26986 (GRD)'.PERMIT APPLICATION
County of Riverside
Department
of Building and Safety
4080 lemon 51. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Sire -11 227 North "0' Street 46.209 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: 922.2670
This permit becomes void it work not commenced within 180 days from date 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 Pam licensed under provisions of Chapter 9 (comment- pleted it 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 Prdlessions Cade, and my license is in lull force and effect. permit 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
OWNER -BUILDER DECLARATION: I herebyaffirm that I am exempt from the Contractor's License Law for the NOTICE TO APPLICANT: Il, after makinglhis Certificate of Exemption, you should become subject to the Workers'
p Compensation provisions of the Labor Code, you must lorthwith 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
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-
❑I hereby certily that no excavation five (5) or more feet in depth into which a person is required to descend, will
empt therefrom and the basis lot the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
mit subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).): be made in connection with work authorized by this permit, and that no building structure, scallolding, falsework,'
-
or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
❑, I, 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 Coniraclor'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 thereon, and who does such work himself
or dustrial Safety, as noted above. unless such person has a permit to do such work from the division.
through his Own employees. provided that 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 Safety 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 allirm that there is a construction lending agency for the perfor- .
• 7044, 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.). -
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
01 am exempt under Sec. . B.8 P.C. (Attach Certificate).
Date Owner •
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate
that the information given is correct. I agree to comply with all state laws and county ordinances relating to
building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
WORKERS' COMPENSATION DECLARATION: I hereby affirm that,l have a certificate of consent to sell - insure, ora tYenter the property for which I have applied for this for the gf/making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
permit purpose
•�upon
f �1••�"•.
[)Certified copy is hereby furnished./�iF
<✓< .� +• 1r. -.
.F '[Yale
Cerlilied copy is filed with the County Building Inspection Department or County Department. "Signature of Appiicanleor-Ager l % : - �-
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CONTRACTOR -FIRM NAME
LICNC p 1%,
ADDRESS^y
CITY/COMMUNITY/STATE/ZIP ,
PHONE p
'BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC I3
PLAN If PLAFSXXAMINETIAPPROVE DATE
ANGE I •
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f9 _ZlQnl, D o LOT SZ I I END
PLAN CHANGE
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FORM 284.208(11.81) INSPECTOR
N uVV
IPLAN CHANGE $15.00 1
CAy CK
P E R d1 S 'rok PLAN CHANGE
TOTAL PERMIT COST IS
COUNTER 8.1.
1 r ip
$15.00.
TOTAL
FEE
COUNTER L.U.T.
$15-x 001
$15.00
'r
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
A
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.
NON
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 (Botts)
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 r
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
PSL P/
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 ' Final
STREET