sqc.
CONSTRUCTIONaffirmued thatthere is a construction lending agency for the perlor-
RUCTof I N LENDING
which Ns permit hereby
`7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
0! 3 $3
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
❑I am exempt under Sec. . B.& P.C. (Attach Certificate).
LOT SZ/�
Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate
,Date
that the information given is correct. I agree to comply with all state laws and county ordinances relating no
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure, or
y
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 lot this permit for the purpose OI making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
e ,
'
^
❑Cerlilied copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County _ DepArlment_
.•.--.•y-;; r — ,,.Signature of Applicant or Agent. - Oats
Print Applicant/Agent Name
APPLICANT NAME (L, F, MI)
PATTON, PATRICK T
,iON411 GRE£NWAY
bT.'%t.TFs11 z SPRINGS CA . 9,22400000
�B1S19br3RESSISPACE AVE NAVARRO
, it" Oryl�M1jl`J�T`{($7�pT,F/ZIP CA 922530 0 n 0
tr 7G {I {V7 l07
�/`3WSTJ.1%•41hMl2'n
�
TWN
OOI
S
VITO 000 0 108
1 ..
�. P . `
w� 1
SB
LQ UNIT 12 BLK III
p�a2[.:Ejf}irytA�yl�y(E
TY'A 1 411Y yMl)PATRICK 1,
PHONEp
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITYISTATE/ZIP '
PHONE p
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME 1
LICNCil
ADDRESS
CITYICOM M UN ITYISTATEIZI P
PLAN p
PLANS EXAMINER
APPROVE DATE
'DIUMM1 ATT GARAGE
QRL01
to I
COUNTER B.I. ;,
7
1
921n
a1 Y5 1
0V5
0! 3 $3
rND
ZONE ORD p
LOT SZ/�
.Eton
1 9J
110,
{k />t
0 0
T H I S
Y,ou must see the
a Permit can he
Description
HBLD HEALTH
H LD ROAD
.f
'APPL/PRMT d
00019632
_ PS DATE /'� A
i�D 06/qi/�2 (l� I
.,gip•
1 ..
�. P . `
. F
TOTAL .
{ FEE
CA
CKNC
COUNTER B.I. ;,
7
1
COUNTER L.U.T.
x t
J
APPLICATION FOR STRUCTURAL. PLAN REVIEW
�y
I S A N A P P L I G A T I 0 N 'O N L Y
follpw,inq �p.artMent% (,if lister!) for concurrence BEFORE
issued:
------------------------`------ Dept to Sea -- -
0 HEALTH
FORM 284-208(11-81) ASSESSOR,,
a� 1
ROAD-
76/
i NAME
i .1"-StyAPPLICANT
pI IY.R YlJ� • 'i
CREENWAY
l 4a �''�''rlsAfflp SORINGI Gly 922400000
Ef M1�twirQssB.S,CE8_ VRESS/SPACE 'AVENAVARRO
CA 92y25
773 y`°�
/
Q'Ci�,��iIZIP'
T4 4
U -21a
25,
TWN
9
�1
p5N(3}0006
WOO O
E lY
S
U1� 000 _008
TOTAL .
FEE!
�
58
CK
AT- E LQ ,IJNIT• 12 BLK III
,1Yf._l,�;l•Wev'�MII�f t71� 1.4� 4ifi F•
PHONE# .
'f. CONTRACTOR- FIRM NAME
LICNC #
ADDRESS%.
CITYICOMMUNITYISTATE/ZIP ,
PHONE #
BLDG. INSPECTOR
FINAL DATE
I ARCIENG FIRM NAME
LICNC'#
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PLAN#
PLANS EXAMINER
APPROVE DATE
<'.15MpGf N ATT GARAGE
i5:0
Rz9^i
029
1 Oft
OV -6i
OQ90%11F4D
ZONE ORD #'
LOT SZ
a { li 0 1
0 OS9
B
A PLIPR T P DAT
�f RIT4634� x� a�/0'r��� 27311.
9
�1
TOTAL .
FEE!
CA
CK
NC
I COUNTER B.I. _ - `CO NTER L�U!T /
APPLICATION FUR aTiiliC"{URAI.. PLAN REVIEW1 2-7311.1
T a A ii! AP P L I C A•T 10 N Q N i. Y.
�YouY MUST see the following Deparl«enis Cif Hired) for concurrence BEFORE
a Permit can be i°. stied s .
Di
�r.r pt or► Dept to scree -----
HOLD �.HEALTH - HEALTH
HOLD ROAD ROAD
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & 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
10A
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)
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