25742 (GRD)PEflM1T APPLICATION
County of Riverside
Department of Building
and Safety
4080 Lemon SL 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street
227 North "D" Street 46209 Oasis St. Rm. 310 160 N. Broadway
Riverside, CA 92501 Banning. CA 92220 Hemet. CA 92343
Perris. CA 92370 thio. CA 92201 Blythe. CA 92225
Ph: 7876146 Ph: 849.7312 Ph: 658.4464
Ph: 657.3898 Ph: 342.8271 Ph: 9222670
This permit oecomes void it work not commenced within -180 days Ifom.0te of issuance, OR, it work has heel' suspended of abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby aflirm that I am licensed under provisions of Chapter 9 (comment-
pleted 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 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- -
TOTAL
FEE '
lion Laws of California.
❑
Date __ Applicant _
16E ,
J IAM' (LM t I
NOTICE TO APPLICAN T: If, after making this Certificate of Exemption, you should become subject to the Workers'
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 permil 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
BLDG. INSPECTOR
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 [he Business and Professions Code) or that he is ex-
❑I hereby certify that n0 excavation five (5) or more leer depth into which person is required to descend, will
empt therefrom and the basis lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
t. n
made in connection with work authorized by this permit. and that building structure. scaffolding, falsew
mit subjects the applicant to a civil penally of not more than live hunderd dollars ($500).):
or le 41.
or demolition or dismantling [hereof, will be more than thirty-six (36) feel 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 oflered 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 permit from the Division of In -
Law ones not apply to an owner of property who builds or improves [hereon, and who does such work himself or
dustrial Safely, as noted above. unless such person has a permit to do such work from the division.
lhrouo. his own employees, provided that such improvements are not intended or offered for sale. It however.
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.)
❑I, as Owner of the property, am exclusively contracting with licensed contractors to construct theproject (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
mance of [he work for which this permit is issued (Sec. 3097. Civ. C.).
7044;9usiness and Pro'essions Code: The Contractor's License Law does not apply to an owner of property who
c 615 0
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
Of am exempt under Sec. B"8 P.C. (Attach Certificate).
Date Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
that the information iven is correct I a ree to com I with all state laws and count ordinances relatin to
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 filed with the County Building Inspection Department or County Department.
APPLICANT NAME If, F, MI)
Milt), DAN
ADDRESS
; 4100 AVE: CARRANZA
CITYICOMMUNITYISTATEIZIP * i
LA WU�i�4TA CA i�..2530000
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eeU,,RES�Sg7ISfPACE
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TOTAL
FEE '
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PHONE q
CONTRACTOR -FIRM NAME
LICNC p
ADDRESS
CITYICOMMUN ITYISTATEIZI P
PHONE M
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC If
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN p-qg T C
PLANc r, I <±
APPROVE � E
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U�J7MUG PLAN CHECK
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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 for this permit for the purpose of making inspections.
Signature of Applicant or Agent r Date
Print Applicant/Agent Name
00010110 05e,tI1 / 25742
Gil't'1T9ING PLAN REVIEW FCC $1ti-OU
TOTAL
FEE '
CA
I CK (
I NC
COUNTER B.I.
oe
COUNTER L.U.T.
rERMI T FUR GRADING PLAN REVIEW
TOTAL PERMIT COST IS $151 00
I of L ots s 0 Ct1 YDG' C'u t t 0 Fill t 303 Total Moveds 303
Grading Plan Review Fee (base on cubic yds Cut and Filled) i.at $151.00
INSPECTOR
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 8 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. E]
No
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) r i 1
12C Ceiling (Blown)'
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents t
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
PSL P)
ELECTRICAL APPROVALS
.26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring t I
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service t
32 Final G
STREET NAME
r(t ply°1„y ,�s.j 4';i p. (t�� . ��`.;;� tj: i,:-1.•1 �")' t� �.