39513 (PLBG)' PERMIT APPLICATION
Countyy'of•Riverside
r-- Department of
84ilding and Safety
4080 Lemon Sl. 2nd Floor 135 N. Alessandro Rd. Am. 203 880 N. Slate street 't
i - 227 North "D" Sveel 46.209 Oasis St. Am. 310 160 N. Broadway
,. Riverside. CA 92501 Banning. CA 92220 .Hemet. CA 92343
PR 787.6146 Ph: 849.7312 Ph: 658.4464
{ Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225 '
�. Ph: 657.3898 Ph: 342.8271 Ph: 922-2670
This permit becomes void tl work not commenced wilhin 180 days Irom date of issuance. OR. if work bas beer suspe60ed
or abandoned for a period of 180 days.
;y❑ <
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-'
'LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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 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-,
0 $10.00
lion Laws of California.
a -
Date Applicant
OWNER -BUILDER DECLARATION: I hereby affirm that, I am exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: If, after making this 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'
fallowing 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
FEE
permit to lite 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-
,
Of hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend. will
empi Therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
(nit subjects The applicant to a civil penally of not more Than five hunderd dollars ($500).):
be made in connection with work authorized by this permit. and that no building structure. scaffolding, falsework, ,
Interc:pT 1 4
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 B. C.A.C. ).
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
ElAs owner -builder. I will not employ anyone to do work which would require from the Division In
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
a permit of -
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. 11, however.
the building improvement is
❑Division of Industrial Safety Permit No.
or sold within one year of completion, the owner -builder will have the burden of prov.
' ing that he did not build or improve for the purpose of sale.) A
MICROFILM FES:
01, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm 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 o1 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
J: tractor's License Law.)
Lender's Address
"• Qfam exempt under Sec. . B.8 P.C. (Attach Certificate).
t�:di.n<�� •''� �•-•••-•
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY' I 'f I h
COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, Ora
of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
copy is hereby furnished.
t •.
copy is tiled with the County Building Inspection Department or County Department.
s APPLICANT NAME (L, F, MI) `.. -
'S');HON, FAM11"Y PARTNERSHIP
�X (31 i HIGHWAY 1 I 1
I. �%0Oty1�l TT`y$T:t 21P CA 92 30000
, d�B•6t�TEaAD�DRESSISPACE HIGHWAY III. I q
44�� CCiA ii .: fl 6 l,V 1 8
' LWO1 tllbf�:T11�'ZtP CA 9w253a� 00
y�°q��T7 �'�0 ��'a � ry�pp�i��:� �`iE ,EA 6
•X; 19 67 o A A A LOT Mt3A q SB
z. ITRACT
�°.° ��1i 9 e F'`P°AMILY PARTNEC SHrP, EW.
` CONTRACTOR -FIRM NAME LICNC N
.11 PHONE It . I BLDG. INSPECTOR I FINAL DATE
'11 ARC/ENG FIRM NAME
MUNITYISTATEIZIP
f'< 1 PLAN 0 QS IINER APPROVE DATE
1�$¢ - Fri wr�e�n. �• ?e. �2—
1` L.°��V MI�P�PYNGr_
cern y ave read this app Cal on and state
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
er u
to entpon the property for which I plie 't
have apor this permit for the purpose f making inspections.
Signature of Applicant or Ag Date
`i pryp•�1J �,t
Print
Applicant/AgentNaame 1071/00
y 0Aa ry 'Cl
CONSTRUCTION TRUC:TION FEE 0
PLUMBING FEE $44,00
JPC; % HRS iR 15-00 $105.00 1
SMI FEE
M_,ICROF I.LM FEE
A., E6 A " E:f°�; 01151"o Jonloll) d►1ffiBl gF D �
EON, p LOT SZ i7 A V END CA Cb NC COUNTE
Ciaac A owe ,c.�.
TOTAL . $ 1
FEE
COUNTER L.U.T.
loo
r
S T R U G T U R 'A L( BUILDING ) P E R M
I T
' `TOTAL PERMIT COST IS
$153.80
' `1CONSTRUUTICIN ISTIMATE (NOTEt Not to be used
property valuation)
Description FCC Group- Type
S9 Ft Rate
Valuation
PRIMARY MISG _ M M
0 $10.00
$0
Construction Fee based on Total Actual Valuation
of 60
x•st
$0.00
PLUMBING FER COMPUTATIONS Permit Fee (if
applicable)
FEE
s4;:, 00
FIXTURES -Dar .9ink1 0 Drinking F'ntn1
0 Flr Drain1 3
SEWER --flu ildi.ng 1 0 Industrial Waste Pretreat
Interc:pT 1 4
FEE:
$22,00.
Pr.'ua•te Sewage Disposal -New: 1 Old: A
smx
F'EE1
$10.10
,E
$0.00
MICROFILM FES:
$4.80
' PC: 7 HRS Q IS. AA .
�►t Ali . Ail
r
•
7.,.
FORM 284208 (11-81)..It
INSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
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
10A
Fireplace T. 0. Ej
OP'N
NO.
ADDITIONAL INFORMATION
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick Vaallueoe, V y
7A Walls (Botts)
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
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 NAME
E