00006718 Gradingx,•.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
;with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect.
I icense Class Lic. Number a "+r ; • �! 'ih /
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
reason (Sec.•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
signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing
with Section 7000) of Division of the Business and Professions Code) or that he is exempt therefrom and the basis for
the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil
penally of not more than five hundred dollars ($500).): .
'. Q I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, ;and the
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who does such work himself or 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 proving that he did not
�build•oi improve for the purpose of sale.).
P.I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.).-
'_ 1 am exempt under Sec. . B. 8 P.C. (Attach Certificate).
;Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby alfirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance, of a certified copy thereof (Sec. 3800, Lab. C.).
Policy No. —Company
r Certified copy is' hereby furnished.
60 Certified copy,is filed with'lhe County Building Inspection Department or County
•.Date'�`T�'' i'" r''' I '..Applicant
Department.
APPLICANT NAME (L F MI),. ,,,�A� U `.i.tiy`r,F _-� ^-• ---- •- - --
a_S... '`
rrnmll NrrLit RllUM _ ._
CITY/COpM'MUNITY/STATE/ZIP • • _ , �"t -Z 4.
=539 000
JOB SITE ADDRESS/SPACE �' v.?r' " j 5✓,m
—Veux1)WrrRU1)10.`
County of Riverside
BOK �v
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X3.40'8-4'
Department of Building and Safety
TWN F-
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4080 Lemon St. 2nd Floor
135 N. Alessandro Rd. Rm. 203
880 N. State Street 227 North "D" 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: 781-6146`,.
Ph: 849.7312
Ph: 658-4464 S Ph: 657-3898
Ph 342.8271
Ph: 922-2670
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.
LICNC q
x,•.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
;with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect.
I icense Class Lic. Number a "+r ; • �! 'ih /
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
reason (Sec.•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
signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing
with Section 7000) of Division of the Business and Professions Code) or that he is exempt therefrom and the basis for
the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil
penally of not more than five hundred dollars ($500).): .
'. Q I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, ;and the
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who does such work himself or 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 proving that he did not
�build•oi improve for the purpose of sale.).
P.I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.).-
'_ 1 am exempt under Sec. . B. 8 P.C. (Attach Certificate).
;Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby alfirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance, of a certified copy thereof (Sec. 3800, Lab. C.).
Policy No. —Company
r Certified copy is' hereby furnished.
60 Certified copy,is filed with'lhe County Building Inspection Department or County
•.Date'�`T�'' i'" r''' I '..Applicant
Department.
APPLICANT NAME (L F MI),. ,,,�A� U `.i.tiy`r,F _-� ^-• ---- •- - --
a_S... '`
ADDRES/S� t
•riJ)�1%�:-il i>'- �::�''��C.�B�FI� Fi�IfB�Gi:. r
CITY/COpM'MUNITY/STATE/ZIP • • _ , �"t -Z 4.
=539 000
JOB SITE ADDRESS/SPACE �' v.?r' " j 5✓,m
—Veux1)WrrRU1)10.`
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-
CONTRACTOR -FIRM NAME'' Y'-� �;'}•
ADDRESS ,
CITY/COMMUNITY/STATE/ZIP
PHONE If
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE q
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the.
permit is for one hundred (S100) or less. I certify that in the performance of the work for which this permit is issued. I
f. shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE•TO APPLICANT: IL after making this Certificate of Exemption, you shouldbecome subject to the Workers'
Compensation. provisions of the Labor Code, you must forthwith, comply with such provisions or this permit shall be
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that he excavation live (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.) ,
R As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
Safety, as noted above, unless such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit'No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all ,
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date .
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 state laws and county ordinances relating to building con-
struction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
the property for which.) have applied for this peimit for the purpose of making inspections..,,:
Signature of Applicant or Agent i Datei.:-J—�,,.,7 t a
Print AoDlicant/Aaent Name
0107S73:
TOTALAPOMICT COST IS 65'
CU' YO cud i 111 X400`- NtmvJd:f�
or
0 OpInd 1 9400 F"4i��ill><a
r}ithd Fir 1. 9760. Data a
(6co"t. afi d
'based 041-Cub1`-` d , Fd) tai $36.Q#
J
F
i4,
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
ti
MECHANIC&L-APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slob Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
ADDITIONAL INFORMATION
.
-------------•- _..... --
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
-- - - - - PLUMBING APPROVALS----------------------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
'
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
t
r
ti
APPLICANT NAME JL F MI)-,
t
DEB
y�y ADrIppDRESttSii '„
•�gr�yyrr pp��.
ENlDND,�A-• rR6iy,, !_ 0
� '
[ yfG� .\1 pry�
t aCITY/COMMUNITY/STATE/ZIP'
t� 9 til WTA CA 6'0100
its JOB SITE.ADDRESS/SPACE
5'AV�PfIDA ••�tilF3�i�
``Cl/T.Y,/COMM}UNFFITL�Y``/qSST��ApTTE/ZIP CA ���µ�3g ,4,:., •"r'"'��`-
BOK,.
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CONTRACTOR-FIRM NAME
'i
ADDRESS + -
{t '
CITY/COMMUNITY/STATE/ZIP
'PHONE a
IICNC a
ARC/ENG FIRM NAM'LAN
t'•ADDRESS �. ...
;r
CITY/COMMUNITY/STATE/ZIP .. _
'PHONE a
LICNC a
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FUSE OF PERMIT
t i AIDXWGPLAN'l 0HtCtE'
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FORM 284.208 (2/81)
1,
' ,w.:,,nr. :'..�. _:.,k�.: __ _.,..:. .A... e. ti- ,._:..${ �4l.'eg.j. z. ,§�:-,., _r .. �.+ kf._+t •.".+`i•
., .. :d'... _. d
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Figs & Frms
34
Plenums 8 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.
°O.
ADDITIONAL INFORMATION
-
r
-- _ .. - ---- -
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 I
Tank Pit L. Line
'
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 "Power Pole
27 Conduit
28, , Service Entrance
29 Wiring
20A Grounding Wire
298' Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
]Ph:`:G;r_V E(LP AbPE:.RT.I.ES INC:
PERMIT APPLICATION
p
ICIT^/COfx11y1� 5�A�E/ZIP C A 7 2 2 b J V 0 0 0
Wb/pDRE33/SPACE A V E:. N I D A R U B I O
County of
Department of Building
Riverside
and Safety
L1L
V1'22
4080 Lemon St. 2nd Floor 135 N, Alessandro Rd. Rm. 203 880 N. Stale Street
227 North "D" Street 46209 Oasis St. Rm. 310 160 N. Broadway
TWN
'
Riverside. CA 92501 Banning. CA 92220 Hemet, CA 92343
Perris. CA 92370 Indio. CA 92201 Blythe, CA 92225 '
RC4 0 0 0
Ph 787.6146 Ph: 849.7312 ,. Ph: 658-4464
Ph: 657.3898 Ph: 342.8271 Ph: 922.2670
U°1 0
,•
This permit becomes void if work not commenced within 18D days from date of issuance. OR, if work has
been suspended or abandoned for a period of 180 days.
pIA({6�(L, F. Mn P R Q P E R T I E J I
CONTRACTOR -FIRM NAME
LICENSED 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 it the
-
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull 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, 1
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STAT E/Z I P
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
.
License Class Lic. Number
Date Contractor -
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
-
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
FSB
0,0
reason (Sec. 7031,5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
070
.1. 5D
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: -
LOT SZ
signd statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing
I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be ,
END
.
witheSeclion 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, falsewark, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
- penalty of not more than five hundred dollars ISM).):
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2. Sec 341, Title 8.
C.A.C.)
•
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
Q As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial .
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code. The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and whQ(does such work I Imself or If rough
�aretY• as noted above, unless such person has a permit to do such work from that division. _
®,i.D" rwlslo�naof Industrial -safety Permit No.
-(he
•
his own employees, provided that such improvements are not intended or offered toy=sales 11. owever the building -or
Oat' e R Y+ Applicant
improvement is sold within one year of completion, the owner -builder will have the burden o proving that rye did not
build or improve for the purpose of sale.). W
N
CONSTRUCTION LENDING�A NCY: I hereby affirm that there is a construction lending agency for the performance of
tortewhich it is issued Civ. C.). -
.` .�
A
1, as owner of the property, am exclusively contracting with licensed contractors to co sir ct the prof ct (Sec. 7044,
��Lender's
work thislper (Sec. 3097.
and Professions Code: The Contractor's License Law does not apply to an own r o property ho builds or:
improves thereon, and who contracts for such projects with a contractor(s) licensed urs ant to the Conlrads0
AdmPsiness
Lender's Add ess
License Law.).
1 certifyAhal 1 have res 'this application and state that the above information is correct. I agree to comply with all
❑ I am exempt under Sec. . B. 8 P.C. (Attach Certificate),
city and county ordinances and state laws relating to building construction, and hcreby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes. _
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
Signature of Applicant or Agent - Date
•
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Q.
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 state laws and county ordinances relating to building con-
struction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
'
Certified copy is hereby furnished.
the properly for which.I have applied for this permit for the purpose of making inspections.
Certified copy is filed wilh'the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
�.
Date Applicant
Print Applicant/Agent Name
]Ph:`:G;r_V E(LP AbPE:.RT.I.ES INC:
J;C`C'BJ AVE NIDA RUBIO
p
ICIT^/COfx11y1� 5�A�E/ZIP C A 7 2 2 b J V 0 0 0
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pIA({6�(L, F. Mn P R Q P E R T I E J I
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
PHONE 4
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STAT E/Z I P
PHONE p
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GRADING PLAN REVI:.7 W FC..E $15.00
PERMIT FIOR
GRADING PI -AN REVIEW
TOI AL PERMIT
CCIG'i I'S, $15.00
of Lots: 1 CU YD'S•.Cut :
0 Fill: 300 Total. Moved: 300
PERMIT F'Ok GRADING F'E AN RE,VI.EW
TOTAL
FEE
qy 1 5 0 0
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FORM 284-208 (2/81)
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PERMIT FIOR
GRADING PI -AN REVIEW
TOI AL PERMIT
CCIG'i I'S, $15.00
of Lots: 1 CU YD'S•.Cut :
0 Fill: 300 Total. Moved: 300
Grading Plan Review Fee (based
on Cubic. yds Cut arta Filled) 11.1.',,00
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FORM 284-208 (2/81)
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