011156 (BLCK)APPLICANT NAME (L, F, M1)-----�--
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ADDRESS
CITY/COMM UN I TY/STATE/ZI P
963`50000
.108 SIDRESS/SPACE
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' OWNER NAME (L, F. III '
CONTRACTOR -FIRM NAME
ADDRESS
C I T1?CO M M U N I TY /STA TE/Z I P
PHONE #
LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE #
LICNC #
USE OF PERMIT
DWLC & ATT GARAGE
BLZON
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FSB
020
SSB
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ZONE ORD #
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APPL/PRMT q Ps DATE -1-011156
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APPLIOA'T'ION FOR STRUCTURAL PLAN REM
TOTAL .
FEE
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F011156
APPLICATI04 FOR STNUCTt UAL PLAN OF -VIEW
i IS AN APPL x CAT ION IDNLY
you oust wee the following (if lielted) for, covicurrence. BEFORE
8 POrmit can be issued a
W4�4 M
HEALTH'
14OLD- ROAD
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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 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
Garoge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
u
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 (Botts)
12C Ceiling (Blown)
14 Final
-------------------F�:1,L;61�iG ./;Cf-�O=J'.1C�-----------.------
15 Ground Plumb t ;•
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
298 Bonding
. 30 , Fixtures '
31 Service
32 final
t .
STREET NAME
r/'..C.:
County
of Riverside
Department of
Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street
227 north "0" Street 45209 Oasis St. Rm. 310 160 N. Broadway
40 Riverside, CA 92501 Banning, CA 92220 Hemet, CA 92343
Perris, CA 92370 Indio, CA 92201 Blythe, CA 92715
Ph: 787-6146 Ph: 8447312 Ph: 6554464
Ph: 657.3898 Ph: 342-8271 Ph: 922-2670
This permit becomes void it work not commenced within 180 days from dale of Issuance. OR, if work has ban suspended or abandoned for a4leriod of 180,days.
S
A.
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 If the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
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' Compensation Laws of California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: It, 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.
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
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
signed statement that he is licensed pursuant 10 the provisions of the Contractor's License Law (Chapter 9 (commencing
0 1hereby certify that no excavation live ((5) or more feet in depth Into which a person is required to descend, will be
with Section 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, falsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2. Sec 341, Title 8.
penalty of not more than live hundred dollars ($500).):
C.A.C.)
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
[] As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
Safely, as noted above, unless such person has a permit to do such work from that division.
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 who does such work himself or through
0 Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. II, however, the building or
Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
build or Improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
work for which this permit is issued (Sec. 3097, Civ. C.).
1, as owner of the properly, am exclusively Contracting with licensed contractors to construct the project (Sec. 7044,
Vu
Lender's Name
ness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
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improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address
License Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
E] I am exempt under Sec. . B. 8 P.C. (Attach Certificate),
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.
Date Owner
IWORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. or a
certilicate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
Policy No. _ Company
E) Certified copy is hereby furnished.
❑ Certified copy is filed with'lhe County Building Inspection Department or County
Date Applicant
Department.
APPLICANT NAME (L. F. MI)
ADDR S
CITY/COMMUNITY/STATE/ZIP
926350000
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
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TRACT NAME
DESERT rLUD MANOR 41
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
C ITN"COMM UN ITY/STATE/ZI P
PHONE 4
LICNC k
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC p
USE OF PERMIT
BL
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FSB
I SSB
SSB
RSB
OFC
ZONE ORD a
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END
SIDE
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 whicly I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT x PSJ DATE 01115 6
h . al
PPLTCM
ASSESSOR COPY . TOTAL .
FEE
011156
APPLICATION FOR STRUCTURAL PIAN REVIEW
TN 1 IS AN AP Fel» I CAT 1 ON 0 N L Y
You rust see the following Departments (if listed) for concurrence BEFORE
a Permit can be issued&
NOIn-• Description Departm
HOLD -
ROAD '
X77