25652 (SFD)PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd Rm 203 880 N Slate Street
227 North "0" Street 46209 Oasis St Rm 310 160 N Broadway
Riverside, CA 92501 Banning. CA 92220 Hemet, CA 92343
Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787.6146 Ph 849-7312 Ph 658.4464
Ph 657-3898 Ph 342.8271 Ph 9222670
This permit becomes void it work not commenced within 180 days from dale of issuance. OR, it work has beer suspended
or abandoned for a period of 180 days
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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-
I pleted it ille 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- Campensa-
ing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
lion Laws of California.
O
Date -- -- ---------__.__Applicant _
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NOTICE TO TO APPLICANT: If, after makingthis Cerbhcale of Exemption, you should became 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 lorthwilh 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
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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 live (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-
be made in connection with work authorized by this permit, and that no building structure, scaflolding, lalsework,
mit subjects The applicant to a civil penalty of not more than live hunderd dollars ($500).):
or demolition or dismantling Ihereof. 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 permit from the Division of In -
Law does not apply to an owner of property who builds or improves Ihereon, and who does such work himself or
duslrial Safety. as noted above, unless such person has a permit to do such work from The division.
through his own employees. provided Thal such improvements are not intended or offered for sale. II, however,
-
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
[)Division of Industrial 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 construct the project (Sec.
CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the perfor-
7044. Business and Professions Code: The Contractor's License Law does not apply t0 an owner of property who
mance of the work for which this permit is issued (Sec. 3097. Civ. C.).
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 Centlicate).
Date—Owner
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certily I have read this application and stale
that the infor on given is correct I a ree 10 tom I with all slate laws and count ordinances refalin to
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.).
❑Certilied copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County ---Department
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711j"40-568-1048 BLDG.
INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
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ADDRESS
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APP OVE DATE
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building con r Zion, and authorize a representative of the County of Riversitle. Department of Building and Safety
to enter up a property for w 'Ch I have applied for this permit for the purpose of making^inspections.
ignature of A scant or gent Date
Print Applicant/Agent Name
VPU 376725 a 104/26762 252
ESTIMATED PLAN REV FEE ;; i b . _ .°
TOTAL
FEE
$1511 .77
CA
C%
NC
I COUNTER 8.1.
COUNTER L.U.T.
PERMIT FOR STRUCTURAL PLAN REVIEW
TOTAL PERMIT COST IS $151.77
CONSTRUCTION ESTIMATE
Description
PRIMARY DWLG
SECNDRY AIRCON
SECNDRY PRIGAR
Est Plan Rev Fee based
I NSPECTOR
(NOTEo Not -to be used as property
FCC Group Typpe Sy Ft
R-3 WOC1D 1211
M-1 WOOD 1320
on Total Estimated Val'tn of
-
valuation)
Rate Valuation
$27.60 $33423
$2420 $2664
$7.10 $2912
$38?1t9 i s t $151.77
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums & 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. E
43
Final
IDA
Fireplace T.O. E]
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE -SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R ~
Value
7A Walls (Botts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 1 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
4 —