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00021920 (SFD),e r-1 ♦ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- PERMIT APPLICATION pleted it the permit is lot 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' Compensa- • Ing with Section 7000).ol Division 3 of the Business and Professions Code. and my license is in lull force and effect. tion Laws of Calilornia. County of Riverside Date __ Applicant OWNER -BUILDER DECLARATION: I hereby allirm That I am exempt from the Contractor's license law for the Y P NOTICE TO APPLICANT: II. after makingthis 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 Department of Building and Safety deemed revoked. 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Am. 203 880 N. Slate Street 227 North •'D" Street 46209 Oasis Si. Rm. 310 160 N, Broadway Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343 Perris. CA 92370 Indio. CA 92101 Blythe. CA 92215 Ph: 78.' 6:46 Ph: 849.7312 Ph. 658.4464 Ph: 6573898 Ph. 3428271 Ph: 922.2670 This permit becomes void it work non commenced within 180 days Irom date of Issuance. OR. it work has beer suspended or abandoned for a period of 180 days. duslrial Salety, as noted above. unless such person has a permit to do such work from the division. ,e r-1 ♦ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- i LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- pleted it the permit is lot 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' Compensa- • Ing with Section 7000).ol Division 3 of the Business and Professions Code. and my license is in lull force and effect. tion Laws of Calilornia. i ❑ Date __ Applicant OWNER -BUILDER DECLARATION: I hereby allirm That I am exempt from the Contractor's license law for the Y P NOTICE TO APPLICANT: II. after makingthis 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 following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to con- deemed revoked. slruc(, alter, improve• demolish, or repair any structure, prior to its issuance, also requires the applicant for such S permit to life 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- ex- Ell hereby certify That no excavation five (5) or more feel 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 any applicant for aper- mil subjects the applicant to a civil penally of not more than live hunderd dollars ($5000)) be made in connection with work authorized by this permit, and that no building structure. scallolding, lalsewo-k, .1: or demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap. 3.2• Grp 2. Art 2. Sec 341, . ❑ 1• 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 Contractor's License OAS owner -builder. I will not employ anyone to do work which would require a permit Irom the Division of In - Law does not apply to an owner of properly who builds or improves (hereon, and who does such work himsell or duslrial 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, Industrial the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov- ❑ Division of Salary Permit No. Ing that he did not build or improve for the purpose of sale.) ❑I• as owner of the properly, 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 properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- tractor's License Law.) 01 am exempt under Sec. B.8 P.C. (Attach Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a certilicate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.). ❑Certified copy is hereby furnished. ❑Certified copy is filed with the County Building Inspection Department or County Department. DAN APPLICANT HOR MI) aJ L VUR" 1638 PTALO IDNW11.11'r-'ffr CA 922600000 YO7B,;(¢ AVE R11�^L•+fIO 1L.7!'iMCObiV WCA4 �1�fyJ1f[1JREESSSII7SPP�A�C/E J. (vl/YIZIP tlr�r�q „Rn 22530000 77 4 1 ft'5'3 i7 1 2 J TWIN Ii O V WO S IVVTO 0 0 0 18TO 0 3 1 property 101SB *1 t1 77 CA SVVATAQ #18) BLK-185 PN�idT4-EEYpt�gE,M3/E,��Ry T� DEV A/G.Y CO6. {.J ONE# Lf�fLN•AVf6// qNi Y7�4JRN pip r(� LIJ W��36 MORS 1638 OITY,J601rtrUf�YTY7S9 EIRPT CA 922600000 170P41Qfy� i0i4f 56�8-,C, 1 ♦ V fJ 8 BLOG.INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNC If ADDRESS CITYICOMMUNITYISTATEIZIP PLAN M P SE_ ER APGPA' OVE ATE r O a-F�. ��g$EFp,E y��• r rL/WOL,.IYRMIyp�pAil 1 GARAGE Sl Q R 3 N 04 V O 3 V gg 1� O VII JO nq�g� TV 11 Estimated qT� iF�Yai of - ZONE ORD N LOT SZ 0 UN13 0 o { SIOB CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor- mance of the work for which this permit is issued (Sec. 3097. Civ. C.). Lender's Name Lender's Address 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 construction, and authorize a representative of the County of Riverside, Department of Building and Safely to enter upon the properly l�or,,'►w'hiicch I have applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name (fill P12"I 7, Q CPAP 0711; 3 9 57 9 ESTIMATED FLAN REV FEEi.er r, TOTAL•. PERMIT COST IS $151,77 'CONSTRUCTION ESTIMATE (NOTEs Not to be used as property TOTAL . .- p FEE *1 t1 77 CA CIX NC COUNTER B.I. COUNTER L.U.T. PERMIT FOR FOR STRUCTURAL PLAN REVIEW FORM 284.208 (11.81) 1 NSPECTOR valuation) Rate Valuation $27.60 $334,213 $82.20 '2664 $3>3997 iso $2 $1 i , 77 TOTAL•. PERMIT COST IS $151,77 'CONSTRUCTION ESTIMATE (NOTEs Not to be used as property Description FCC Group Type Sq Ft PRIMARY DWLG 101 R-;3 V --W 1211 SECNbRY AIRCON 900 R-3 R 1211 SE�NDRY PR IraAR 436 M WD 320 4c Est Ian Rev Fee baud an Total Estimated Val'tn of FORM 284.208 (11.81) 1 NSPECTOR valuation) Rate Valuation $27.60 $334,213 $82.20 '2664 $3>3997 iso $2 $1 i , 77 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs 8 Frms 34 Plenums 8 Ducts 2A Slab Grade 35 Furnace Comport. 3 Steel 36 Inlets 8 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. ❑ 43 Final IDA Fireplace T. 0. P' ADDITIONAL INFORMATION ; SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick Value 7A Walls (Botts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater "' 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L.Line PSL REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Servicer%—,- :. 32 Final STREET NAME VWOWT920 JAW 08/033 02 39872 SOURS 9638 .. CA 92',1600000 55S4 8PURESSISPACE AVE RlJBIO N INA41,n n k L1AcOCd,1�d T61'�ZIP '. {. A 922530000 �j ' �� / �P jr/3 In ' -2 f2 a TWN �i {J e1 47 lb 0 S -tiff-0 0.0 0 To 0 a TOTAL . FEE Sa CA fWW "EAQ 018, Op185 �LK�- P- ELM 67EVERT, NIGV CO PHONE# L901RAIVa"NTi'URN LeV,%ttS436 VEHEts 1638 PIA. orruw I REIRPT CA 922600000 / 7lN%44� 568—.11 I d 1� l 0 A. {J'•P BLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME' LICNC # ADDRESS CITYICOMMUNITYISTATEIZIP - PLAN # PLANS EXAMINER APPROVE DATE Vbff. eRMIA ATT GARAGE . UOO1. .IRfN 000 01ST) 01M 01st) 1 1210 1. ,.ZONE ORD#. LOT SZ 10 (11190 (0 d SIDFa VWOWT920 JAW 08/033 02 39872 TOTAL . FEE CA CK INC- I COUNTER B.I. COUNTER L:IJJ. : s , APPLICATION *FOR -$TRUCTURAL PERMIT ..T N 1 8 .' :1 5 A N A P P LI C A T 1 0 N d N L Y NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums 6 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. C] 43 Final 10A Fireplace T. 0. C3 FI ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Loth 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 ~Y 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 Q Z Receipt No. L�0 S 6S-" l7 Issued By District: Riverside ❑ Indio ❑""" Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (New 10/81) J "r Date / 3 PINK - Building Dept. GOLDENROD - Attached to Plans t RIVERSIDE COUNTY DEPARTMENT OF HEALTH APPLICATION FOR PERMIT TO INSTALL A RESIDENTIAL -SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to the specifications required on the attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name- Mailing Address / City ,',� )) State Zip Code Phone 'Property Address 'City or Community 'Legal Description of Property / l/ yrs // vi4i G C " . 'Assessors Parcel No. Water Serving Property From Signature of Applicant/ /' `� Date 'The above information must be verified from Building Application Staff Use — Do Not Write Below This Line Initial Date Soils feasibility report required Yes ❑ No i Detailed boring report required Yes ❑ No Detailed contour plot required Yes ❑' No Soils or boring report by Date Approved by Date J TypOthe�r�� +�� ✓ / Sr Soils Map Page Tract File No. Number of Bedrooms Septic Tank Size (gallons) Rate Required (sq. ft./100 gal or gal. sq. ft./day) ,�... a Y / ®oa, Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) ^,r Seepage Pit Diameter Seepage PitVerticalFeet Number of Seepage Pits Maximum Depth of Pit C` / 7 Location of System Additional Requirements A permit is a p oved%denied for the installation of a subsurface disposal system as indicated on the accompanied plot plan ustng`the requirements set forth in Section C above. Signature of Health Official Date Receipt No. L�0 S 6S-" l7 Issued By District: Riverside ❑ Indio ❑""" Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (New 10/81) J "r Date / 3 PINK - Building Dept. GOLDENROD - Attached to Plans 1 • r APPLICATION FOR TREE PLANTING ' I'(we), the undersigned,hereby certify and acknowledge that I (we) have read the application and agree that if trees are required under River- side County Ordinance No. 457, the applicant agrees to install said trees prior to final inspection. It is understood that no final inspection^ will be given until said.requirements hove been met or exception has been granted by the County. Now, therefore, it is agreed that the prop- erty owner shall cause the property lines to be surveyed in the event no survey stokes can be found. Further, it is agreed that the County of Riverside shall assu no responsibility s uld trees have�move� to lot line errors. Owner's Name� ��Build�in--g Permit No. � 2� Moiling Address O� �' 3 y r Cit Q�+//x-ae'y state _`2ip 2 0 Job Address 19 Community Legal Description Assessor's Map, Book & Page�7=�T7 �C`i �� Type Structure Z P Type of Soiljs water available Road Dept. Plot Plan No. 3p Type of existing trees in road right—of—way Trees preferred by applicant (1) (2) (3) Date 7�oX Owner's Signature Planning Commission Case No. ROAD DEPARTMENT—APPROVAL Approved species Number of trees a (Spacing of trees Distance from lot lines: Front Side W Additional requirements Date Building and Safety notified Signature Reason t— w U. Q Request for hearing: YES ❑ Owner's Signature W 06 REQUEST FOR EXCEPTION (attach additional page if necessary) (Forward application to Planning Dept. if exception requested) NO REQUEST FOR HEARING Planning Dept. Concur Date Road Dept. Non -concur ❑ Explanation Signature Concur Non -Concur M Date Signature REQUEST FOR HEARING AND COMMITTEE DECISION Date hearing established Date hearing notice mailed to owner Approved ❑ Disapproved Date Owner notified of decision Date Building & Safety notified` Signature Final Date Inspector _ Job Address Requirements for tree planting complied with Remarks 284-230, REV. 1/74 APPROVAL BY BUILDING INSPECTOR Building Permit No. -ommtrnity (Detach and forward above information to Road Department Riverside) DAIi+I N 7� �� '. MI) f OURS 16:38 CA 922600000 UCQTBY rliB�',9t��Dj'�R�TE�SySIIS�gPACE AVE R f B I IR P'!�A NCA wUAC'V07w[w�..D i`1 i ZIP �y �y +p �9 �9 �q p� T2253000N 714 TWN O fold 0 NO S Iful)000 O'D0:3 011 SEI CA O l MP3 0 K -/1 85 pSy�/4�.tVA}XAt�M� pB�E�+. 1Q'p. 1N^I�tl�.p.,9"[IpMp�7EMGdgE�fiR 1 DEV CO � PHONE M QNB+ p t,, ! ;gfQ'O V Vjtl N AUR N Llwdi�/i.:436 i VMS 163EI PrA -iuw.IS 'RYY' CA 922600000 sllT I— ©0—A 0 ACJ BLDG. INSPECTOR FINAL GATE ARC/ENG FIRM NAME LICNC 4 ADDRESS CITVICOMMUNITYISTATEIZIP PLAN # PLANS IEXAMINER APPROVE DATE BMW% ATT C;ARAGE iso- . RIfN 014V 0T.0 I Oda. 070 IFND ZONEORD# 1. LOT SZ ONvNiA t;9 w0 7�I T 9 n xP,§ 107' /1 Slaw '39573 TOTAL . FEE �j �- CA CK NC COUNTER B.I. COUNTER L:U.Y.-/' ti APPLICATION FOR STR.UC;TURAL.. PLAN REVIEW 'T' H I S 13 A N A P P L I C A T x U N U N L. Y .. Yee► nusxt see the following Departments (if listed) for concurrence ence NEFOR a Por mit Can be iss sed e t to See HOLD -ROOD, HEALTH t_AAD USE FORM 284208111.8x,- INSPECTOR NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs 8 Firms 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 IDA Fireplace T.O. ❑ No ADDITIONAL INFORMATION _ y SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Loth 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 128 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 r PSL P/ ELECTRICAL APPROVALS 26 Power Pole 127 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME