00004731 (BLCK)APPLICANT NAME (L. F, MI)
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FORM 28C-208 (2/81j
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NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System I
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
p�
Combustion Air I
!�
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance I
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 (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
I REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
i
P/
I
26 Power Pole
27 Conduit
28 Service Entronce
29 '- Wiring
29A Groonding Wire
.:
29B Bdfding
30 rFixtures -
31 Service
32 Final
STREET NAME
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>.• s{' ;county of Riverside
DepartMent of Building and Safety
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4080 Lemon St.' 2nd Floor 135 N. Alessandro Rd. Rm. 203 • 880 N. Stale Streel-
227 North "0" Street - 46-209 Oasis Sl. Rm. t10 160 N. Broadway
Riverside, CA 92501 Banning. CA 92220 Hemet, CA 92343" •
_
_. Perris. CA 92370 -• Indio, CA 92201 Blythe,, CA 92225
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Ph: 787.6146 Ph: 849-7312 Ph: 658-4464 .'
Ph: 657-3898 Ph: 342-8271- Ph: 922-2670 1
• �= . ,,..f ,This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work
has been suspended or abandoned for a period of 180 days.
-: LICENSED CONTRACTORS DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSULANCE: This section need not be completed if the
! with Section 1000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
permit is for one hundred ($100) or less. I certify that in the perform,nce of the work for which this permit is issued. I
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shall not employ any person in any manner so as to become subject .o the Workers' Compensation Laws of California.
License Class Lic. Number
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Date Applicant
.-NOTICE
-Date- • Contractor
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TO APPLICANT: It, after makingthis Certificate of Exem eon, you should become subject to the Workers -
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DECLARATION: I hereby affirm That I am exempt from the Contractor's License Law for the following
nply ith such provisions or this permit shall be
Compensation provisions of the Labor Cde, you must forthwith co
,OWNEH•BUILDER
reasa'n (Sea' 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
deemed revoked. -' 1
7
.impiove, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to life a
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
*signed statement that.he is licensed pursuant to the provisions o1 the Contractors License Law (Chapter 9 (commencing
I hereby certify that no excavation live (5) or more feel in depth trito which a person is required to descend, will be �.
with Section 7000) o1 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, talsework, 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 (s500)J:
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.)
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❑ 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
Raiety, as noted above, unless such person has a permit to do such work from that division.
is is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law
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does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
❑ Division of Industrial Safety Permit No.
} Ais own employees, provided that such improvements are not intended or offered for sale. Il, however, the building or
``improvement
Date Applicant
is sold within one yearofcompletion, the owner -builder will have the burden of proving that he did not
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-� build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a cwnstruction lending agency for the performance of,
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the work for which this permit is issued (Sec. 3097, Civ. C.).
T1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044.
builds
Lender's Name 1
siness and Professions Code: The Contractor's License Law does not apply to an owner of property who or
',improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address
:gLicense Law.).
I certify that I have read this a plication and state That the above information is correct. I agree to comply with all
'.
z ❑x I am exempt under Sec. . B. 8 P.C. (Attach Certificate),
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city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned for inspeGion
Date Owner ? ', :;•ir <,y .,
property purposes.
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WORKERS' COMPENSATION DECLARATION: I hereby alfum that I have a certtllcate of consent to self -insure. ora
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Signature PD or Agent Date .
Applicant of nature
•?Sd certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ce'tity I have read this application and state that the ,
} Poli No. ComD anY
information given is correct. I agree to comply with all state laves 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 '
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} Certified copy is hereby furnished. +��
the property for which I have applied for 'his permit for the purpose of making inspections. i
I -Signature
Certified copy is tiled wilh'the County Building Inspection Department or County Department.
of Applicant or Agent Date . I
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"Date - Applicant % ,•• Y•
Print Applicant/Agent Name r
,APPLICANT NAME (L. F, MO ••--` ' --- - - •,
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APPL/PRMT k PS DATE
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FORM 284-208•(2/81) '._. r,
' '. ... 4
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'lu'Y __.. �� ± 1
.' tr ' ' r - �.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
1
DATE
INSPECTOR
w
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System I 4
2
Ftgs 8 Frms
34 Plenums 8 Ducts
2A
Slab Grade
35 Furnace
Comport.
3
Steel
O y J
36 Inlets 8 Outlets
4
Grout Blocks
01
9
✓
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
Go.oge Fire Wall
42 Commercial Hood r
10
Fireplace P. L.
43 Final
10A
Fireplace T.O.
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NO
-•►__ �. _....
ADDITIONAL INFORMATION k•
I
r. .�....-_ ...... - _.. -.r� «w....y _ ._.�.. __.w _,.. A. +► -
-- ------ ------- - ---
SEWAGE (SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Intemol Lath
12A Drywall
- X19 — —Finish• -Grade � .. ... .. .,.........- ..._ _ �. tet. ..w .- s.
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
I
I Pit L. Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME t