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00018138 (SPIN)❑ - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- County of Riverside pleted it the permit is for one hundred ($100) 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' Compensa- in g with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. tion Laws of Calilornia. Department of Building and Safety Date Applicant 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 20b 880 N. slate street 227 North "D ' Street 46.209 Oasis St. 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: 849.7312 Ph: 6584464 Ph: 657.3898 Ph: 342-8271 Ph: 9222670 This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has beer suspended nor abandoned for a period at 180 days. ❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the ❑ - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- LICENSED CONTRACTORS DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9 (commenc- pleted it the permit is for one hundred ($100) 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' Compensa- in g with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. tion Laws of Calilornia. ❑ Date Applicant OWNER -BUILDER DECLARATION: I hereby allirm That I am exempt from the Contractor's License Law for the Y P NOTICE TO APPLICANT: If, after 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 S 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 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 n01 more than fivelhunderd dollars ($500).): be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework.' TRACT NAME SCV LAQ 016, BLK-154 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 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 10 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 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 ollered for sale. ll, however. FINAL_ V S—�3� 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.) CITYICOMMUNITYISTATE/ZI P ❑I, 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 lot the perfor- mance of the work for which this permit is issued (Sec. 3097. Civ. C.). 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who USE OF PERMIT ;PEC TTNSP--FIREAMAGpEnnROOF� OF GAR builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Con- Lender's Name tractor's License Law.) Lender's Address ❑1 am exempt under Sec. . B.& P.C. (Attach Certlllcale). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -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 tiled with the County Building Inspection Department or County Department. APPLICANT NAME (L, F, MI) LLOYD PERRY DEV INC ADDRESS 24001 ALIC;IA PXWY CITYICOM M UN ITYISTATEIZIP MISSION VIEYO CA 926750000 JOB SITE ADDRESSISPACE AVE CARRANZA Y'i ``i CITYICOMMUNITYISTATEIZIP LA QUINTA CA 922530009 BOK y 773 PAG 1 '1 �1 PRC 026 C 3 TWN IAL RNG 000 SE 00 S TRACT LOT 000000 1 MOD 10111 SB TRACT NAME SCV LAQ 016, BLK-154 OWNER NAME SCA17lYY' DANIEL PHONEp CONTRACTOR --FIRM NAME LICNC p ADDRESS CITYICOMMUN ITYISTATEIZIP PHONE qBL NSP T FINAL_ V S—�3� ARC/ENG FIRM NAME LICNC If ADDRESS CITYICOMMUNITYISTATE/ZI P PLAN If PLANS EXAMINER APPROVE DATE USE OF PERMIT ;PEC TTNSP--FIREAMAGpEnnROOF� OF GAR B0V R}N V FSB I SSB I V0 SSB I 00W PISS 008. OFC I ND ZONEORD# LOT SZ INSP'TN/FgE s6 0 r fl0 END 10000 SIDE CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale that the information given is correct. I agree to comply with all slate 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 X� for which I have applied for this permit for the purpose of making in lions. Signature of Applicant or Agent Date Applicant/Agent Name 1 /0006138 A 05/1282 34745 SP�: y C IAL INSPECTION 5FECTAL INSP'TN/FgE s6 0 r fl0 f TOTAL f FEE - Q $30 .,/A- CA CA CK�/ /� NC COUNTE B.I. / COUNTER L.U.T. TOTAL PERMIT COST -IS :!:-2 84-208 (11.81) INSPECTOR $30.00 PERM M SP�: y C IAL INSPECTION TOTAL PERMIT COST -IS :!:-2 84-208 (11.81) INSPECTOR $30.00 PERM M May 13, 1982. Tl epantmeNt o f Tui. big acid Safety Lloyd Perry Dev. Co. 52-720 Avenida Carranza La Quinta, California 92253 Administrative Office Bldg., Room 310 46-209 Oasis Street Indio, California 92201 (7l4) tPH:342-8271 Re: Fire Damage Inspection (Owner Daniel Slanny) Dear Sirs: A building permit is required from Riverside County Department of Building and Safety for repair and remodel of fire damaged areas._ ` Provide two sets of plans showing fire damage repair and any a structural changes that will be made. Provide new 1 hour separation walls on each side of the garage. The window inbetween the garage and breezeway must be filled 34 in and the plaster in the breezeway attic must be repaired. All .?/ electrical wiring must be replaced in the garage area. Provide new cover plates for receptacles and switches. Spray smoke covered lumber for odor removal. ' Sincerely, DEPARTMENT OF BUILDING AND SAFETY t R.COLLINS Plan Checker RC:jm cc APPLICANT NAME (L, F, MI) 'LLOYD PURY DtV INC: ADDRESS r -'e.400 8 �t y /�- PKWY ALICIA PKUU CITYIICOMMUfNITYpIIS��TATEIZIP +gyp r p� .ry (� �9 MISSION 49IEr7O CA 726750 W 00 JOB SITE ADDRESS/SPACE 52.720 CAVE MARRAN A CITY/COMMUNIyT'YISTAATEE/ZIP t p n��t (� t�, f' LA QUINTA CA 9C2w'd:��Y3000N BO}Kv�. 77 PAGQy 291 23 d PRC .1 0264 C 3 TWN R„NGn 00 SEE f' 00 S TRACT LOT oaoaop MOD oil SB T�RrA�CwT NAME V LAG 016, BLK-154 OWNER NAME ��MI)�� SCANNCONTRACTOR-FIRM PHONEp NAME IICNC # ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# BLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNC # ADDRESS CITY/COMM UNITY/STATEIZIP PLAN #PLANS EXAMINER APPROVE DATE USE OF PERMIT ” SPEC ' INSP—F IRE DAMAGE ROOF OF GAR BDO RSB IN FSB I SSpip ®SVv I IIS UQO OFC .CAPD ZONE ORD # LOT SZ END p SIDES 0000 APPLICATION FOR SPECIAL INSPECTION T 15 A N A P P L,. I C: A T x 0 N O N L, Y FORM 284.208(11.81( INSPECTOR