00018124 Grading- 4080 Lemon St. 2nd Floor - 135 N. Alessandro Rd. Rm. 203 880 N. State:Slreei
,DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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' Riverside, CA 92501 Banning. CA 92220 Hemet. CA 927,3
❑I hereby certify that no,ekcavation live (5) or more feet in depth into which a person is required to descend. will
Ph: 787.6146 'Ph: 849.7312'' Ph: 658.4464
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 Ihirly-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
w4lw
This becomes it within 180 from it
'Tille'8. C.A.C.). ,
permit void work not commenced days date of issuance. OR. wor has beer Suspended
or i
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comment-`
n
dUStrial,$afety. a5 noted abOv¢, unless such person has a permit f0 d0 such work from the division.
o
ing with Section 7000) of Division 3 of the Business and Professions Code. and'my license is in full force and effect.-,,\
�:'.
' the building or improvement is sold within one year of completion, the owner -builder will have the burden ol.prov-
- ❑ Division of Industrial Safely Permit No.
OWNER -BUILDER -DECLARATION: I hereby affirm that I am exempt from the Contraclor:s License Law lot the.
following reason,(Sec. 7031.5. Business and Professions Code: Any city or county which requires'a permit to con-'
CONSTRUCTION,LENDING AGENCY:-, I hereby affirm That there is a construction lending agency for the perfor-
strucT!aller, improve.Aemolish, or repair any structure, prior to its issuance, also requires the applicant for such
�.
ION
de
nd Safety
227 North -0 Street 46.209 Oasis St. Rm. 310 160 N. Broadway
Perris, CA 92370 Indio, CA 92201 Blythe. CA 92225
Ph: 657.3898 Ph: 342.8271 Ph: 9222670
mod for a period of 180 Days. '
'IFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be Com
A if the permit is for one hundred($100).or less. 1 certify that in the performance of the work for which this
�it.is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-
La'ws of California.
Applicant
CE -40 APPLICANT: ll: alter making this Certificate of Exemption, you should become subject to the Workers'
�ensalion provisions of the Labor Code, you must forthwith comply, with such provisions or this permit shall be
ieO revoked.
permit to life 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 3 of the Business and Professions Code) or that he is ex-
,DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
'}
empt therefrom and.the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for aper•
❑I hereby certify that no,ekcavation live (5) or more feet in depth into which a person is required to descend. will
mil subjects the applicant to a civil penalty of not more than live hunderd'dollars ($500).):.
-
be made in connection with work authorized by this permit. and that no building structure, scaffolding, falsework,
or demolition or dismantling thereof, will be more than Ihirly-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
'Tille'8. C.A.C.). ,
structure is not intended or ollered lot sale (Sec. 7044, Business and Professions Code: The.Conlractor's License
1 - ' -
I will not employ anyone'lo work which o' Id require a permit from the Division of In
❑As ownerbuias
Law does nota I to an owner of properly who builds or.improves roves thereon, and who does such work himseWor
Law Y P P y P
n
dUStrial,$afety. a5 noted abOv¢, unless such person has a permit f0 d0 such work from the division.
o
through his own employees, provided that such improvements are not intended or offereofor sale. II, however,
�:'.
' the building or improvement is sold within one year of completion, the owner -builder will have the burden ol.prov-
- ❑ Division of Industrial Safely Permit No.
Ing that he did not build or improve for the purpose of sale.)
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-
.❑l,
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
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
❑I am exempt under Sec. . B.& P.C. (Attach Certificate).
.
DateOwner.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I Certify I have read this application and state
CONTRACTOR -FIRM NAME
that the information given is correct. I agree to comply with all slate laws and county ordinances retailing to
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cerliliCale of consent to sell -insure, or a
' - building construction, and authorize a representative of the County of Riverside. Department of Building and Safety
to enter upomthe property for which I have applied for this for the of making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. lab. C.).
permit purpose
❑Certified copy is hereby furnished. .
❑Certilied copy is filed with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F. Mf)
PSDATE '34743 A74
PLAtf.REVIEW FEE $10.00
ADDRESS, _
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NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & 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. ❑
OF'N
NO.
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
P/L
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
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PrL�ICANT: NAME IL,MQF, M
."T"5. At E' RAMIREZ
4%QUQ� RESSISPACE
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NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Bock
33
Ventilation System
2
Figs & Frms
34
Plenums & 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.O. 0
NO
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 Heof6r '
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
P/L
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
APPLICANT NAME (L, F MI)-
•;- ADDRESS
CITY/COMppM��Ul! N;;ITY/STATEIZIP•' �gry}�"s -v •':`
it. 'LA {N4S-I'N i A..
yJOB SITE,ADDRESSISPACE
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OWNER NAME (L F'Ml) - ,:.
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':PHONE # '
CONTRACTOR•FIRM NAME
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CIT.YICOMMUNITYISTATEIZIP ,
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INSPECTOR '�.-"
FINAL DATE
ARCIENG FIRM NAME
LICNC p `_
{ADDRESS
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,CITY/COMMUNITY/STATE/ZIP "
-PLANq
PLANS EXAMINER- APPROVE DATE
'USE OF PERMIT.
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NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums & 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.
FI
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE a 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
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