26708 (SFD)County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N Alessandro Rd Rm 203 880 N. State 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 Indio. CA 92201 Blythe, CA 92225
Ph: 787.6146 Ph- 849.7312 Ph 6584464 Ph 657.3898 Ph 342.8271 Ph: 922.2670
This permit becomes void d work not commenced within 180 days from dale of issuance. OR, d work has beer S nded or abandoned for a penod of 180 days
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comme ic-
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
F1
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
fol owing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to con-
st uct, alter, improve, demolish. or repair any structure, prior to its issuance, also requires the applicant for such
pE-mit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Ciapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
eript therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
mt subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).):
D I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
st-ucture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
L:w does not apply to an owner of property who builds or improves thereon. and who does such work himself or
Itrough 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-
irp that he did not build or improve for the purpose of sale.)
❑l, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7344, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
h_ailds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
IactOr's License Law.)
❑I am exempt under Sec.
Cate
B 8 P.C. (Attach Cerlilicate).
IWORKERS' COMPENSATION DECLARATION I hereby affirm that t have a certificate of consent to sett -insure, or a
rertificale of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800, Lab. C.).
❑Cerldied copy is hereby furnished.
❑Certified copy is tiled with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, MI)
DAN
11
ADDRESS
DOX 1638
CITYICOMMUN ITYISTATEIZI P
PALM DESERT CA 922600000
JOB SITE ADDRESSISPACE
54120 AVE CARRANZA
CITYICOMMUN ITYISTATEIZI P
LA AUINTA CA 922530000
BOKPAG
PAC
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TWN
PING
SE
S
7741i'
006
4
1
0
000
00
COUNTER B.I.
TRACT LOT
MOD
SB
000000 00
011
TRACT NAME
SCV LAG) 026 DLK-235
OWNER NAME (L,F,MI)
HORN, DAN
PHONE If
CONTRACTOR- FIRMNAME
LLyJb436
ADDRESS
BOX 1638
CITYICOMMUN ITYISTATEIZI P
PALM DESERT Cts 922600000
PHONE M
714-568-10413
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC If
ADDRESS
CITYICOM M UNITYISTATEIZI P
PLAN If
P E MI ER r
APPROVE DATE
_i s � �Z
USE OF PERMIT
DWLG & ATT GARAGE
13L I N
00 R
FSB
020
SSB
010
SSB
005
RSB
010
OFC
IND
ZONE ORD M
LOT SZ
ENDSIDE
0050 10100
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted if the permit is for one hundred (5100) 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-
tion Laws of California.
Date _ _______Applicant
NOTICE TO APPLICAN C If. atter making this Cerbhcale 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:
01 hereby certify that no excavation live (5) or more feel in depth Into which a person is required to descend. will
be made in connection with work authorized by this permit. and that no building structure. scaffolding, talsework,
or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
Title 8. C. A.G.).
❑As 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.
❑Division of Industrial Safety Permit No
CONSTRUCTION LENDING AGENCY: I hereby allum 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 C6i13 N� n, and authorize a representative of the County of Riverside. Department of Building and Safety
IO enter upon the Operty for which I have applied for [his permit for the purpose of making inspections.
S
,�,,,Idlilufe of Applicant or Agent Date
Print Applicant/Agent Name
APPLIPRMT M PS DATE /1 �J 08^
00016730 CF! 04/20/82 2Wh I
ESTIMATED PLAN REV FEE $151.77
i
TOTAL
FEE
$151.77
CA
CvNC
COUNTER B.I.
COUNTER L.U.T.
f�
PERMIT FOR STRUCTURAL PLAN REVIEW
TOTAL PERMIT COST IS $151.77
CONSTRUCTION ESTIMATE (NOTEt Not to bf usled as property valuation)
Dfasc:ription FCC Group Typpe Sq Ft Rata Valuation
PRIMARY DWLG 101 R-3 V—W 1211 $27.60 $33423
SECNDRY AIRCON p00 R-3 R 1211 $2.20 • 664
SECNDRY PRIGAR 436 M WD 320 $?.10 * 912
Est Plan Rsv Fors based on Total Estimated Val'tn of $38999 iss $151.77
! NSPECTOR
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
M
Smoke Detection Device
9
Garage Fire Wall
42
-Commercial Hood
10
Fireplace P. L. C]
43
Final
10A
Fireplace T. 0.
No
. ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
R
Value
7A Walls (Batts)
12B Ceiling•(.Bafts).'
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 LINE
P/L P/
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire .+a�
29B Bonding'
30 Fixtures
31 Service
32 Final
STREET NAME