Loading...
55065 (SPIN)PERMIT APPLICATION County of Riverside Department of Building and Safety I{, 4080 Lemon SI. 2nd Floor - 135 N. Alessandro Rd. Rm. 203 • 880 N. Slate Street 227 North "D" Street 46209 Oasis St. Rm. 310 6014N.•.&WduGj_;, iv Rerside. CA 92501 Banning. CA 92220 Hemet, CA 92343 �60 Perris. CA 92370 Indio. CA 92201 .CA 92225 ' r Ph: 787.6146 Ph: 849.7312 Ph: 658.4464 Ph: 6573898 Ph: 342.8271 Ph: 9222670 This permit becomes void it work not commenced within 180 days from date of issuance, OR, it work has been suspended yEl or abandoned for a period of 180 days. ` CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-I �LICENSED CONTRACTORS DECLARATION: I hereby allirm 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 full force and effect. permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa- 4a tion Laws of California. _ , PHONE# Dale Applicant OWNER -BUILDER DECLARATION: I hereby affirm That I am exempt from the Contractor's License Law lot the NOTICE TO APPLICANT: ll. after making this Certilicate of Exemption, you should become subject to the Workers' 1 Compensation provisions of the Labor Code. you must forthwith 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. I ..tract. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such per'it to file a signed statement that he is licensed pursuant t0 the provisions of the Contractor's License Law DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: r ' S(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 lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- Of hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend. will ,;mit subjects the applicant to a civil penalty of not more than five huntlerd dollars ($500).): be made in connection with work authorized by this permit, and that no building structure. scaffolding. lalsework, , Q- "l, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the or demolition or dismantling Ihereol, will be more than thirty - six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341, , Title 8. C.A.C. ). ;structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License OAS owner -builder, I will not employ anyone to do work Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or which would require a permit from the Division of In - duslrial Salely. as noted above, unless such person has a permit to do such work from the division. Ihrough'his own employees, provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prow O Division of Industrial Safety Permit No. ing,that he did not build or improve for the purpose of sale.) � � t 111. ,t as owner of the property, exclusively contracting with licensed contractors to construct the project (Sec. CONSTRUCTION LENDING AGENCY: I hereby allirm [hat there is a construction lending agency for the perlor- 7044, Business and Professionss C otle: The Contractor's License Law does not apply to 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 contraclpj(s) licensed pursuant to the Con- Lender's Name ' I :trac(or's License Law.) r.: Lender's Address 9[]I am exempt antler Sec. . B.8 P.C. (Attach Certificate). �j. n {/IVDU F7 ate Owner CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state CK NC —[COUNTER that the information given is correct. I agree t0 comply with all slate laws and county ordinances relating to 'r ORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a 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 I his permit for the purpose of making inspections. i ertificale of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.). ,'[]Certified X copy is hereby furnished. f.' ".x"T'r4V.1,Z, :S ❑(Certified copy is tiled with the County Building Inspection Department or County Department. Signature of Applicant or Agent ' Date• t - - - — — - �—^— — _ ——_—t....r. L_©p• Gca VJ+genLNam= .—.—.— — — _ --- APPLICANT ryry AA�NAME (L, F, MI) P� CO i9 EGolel d. -- SHOE r LAW ADDRESS i'1 2yyy1�����rr��LL W,,IIWY III cljY/HoM IJ 11`1 l W,P 1 CA 922530000 JC`AW §PrSS/SPACE ",•,Y 4 �¢ HW Fh 9 �jry �/� r�►n CITVI�OMtvT�T w.►. 1`: 1 YYP CA 7 225414 0.0 0 9225300.00 BO PAG 411. PRC; � 02" C 1 a 05 E167 SEq 9 p t S 0 TR�C� 0000 LOT M0d11 Y SB TFIgby,MES I /� ��1+(+F7.WI O F.MI)/ (Y CO PHONE# CONTRACTOR -FIRM NAME LICNC p ADDRESS CITY/CO M M UN ITYISTATE/ZIP PHONE d BLD SP TORf�__R F,NAL DATE ARC/ENG FIRM NAME LICNC N ADDRESS '. CITY/COMMUNITY/STATE/ZIP PLAN If PLANS EXAMINER APPROVE DATE• yT q�1 r Q �y USh? PE A.' Y�1F'�"y'OCCU1'"""'BLD B, UNI (DBA FIR BLV Jqg S FSB IT6 U $$@a �J(j (lSbe �J-l7 OFnJ N t�.P-O�§114b LOT SZ FEE END �j. n {/IVDU F7 APPLInnPR�Mt*Tp.g� PS DATEf �y 55065 M i /1 i • SPECIAL INSP ' TN FEE �tTOTAL if $.EE Q ' CA ,t CK NC —[COUNTER B.I.` COUNTER L.U.T. ,s TOTAL PERMIT COST 18 $30.00 I Ln 1 e IF ORM284.208(11.81) INSPECTOR 55065- P E R M I i° NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Figs & 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 11 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 ZT—as` IDA Fireplace T.O. E] No .. ADDITIONAL INFORMATION 9 T' r. _.r •. • - w -• �„ .,r _. �. .. _ .,. SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Loth 12 Internal Lath 12A Drywall 13„ Finish Grade. .. .. _. _. _. ..«a _ . INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 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 " / Z �7 Tank Pit L.Line REAR OF PROPERTY LINE PSL P/ I ELECTRICAL APPROVALS 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final Z STREET NAME DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE OFFICE DATE TIME r PERMIT NUMBER / INSPECTION ADDRESS ��/ SPACE NO. OWNER COMMON Y BUILDING PLUMBING ELECTRICAL MECHANICAt REMARKS: OWNER/CONTRACTOR TEL.NO. REQUESTED FOR: A.M. P.M. I�tON TUES WED i THUR r FRI 2e4-" 11/7s Date County of Riverside Department of Building and Safety price --;gW hereby makes (owner or contractor) application for temporary use of permanent electric service at %Fj Aw, //j NO7-a- /_U ajA;7 ci . for security lighting (address) and/or equipment testing. Access to service and disconnective means shall be limited to the following people L n/., C7 )-CJr/flr— Name POSitiGFj Name Position Name /Position Security to the above areas shall be by padlock '✓ fenced area other •(describe) It is understood that this permit if issued is for a maximum of ninety (90) days. Failure to finalize the original building permit within the designated. 'time may result in the discontinuing of electric,service. The applicant for this permit agrees to accept total responsibility and lia- bility for any accident resulting from the use of the electrical service. f Z- Nadie Po ition