26563 (GRD)PERMIT APPLICATION
County of Riverside
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. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning, CA 92220 Hemet. CA 92343
s. Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 7876146 Ph: 849.7312 Ph: 658.4464
Ph: 6573898 Ph: 3428271 Ph: 9222670
This permit becomes void it work not commenced within 180 days from date of issuance. OR. if 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 1 am licensed under provisions of Chapter9 (comment-
I pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this
permit issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
lion Laws of California.
' O
Date. Applicant '
�, -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: II. after makinglhis Certificate of Exemplion, 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
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
'
permitAo 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-
QI hereby certify that no excavation live (5) or more leel in depth into which a person is required to descend. will
empt therefrom and the basis for 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 five hunderd dollars ($500).):
be made in connection with work authorized by this permit. and (hal no building structure, scaffolding, lalsework, ,
Q, I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
or demolition or dismantling (hereof, will be more than thirty-six (36) feel high. (Chap. 3.2. Grp 2. An 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
Q 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 himsell or
dustrial Salety. 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. If, however,
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
❑ Division of Industrial Safely Permit No.
,ing that he did not build or improve for the purpose of sale.)
as owner of the am exclusively contracting licensed to construct the
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
..QI, property. with contractors project (Sec.
Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
mance
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
QI 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 state .
_
that the information given is correct. I agree to comply with all slate laws and county Ordinances relating to
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure. of a
building construction. and authorize a representative of the County of Riverside. Department of Building and Safety
tenterupon�thpe�prr/ope/rly�for,which I have applied for This permit for the purpose of making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
Y
4 QCertified copy is hereby furnished.
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QCertified copy is filed with the County Building Inspection Department or County Department.
Signature of Applicant or Agent/ Date !
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A.3PJ.4IRJVME�I•"WILY PARTNERSHIP
ADD' S
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FIRM NAME
''* I CITY/COMMUNITYISTATE/ZIP
P�L�j Frintgt Applicant/Agent Name pp�� /1, 0 R g, �• _//'J� 'Cj jL/y1� ,/q��)
W yT#31 .7. •, .A% V Gid A. 6�JD/TE Id W V V
PLAN CHANCE
LICNC 0
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9 PHONE 11 BLDG. INSPECTOR FINAL DATE
ARC/ENG FIRM NAME LICNC d
(ADDRESS
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4 CITYICOMMUNITYISTATE/ZIP
I I PLAN H
fiLAW_ -CHANGE
00 C:ft Qf - 0'4 10.0 045
ONEORD n c 1,,,,,A)w8A E LOT SZ
SPECIAL INSP
0000 D CA C NC - COUN1", ,
TOTAL PERMIT COST IS $30.00
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FORM 284208 (11.81) INSPECTOR -
ra
TOTAL �� 0
FEE
COUNTER L.U.T.
X9,00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECKANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Figs 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
10A
Fireplace T.O. ❑
NO.
i
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywar( '
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
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME