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26700 (BLCK)County of Riverside I Department of Building and Safety ' 4080 Lemmn'SL 2nd Fiber 135 N. Alessandro Rd. Rin 203 880 N. State Street 227 North "0' Street 46.209 Oasis St. Rm. 310 160 N Sr rflp)de. CA 92501 Banning, CA 92220 Hemel. CA 92343- Perris. CA 92370 Indio. CA 92201 Blythe. CA Ph: 787.6146 Ph' 849.7312 Ph 658.4464. ` Ph 657.3898 Ph 342.8271 Ph922.26. This permit becomes void if work nol commenced within 180 days Irom date of issuance. OR. d work has beer suspended or abandoned for a period of 180 days - F1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. This section r LICENSED CONTRACTORS DECLARATION: I hereby aflum that I am licensed under provisions of Chapter 9 (comment- pleled if the permit is for one hundred ($100) or less. I certify that in the performance of the w 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 Warr 7741A11 tion Laws of California. ODale ------------ -- — — Applicant -------- NOTICE TO APPLICANT: If, afler makingthis Certificate of Exemption, you should become subject OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con- I; h I h 1 11 h deemed revoked. struct, alley, Improve. demo Is , or repau any structure, pr to its Issuance. a so requires t e app Can or suc permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex- 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 hunderd dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the 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 his own employees. provided that such improvements are not intended or offered for sale. 11, however. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov- ing that he did not build or improve lot the purpose of sale.) ❑l, as owner of the proptirty, am exclusively contracting with licensed contractors to construct 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. ___— 8 & P.C. (Attach Certificate). WORKERS' COMPENSATION DECLARATIONS 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.). DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 01 hereby certily that no excavation five (5) or more feet in depth into which a person is required to be made in connection with work authorized by this permit, and that no building structure. scaffoldir or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, A Title 8, C.A.C.). ❑A6 owner -builder. I will not employ anyone to do work which would require a permit from the duslrial Safety, as noted above, unless such person has a permit to do such work from the divisi ❑Dwislon of Industrial Safety Permit No. CONSTRUCTION LENDING AGENCY: I hereby affirm that there Is a construction lending agency lot mance of the work tar 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 appllrallon a that the information given is correct. I agree to comply with all state laws and county ordinances rela building construction, and authorize a representative of the County of Riverside. Department of Building and to enter upon the property for which I have applied for this permit for the purpose of making inspections. ❑Certified copy is hereby furnished. ❑Certified copy is filed with the County Building Inspection Department or County Department. Signature of Applicant or Agent APPLICANT NAME fL, F, MI) HORN, DAN ADDRESS BOX 1638 CITY/COMMUNITY/STATE/ZIP -w PALM DESERT CA 922600000 JOB SITE ADDRESS/SPACE 54060 AVE CARRANZA .CITYICOMMUN ITY/STATE/ZI P LA QUXNTA CA 922530000 BOK PAG C TWN RNG SE S 7741A11 000 00 TRACT 000000 N0221 MOD loll SB TRACT NAME BLK-285 SCV LAQ #26 OW NAME 2N.. `LDAN PHONEX CONTRACTOR-FIRM NANAVON HORN - LI.3;SS436 ADDRESS BOX 1638 CITYICOM MUN ITY/STATEIZI P PALM DESERT CA 922600000 PHONM 714--568- 104@ BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC 0 ADDRESS CITYICOM M U N ITY/STATEIZI P PLAN If PLANS EXAMINER APPROVE DATE USE OF PERMIT DWLG 6 ATT CAR BL 00 ZON R1 FSB 020 SSB 005 SSB oto RSB 010 OFC 1ND ' f ZONE ORD N LOT SZ 0 END g i a SIDER Print Applicant7Agenl Name APPL01 X 0aa167i8 PS XB DATE (1 0 04i20J82 Uh ( TOTAL . FEE CA CK NC I COUNTER B.I. COUNTER L.U.T. APPLICATION FOR STRUCTURAL PLAN REVIEW T H I S I S A N A P P L I C A T I O N O N L Y You must see the following Departments of listed) for concurrence BEFORE a Permit can be issuads Description ----------------------------------------- Dept HOLD- , HEAI_T HOLD- R0� 6 �91� / a -" --J- 7" qv -610 ASSESSOR APPLICANT NAME (L, F. MI) HURN DAN ADDRESS p DO 1L►.'6 CITYI CO M M U N ITY ISTAT E IZI P VALM T1h. SEE T GA 9,22,600000 JOB SITE kDDRESSISPACE 54060 AVE CARRAP, ZA CITYICOM M U N f"f5TATEgIP LA QUINTA CA 92 3001) 0 BQIK d PAG PRCl f�R i+11 0(y )...7 1C TWN 0000 •RING 55E S 001 TRACT LOT MOD SB 000000 00221(](1 TRACT NAME bL K-•-205, SGV LAU 41216 IWrNI-�R NAME (L, F,M PHONE M CCIN7RACT R:FiRM NAME llANA1�1N H(1FtN''�i, L yyA��DDREESS �j lC X 1636 CITY/COMMUNITY/STATE/ZIP PALM DESERT CA 422600000 PHONE N BLDG. INSPECTOR 714 613--1048 FINAL DATE ARCIENG FIRM NAME LICNC N ADDRESS CITYICOM M UN ITY/STATE/ZI P PLAN N PLANS EXAMINER APPROVE DATE 113E OF PERMfT DWLG 6 ATT GAR BL 0 ZON R 1 020 FSB SSB 00 5p SSB RSB 010 010 OFC tim ZONE ORD N LOT SZ END ()0150 SIDE 010 () APPL+PfiMT N PS DATE n 6 7 0 0 i''1C r` (J� TOTAL . FEE CA CK I NC COUNTER B_L COUNTER L U T APPLICATION FOR ;s-f(<UCTl RAL. PLAN Rl,:VIEW T H I Ii I G A N APPLICATION U N Lr Y You most seer the following Departme tz (if lis-ted) For conc:urrenc..e a Permit can be issued ; �. Description ----_--_w..___.w_---- .. - - - ------____-- _. 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