00015800 (PLBG)PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street ,i w
227 North "0' 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: 787.6146 Ph: 8497312 Ph: 658.4464
Ph: 6573898 Ph. 342.8271 Ph 922.2670
This permit becomes void it work not commenced within 180 days from date of issuance. OR. tI work has beer suspended or abandoned for a period al 180 days.
❑
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
LICENSED CONTRACTORS DECLARATION: I hereby affirm That I am licensed under provisions of Chapter 9 (comment-
pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
permit issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa•
tion Laws of California.
S
Date _ __Applicant
r�
NOTICE TO APPLICANT: If, after makingthis Certificate of Exemption. you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm [hat I am exempt from the Contractor's License Law for the
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.
struct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
PHONEN
permit to Zile 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-
01 hereby certify that no excavation live (5) or more feet 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 by any applicant for a per-
be made in connection with work authorized by this permit, and that no building structure. scaffolding, lalsework,
mit subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).):
or demolition or dismantling thereof, will be more than thirty-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
Title 8. C.A.C.).
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
dustrial Safety, 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.
((�
60
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov.
❑Division of Industrial Safety Permit No.
Ing that he did not build or improve for the purpose of sale.)
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01, the contracting licensed to the
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
as owner of property, am exclusive)q with contractors construct project (Sec.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property 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 _
01 am exempt under Sec. . 8.& P.C. (Attach Certificate).
END
Date Owner
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 slate laws and county ordinances relating to
' WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate 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.
APPLICANT NAME (L, F, MI)
MAPUE VEAF PLUMBING
° RiB52 HWY lit
KA uVEMPT CA 722600000
O �E,(r DAESSISPACE COACHEL.LA AR
+ WO{�JJ1 U ITY4TWIP CA 922530000 72530 0 0 LI
T7 �
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X034 w0000 V00
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8
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RING
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654275 16,616
6Y1
se
TRACT NAME
W9W if
PHONEN
WEE`* LEP PLUMBING
,�"�; &%0
Y°MI SIESTA TRAIL,
f�IAILi�I"RS`�Ea T
GA 922600000
91`14t-346-6750 BLDG INSPEC OR
FI
ARCIENG FIRM NAME
EICNC N
ADDRESS
CITYICOM M UNITYISTATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
4s D L»` k TO DWL)G
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END
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building con 'on, and authoriz representative of The County of Riverside. Department 1 Building and Safety
[o enter,.0 oaJ1rp#rnI
r w I have applied for this permit for the purpose al ma Ing inspe ions.
X a�
or Ag Date
Print Applicant/Agent Name
APPLN DATE
0001 5800 P 104/ 05/8
26348 ^W4^
PLUMBING PEC
$6r50
TOTAL
FEE
$6.50
CA
CKu
NC
COUNTER M.IF
COUNTER L.U.T.
/ -r
P L. U M H I N C P E R M I T
TOTAL. PERMIT COST IS
PLUMBING FEE COMPUTATIONS * Permit Fee Wappplicable)
GAS PIPING SYSTEM -1 to 5 Outlets i l 6 nr Mora► Outlets; 0
- sk
FORM 284.208(1181) INSPECTOR
FEET $2.50
-t I
NO.
OPERATION DATE
INSPEC OR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
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.O.
OP'N
NO.
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE S LOCATION f
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
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
i
PSL j 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
APPLICANT NAME (L, F. MI)
PL
16,2 HWY 111
- ,pCIITY/COMMMUNIT IS�T�ATTEIZIP�q
A
ALM DESERT CA 922606000
;JOB SITE ADDRESSISPACE
49806 COACHELLA DR
CIT�Yy,/CO�MlM`U'NMISTT�ATTEIZIP
syn
CA922530
1eB�OgK
PRyC�
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yPAG p
J 19
p
�+.7!Y V
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Do 0
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CJV
TRACTLOT
MOD
SB
004275 Qo16
TOTAL .
FEE
D',1
CK
I NC
TRACT NAME
OWNER NAME (L,F,MI)
PHONE #
JOSELYN. A
i CONTRACTOR -FIRM NAME
LICNC M
,.MAPLE LEAF PLUMBING
343670
ADDRESS
3531 SIESTA TRAIL
CITY/COMMUNITY/STATE/ZIP
PALM DESERT CA • 9i 2600000
PpHONE N
BLDG. INSPECTOR
FINAL DATE
r y
-1 4—•46-6rI 5
ARC/ENG FIRM NAME
LICK #
ADDRESS "
CITYICOMM UNITY/STATE/ZIP
•I
PLAN N
PIANS EXAMINER
I APPROVE DATE
USE OF PERMIT
('ZAqtjNV. Tn MILr.
BL
ZON
FSB SSB
SSB
RSB
OFC
00'
R_I
Q00
00
Dnp
IND
ZONE ORDq
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END
SIDE
0000
APPLIPRMT N
t
/w� DATEIAP /1 /1 ^ A
PS In b �� 2 ju6 .W3 //J1'�
TOTAL .
FEE
CA
CK
I NC
I COUNTER B.1.
c
COUNTER L.U.Tt'
APPLICoATION FOR PLUMBING PERMIT
i
THIS Ta Aar A'PP.LICA`i' I CN 0NL,Y
FORM 284208 (l)-8 1) (Nr PECT0R
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & 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
From:
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.
P'
'
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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
P)
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME