25651 (SFD)County of Riverside
Department OT
Building and Safety
4080 Lemon SI. 2nd Floor 135 N Alessandro Rd Rm 203 4 880 N. Stale ,'•eel 227 North "D" Street 46209 Oasis St Pin 310 160 N Broadway
Riverside, CA 92501 Banning, CA 92220 Hemel. CA 92343 Perris. CA 92370 IMA. CA 9220: ' Blythe. CA 922225
Ph. 787.6146 Ph 849.7312 Ph 658.4464 Ph 657.3898 Ph 342.8271 Ph 922.2670
This permit becomes void if work hol commenced within 180 days from date of issuance. OR, if work has beer suspended or abandoned for a peiiM of 180 days
❑ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby affirm 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 work for which this
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 spas to become subject to the Workers' Compensa-
tion Laws of California.
El
OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law lot the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
struct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
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).):
❑ I, as Owner of the properly, or my employees with wages as their sole compensation, will d0 the work, and the
structure is not intended or offered for safe (Sec. 7044. Business and Professions Code: The Contractor's License
Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or
through his own employees. provided that such improvements are not intended or altered for sale. If. 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 for the purpose of sale.)
Of. as owner of the property, am exclusive)y 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 properly who
builds or improves thereon, and who contracts lot such projects with a contraclor(s) licensed pursuant to the Con-
tractor's License Law.)
01 am exempt under Sec. 8 d P.C. (Attach Certificate).
Date 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.
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TOTAL
/ FEE
3L.VfATAQ 426, BLK-2135
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PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP CA 000000000
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BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
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Wit! — -- —_--------Applicant
NOTICE TO APPLICANT: ll. 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
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
of hereby certify that no excavation live (5) or more lee] in depth into which a person is required to descend. will
be made in connection with work authorized by This permit. and that no buildingstructure. scaffolding, falsework.
or demolition or dismantling thereof. will be more than Thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2. Sec 341,
Title B. C.A.C.).
OAS owner -builder. I will not employ anyone to do work which would require a permit from The Division of In-
dustrial Safety, as noted above. unless such person has a permit to do such work from the division.
❑DivisfonofIndustrial Safely Permit No.
CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the perfor-
mance of the work for 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 to comply with all state laws and county ordinances relating to
building construction, and authorize a representalwe of the County of Riverside. Department of Building and Safely
to enterupgd _propel or whit I have applied for This permit for the purpose of making inspections.
r iiapre ol'Applicant or Agent Date
Print Applicant/Agent Name
UPU'lP" 6721 C`v 04/26VU2
ESTIMATED PLAIN REV FEE
TOTAL
/ FEE
11111till .7y
CA
CI(
NC
COUNTER B.I. !
COUNTER L.U.T.
14
7J PERMIT FOR STRUCTURAL PLAN REVIEW
TOTAL PERMIT COST IS $151.77
CONSTRUCTION ESTIMATE <NOTEi Not to be «sed as property Yaluation>
Description FCC Group' 1'ppa 5q Ft Plate Valuation
PRIMARY DWLG R-3 WOOD 1211 427.60 $33423
SECNDIRY AIRCON R-3 R 1211 42.20 $2664
SECNDRY PRIGAR M-1 WOOD 320 49.10 42912
Eat Plan Roy Fee basad on Total Estimated Val'tn of 4313999 is: $151.77
INSPECTOR
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 (Botts)
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
REAR OF PROPERTY UNE
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final