TUP 55066PERMIT APPLICATION
t. County of Riverside
ra. r Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street
227 North •'D" Street 46.209 Oasis St. Sm. 310 160 N. Broadway
Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343
Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
t Ph: 787-6146 Ph: 849-7312 Ph: 6584464
Ph: 657.3898 Ph: 3428271 Ph: 922-260 '
jn I This permit becomes void if work not commenced within 180 days from date of issuance. OR. it work has been 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-
EO CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions al Chapter 9 (comment-
%eit
pteted if the permit is for one hundred ($100) or less. I certily that in the performance of the work for which this
h Section
ng 7000) of Division 3 of the Business and Professions Code, and my license is in lull farce and effect. a it
permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
e-
lion Laws of California: '
M% I
Date Applicant I
i J OWF ER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
�4fol)pwing
NOTICE TO APPLICANT: If, alter makingthis 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
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
deemed revoked.
£� snru:t. alter, improve, demolish. or repair any structure, prior to its issuance, also requires the applicant lot such
pernit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
-?(Ch;.pler 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
+ therefrom
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: +
t
❑I hereby certify than no excavation live (5) or more feet in depth into which person is required to descend. will
ierno and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant lot a per-
,,,mit subjects the applicant to a civil penally of not more than live hunderd dollars ($500).):
t
made in connection with work authorized
zed by this permit. and (hal no building
n scrp Art falsew
�_ ❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
or will
or demolition or dismantling (hereof, will be more than Ihirly-six (36) feet high. (Chap. 3.2. Grp 2, Art 2. Sec 341.
Chap. 3.2 2. 41.
Title 8. C.A.C. ).
;�;strtclure 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 Irom the Division of In-
1Lav does not apply to an owner of property who builds or improves thereon, and who does such work himself or
Ithro ugh his own employees. that such improvements intended for If,
dusIdal Safety. as noted above. unless such person has a permit' 10 do such work from the division. '
provided are not or offered sale. however.
thefbuilding or improvement is sold within one year of completion, the owner -builder will have the burden of Prov-
❑Division Of Industrial Safety Permit No.
mgt that he did not build or improve for the purpose of sale.)
B.I.
❑% as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby aflirm that there is a construction lending agency for the perfor-
7014, Business and Professions Code: 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.).
bulds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
Lender's Name
4 tractor's License Law.)
Lender's Address 1
r Qt am exempt under Sec. . B.8 P.C. (Attach Cerhlicale).
! D31 GiN6"IT USE OF PERMANENT CEySCE.
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''Dae Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate
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that the information given is correct. I agree to comply with all slate laws and county ordinances relating To
r WDRKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell - insure, or a
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
to enter upon the properly for which I have applied for this permit lot the purpose of making inspections.
I` '✓ / �/ / ''�
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f, jCertilied copy is hereby furnished.
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„ f .✓� ` "',
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1 OCertilied copy is tiled with the County Building Inspection Department or County Department. Signature of Applicant or Agent Dale
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,' APPLICANT NAME
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b "79695 WASHINGTON
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TOTAL
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ADDRESS
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FINAL DATE
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COUNTER L.U.T.
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= ADDRESS
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PLANS EXAMINER
APPROVE DATE
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APPL/PRMT p PP^q d1Sq gDATE 5 5 0 0 0
0 0027594 1w[ A / a 5/!!
ELECTRICAL FEE
90 DAY PERMIT ONLY
$0..00
TOTAL
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NC `:CO/U7,NNTEER
B.I.
COUNTER L.U.T.
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77
55066 111
E L. \ 1". 1 li 1 1. C A -L. P E. R M .1. 1
'T'OTAL. PERMIT COST is 413; 00
ri.LEC'TRICAL. PEE COMPUTATIONS Permit (Fere (ff applicAble) FEET
TEMP SVC—Tem /Cons tr Suc s N 'leap Use "P rml.i Y Acid' l Poles i 0 -FLEE. a
90 %)AY PERMIT �NL.Y
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1FORM 284208 (11-81) INSPECTOR '
$3.00
$10.00
$0,00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
tL
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
IDA
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 (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
Tank Pit L.Line
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring i)_
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final J!.
STREET NAME