00019114 (SATT)permit
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSPTION INSURANCE: This section need not be com-
PERMIT APPLICATION
pleted if the permit is for one hundred ($100) or less. I certi-y that in the performance of the work for which this
permit issued. I shall not employ any person in any mannerso as to became subject the Workers' Compensa-
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
.1
tion Laws of California.
County of Riverside
NOTICE TO APPLICANT: If, after making this Certificate of Ex• mption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt Irom the Contractor's License Law for the
.
Compensation provisions of the Labor Code. you must forthwi-1 comply with such provisions or this permit shall be:
Department'of Building and Safety
deemed revoked.
struct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such
We I
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 -
of hereby certify that no excavation five (5) or more leer in d• plh into which a person is required to descend. will
4080 Leman SI. 2nd Floor
135 N. Alessandro fltl. Rm. 203
880 N. Stale Street QQ� 227 North "D" Street
46-209 Oasis SI. Fm. 310
160 N. Broadway
Riverside. CA 92501
Banning, CA 92220
Hemel, CA 92343 i" 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 becomes void if
work not commenced within 180 days Irom date o1 issuance
OR it work has beer suspended or abandoned for a period of 180 days
UJ4 EU
0
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSPTION 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 certi-y that in the performance of the work for which this
permit issued. I shall not employ any person in any mannerso as to became subject the Workers' Compensa-
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
.1
tion Laws of California.
Dale Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex• mption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt Irom the Contractor's License Law for the
.
Compensation provisions of the Labor Code. you must forthwi-1 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
We I
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 -
of hereby certify that no excavation five (5) or more leer in d• plh into which a person is required to descend. will
ti empt Iherelrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
mit subjects the applicant t0 a civil penalty of not more than five hunderd dollars ($500).):
` be made in connection with work authorized by this permit. and that no building structure. scaffolding, fatsework, ,
• ❑ 1, as Owner of the property, or my employees with wages as their sole compensation, will do the work, and the
or demolition or dismantling thereof. will be more than thirty-s:x (36) feet high. (Chap. 3.2, Grp 2. Art 2. Sec 341,
Title 8. C.A.C.).
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
.
[]As owner -builder. I will not employ anyone to do work w:l ich would require a permit loom the Division of In -
dustrial Safety. as noted above. unless such has a to do such work from the division.
° through his own employees. provided (hat such improvements are not intended Or offered for sale. It, however,
'. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
person prmil
❑ Division of Industrial Safety Permit No.
ing that he did not build or improve for the purpose Of sale.)
LICNC If
Of. as owner of the am exclusively contracting with licensed contractors to construct the (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm that th re is a construction lending agency for the perfor-
property, project
7044 B ' d P f C d ' Th C I I h
mance of The work for which this permit is issued (Sec. 309. Civ. C.).
. ustness an to essions o e. a dntractor s License Law does not app y to an owner o property w o
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
tractor's License Law.)
3❑I am exempt under Sec. B.8 P.C. (Attach Certificate).
,t Date Owner
.;WORKERS' COMPENSATION DECLARATION: I hereby alfirm 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.
B�7130
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Lender's Name _
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN'RY: I Cattily I have read this application and state
(hal the inlorl7i tion given is correct. I agree to comply with all slate laws and county ordinances relating to
building cdr� lr coon, and authorize ac9presentalive of the Ccunty of Riverside. Department of Building and Safety
to enler u° on �, rope rib 'c I�have applied for this ermit for the purpose of making inspections. .
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S gnature of Applicant or Agent Date
Print Applicant/Agent Name
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TOTAL
FEE
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NC,
COUNTEEOB.,II.. �J
COUNTER L.U.T.
PERMIT FUR SMICTURAL PLAN ia.EVIEW
TOTAL PERMIT COST IS $197.60
CONSTRUCTION ESTIMATE (N� t Nat to be used' as property valuation)
eller iplion C Croup Typpe Sq Ft Rate Valuation
PLItIti ARY .DWL.0 F� 101 R"3 WAVID 1093 $2%.660 $52246
SECNDRY PR$GAR' • 436 M-1 WOOD 485 $9.10 $4413
!cwt Plan Rey Fee based on ` oTal Estimated Val,"tn of $566W isi $197.60
1
FORM 284.208 (11.81) INSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
'
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System ti
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
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. 0.
FI
_ , �
ADDITIONAL INFORMATION
... _ _ .. _ . .. _ .. _ _ _ . _
_
SEWAGE SYSTEM SIZE & LOCATION i
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
. 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 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
I
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CA E3'd"y..�2+530040
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BLDG. INSPECTOR
FINAL DATE "
ARC/ENG FIRM NAME
LICNC p
• ADDRESS
s CITY/COMMUNITY/STATE/ZIP
c PLANAr
PLANS,EXAMINER
APPROVE.DATE
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'TOTAL .
FE
'CA
CK'
NC
COUNTER B.L -
COUNTER L.U.T. .. '
APPLICATION FOR PLAN REVIEW
.. W S 1G S' A H A P F''.-11.. 1' C ..A 7 1 0 14- 0:N L Y
i"' -You riot) see the foIIowi.ncy.Deparx�eerotis (i'P List d) For c6- c.urt� enrto BEFORE-
' "a Per mi..t- can be ks sued c _._
f Desrri Tinto k) t s _.:
Pint.I)--43 EA ,, HEALTH_, LAND. USE
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
3B 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 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