010755 (ELEC)�rcni i Rri 11111111
COU
nt of Riverside
Department
of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street
V27 North "0" Street 46-209 Oasis St. Rm. 310 160 N* Bri
Riverside. CA 92501 Banning, CA 91,220 Hemet, CA 9M
."iPerris. CA 92370 Indio. CA gnOl Blythe'. CA
Ph: 787-6146 Ph: 849-7312 Ph: 658-4464
Ph: 657-3898 Ph: 342-8271 Ph: 922-2670
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if
work has been suspended or abandoned for a period of 180 days.
.ICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
Nilh Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
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' Compensation Laws at California.
Jcense Class Lic. Number
Date Applicant
)ate Contractor
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers'
)WNER'-BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law tar the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
,eason (Seca 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing E] I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend. will be.
Nith Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for made in connection with work authorized by this permit. and that no building structure, scaffolding, falsework, or
for the to demolition dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec 341, Title 8,
he alleged exemption. Any violation of Section 7031.5 by any applicant a permit subjects applicant a civil
penalty of not more than five hundred dollars ($500).):
or
C.A.C.)
1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the As owner -builder. I will not employ anyone to do work which would require a permit from the Division of Industrial
Pa
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law ety, as noted above, unless such person has a permit to do such work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through Division of Industrial Safety Permit No
his own employees. provided that such improvements are not intended or offered for sale. 11. however, the but ding
or Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden at proving that he did not
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
build or improve for the purpose of sale.).
the work for which this permit is issued (Sec. 3097. Civ. C.I.
1, asowner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044
Lenders Name
Ainess and Professions Code: The Contractor's License Law does not apply to an owner at property who builds
a;
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address
License Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
I am exempt under Sec. B. & P.C. (Attach Certificate).
city anqrcounty ordinances and state laws relating to building construction, and hereby authorize representatives of
thV, inty to enter. upon the ilpove�.menlio ad,property, for inspection purposes.
Date Owner
7
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate at consent to self -insure, ora
IF i,
Signature of Applicant or'Agent I Dater,
certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
TOTAL
FEE
information given is correct. I agree to comply with all stale laws and county ordinances relating to building con -
Policy No. Company
Departure
struction and authorize a representative of the County at Riverside.Deoparl of Building and Safety to enter upon
F-1 Certified. copy is hereby furnished.
th upa m nsp c
,Vlpiop�rty for which) have plieq.�ar,�Ihis permit for the Itin S,
n Certified 'copy is filed with'ihe County Building Inspection Department or County Department. Signature ot,Applicantior. Agent 7 ' F Date
Date Applicant
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
1'. A, 1}' lh 14 MV b V A (:� jCk n r'
APPUPRIA #
CITY/COMMUNITY/S.TATE/ZIP
LA QUINTA CA 92253 0, 0 1),
JOB SITE ADDRESS/SPACE
78524 WWF -111
CA 92,53000'0
2530000
BOK PAG PRC C TWN RING SE S
613 4V3 0 113 9 Tod 877
19 0
TRACT LOT MOD S13
0 010 0 0 a 11 1 1 1 oil I
TRACT NAME L QU
OWNER NAME L. F
N UNTAY A JfA
L4&-
CONTRACTOR -FIRM NAME
ADDRESS
'I CITY/COMMUNITY/STATE/ZIP
i PHONE # LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0 LICNC #
OL44"'tHANGE, RC'F TO 2645
BL FSB0 SSB`' SSB 1. RSIB ' OFC._
.0 ZON A01to 01 1 1
I op 1 0 1 And
ZONE ORD N I I LOT SZ :'I. END I SIDE
1NbFt(_1UKb WFY
'1,01075
TOTAL PERMIy MT IS
:tRic"TRICAL PEF. COMPUTATION9 lf-of per"Itzi a at $3,00, 'Each
5 AMP/Volt SrQc I If of Akp^10111tv - 0 K f,
to be Charged i N Hof U r 1 -4 of Hoor.it'l , 2 FEE i
A,1X
0Qu
$5.00
$30,010
� y�y
ULPMTRICAL 1''Y '1W:
ID 0-
M X C� R El P't L M Ftp E
KLIECTRICAL
P el- R
h I T
TOTAL
FEE
1NbFt(_1UKb WFY
'1,01075
TOTAL PERMIy MT IS
:tRic"TRICAL PEF. COMPUTATION9 lf-of per"Itzi a at $3,00, 'Each
5 AMP/Volt SrQc I If of Akp^10111tv - 0 K f,
to be Charged i N Hof U r 1 -4 of Hoor.it'l , 2 FEE i
A,1X
0Qu
$5.00
$30,010
� y�y
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & 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
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. 0.
°a
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
�- -1.3. ,• Finish Grade'-'-- "^_- ..•�••_. }----_
INSULATION
Thick R
Value
7A Walls (Botts)
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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
,P/L
P/1
26 Power Pole
27 Conduit '
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME