00018096 (PLBG)County of Riverside
Department of wilding and Safety
4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street I-
. usiness an
227 North "D" Street 46209 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
Pb: 787.6146 Ph: 8497312 Ph. 658.4464
Ph: 657.3898 Ph: 342.8271 Ph: 922.2670
This permit becomes void it work not commenced within 18D days from date of issuance. OR. if work has beer suspended
or abandoned for a period of 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 became subject to the Workers' Compensa-
tion Laws of California.
1 O
Date _ Applicant
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Y P
NOTICE TO APPLICAN r: If, 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 (his permit shall be
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit t0 can-
deemed revoked.
struct. alter, improve. demolish, or repair any structure, prior to its issuance. also requires the applicant lot such
000
�,- permit to file 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-
?
❑I hereby certify than excavation five IS) or more Leet to depth into which person is required n0 descend. will
" empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
' mit subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).):
with n
made in connection with work authorized by this permit. and that building structure. scaffolding, lalsew
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
or 41.
or demolition or dismantling thereof. will be more than Ihirty-six (36) feel high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
feet
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. 1 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. II, however,
IPbuilding or improvement Is sold within one year of completion, the owner -builder will have the burden of prov-
❑Division of Industrial Safety Permit No.
that he did not build or improve for the purpose of sale.)
IIng
❑I, licensed
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
as owner of the property, am exclusively contracting with contractors to construct the project (Sec.
Pr
7044 B d P f Cod Th C tractor's License Law d e i I t n I r 1 h
mance of the work for which this permit is issued (Sec. 3097. Civ. C.).
essions e. a on s o s no appy o a owner o pope y w 0
builds or improves thereon, and who contracts for such projects with a contractors) 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
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)
VALLEY PLUMBING
ADDRESS
!31610 HWY 111, BOX 665
CITYICOM MUNITYISTATEIZIP
INDIO CA 922010000
JOB 46560 CAMEO
5t_O�rCAMEO PALM DR
CITYICOMMUNITY/STATEIZIP
LA QUINTA CA 922530000
BOK
PAG
PRC
C
TWIN
f
PING
SE
S
617
015
009
s
CA
CK v
A
000
00
COUNTER L.U.T.
TRACT LOT
MOD
SB
00211 0a�
011
TRACT NAME
OWNER NAME
LAVOIE1,F,MI) MR
PHONE N
CONTRACTOR -FIRM NAME
VALLEY PLUMBING COMPANY
LICNC N
273080
ADDRESS
P.O. BOX 6651
CITYICOM M U N ITV /STATEIZI P
INDICT CA 922010000
PHONE N
714M345-10 b
BLD INSPECTOR
FINAL DATE
11171
ARCIENG FIRM NAME LIC
ADDRESS
CITYICOM MUNITYISTATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
REPLACE GAS PIPING
Baa
n21N
FSB
000
000
000
IND
ZONE ORD11LOT
SZ
END
�y SIIDE
V 0 00
P L U M B I N G
TOTAL PERMIT COST IS
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 a,ulhoraze'a representative of the C;ounly of Riverside, Department of Building and Safety
to enter upon the prope)tylfor which I have
��applied
�for
lhi permit for the purpose o m,ki inspections.
X )k/ UN , w ' �1 Ju"i _ 1 � s �ty Z..
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLIPRMT N PS DATE34721
00018096 Pig 0�i11/82
PLUMBING FEE $6.50
f
TOTAL .
FEE
CA
CK v
A
NC
i
OUN R B.1
COUNTER L.U.T.
P E R M I T
J
$6.50
PLUMBING FEE COMPUTATIONS * Permit Fee (if applicable)
GAS PIPING SYSTEM- 1 to 5 Outletsi 1 6 or More Outlets 0
FORM 284.208(11-81) INSPECTOR
FEE F $2.50
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSTECTOR .
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
i
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
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
43 Final
IDA
Fireplace T.O.
NO
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 (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
25
Gas Test1,1,01AAAV
Final
Tank Pit L.Line
PSL
REAR OF PROPERTY LINE {
.w
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)
yVALLEY PLUMBING
ADDRESS
81610 HWY ill, 'ACX 665
CIITYIC�OryMyMUUNITYISTATE/ZIP
P QN�y (� rj n
-XNAIO CA 72201` 000
JOB SITE RESSISPACE
AMGO PALM DR
42540CAMEO
CITYIIICOMMMUNITY/STATE/ZIP
53 0 0 0 0
LA QUINTA-» CA 922
BOK
PAG
PRC
C
TWN
RNG
SE
S
'6171052
009
a
NC
€
000
00
TRACT LOTMOD
SB
'002117 _0052
U11
-TRACT NAME
OWNER NAME (L,F,MI)
PHONE p
LAVOIE , MR
CONTRACTOR -FIRM NAME
VALLEY PLUMBING COMPANY
LICNC p
273088
ADDRESS
}y �rH �{- y
:;:y . O . BOX 66
CyIITYICOOMMUNITYISTATE/ZIP
�y .y
@�201
'10D 10 CA YP 0000
PHONE
BLDG. INSPECTOR
FINAL DATE
,-714-345-1016'1
s
'ARC/ENG FIRM NAME
LICNC p
ADDRESS
CITY/COM MUNITY/STATE/ZI P
PLAN p
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
RRIPLACE CA PXPINC
BLZON
0-0
FSB
rzi
SSB
aaa
SSB
009
RSB
000
OFC
114D
ZONE ORD p
LOT SZ
END
SIDE
000.0
APPL'IPRMT p PS DATE^ J� 7
00018096 IAP a J/1 1/8 W'( `Tf I 2 GJO
TOTAL .
FEE
CA
CK
NC
COUNTER B.I. -
COUNTER L.U.T.
APPLICATION FOR PLUMBING PERM14T1 347
rH-1s 15. AN APPLICAT10N ONLY
.- I
s
1
FORM 284-2W (11 .81) INSPECTOR
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. E]
43
Final
10A
Fireplace T.O.
FI
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
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