00019107 (SATT)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
227 North "0" Street 45-209 Oasis Sl. Rm. 310 160 N. Broadway
Riverside, CA 92501 Banning, CA 92220 Hemet, CA 92343
Perris. CA 92370 Indio. CA 9201 Blythe. CA 92225
- Ph: 787-6146 Ph: 849-7312 Ph: 6584464
Ph: 657.3898 Ph: 342.82x7 Ph: 922-2670
This permit becomes void it work not commenced within 180 days from date of issuance. OR. if work las 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: 1 hereby allirm (hat I am licensed under provisions of Chapter 9 (comment
pleted if the permit is for one hundred ($100) or less. I :ertify 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' Compensa-
. Ing with Section 7000) of Division 3 of the Business and Professions Cade. and my license is in lull force and effect.
tion Laws of California.
O -
Date Apelicant
%l
• NOTICE TO APPLICANT: II, after making this Certificate d Exemption, you should become subject to the Workers'
`OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the
Compensation provisions of the Labor Code, you must lornwith 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. v
deemed revoked.
siruct. alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such
VggNAME
F1g4Y..��WyAf'i S,y'" ORATION
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 CERTIFICAT ON:
(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 live (5) or more feet n 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-
".nil subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).):
be made in connection with work authorized by this permi , and that no building structure. scaffolding. lalsework,
ARCIENG FIRM NAME
or demolition Or dismantling thereof, will be more than Ihir y -six (36) feet high. (Chap. 3.2, Grp 2. Art 2. Sec 341.
Ii -1, 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 wort which would require a permit from the Division of In- -
'Law Coes 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.
a through his own employees. provided that such improvements are not intended or offered for sale. If, however.
-
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.)
❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the perlor-
' 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. 497. 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 '
❑1 am exempt under Sec. . B.& P.C. (Attach Certificate).
pate Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF :NTRY: I certify I have read this application and state
that Ihe�inforv�rlalion given is correct. I agree to comply with all state laws and county ordinances relating to
, WORKERS' COMPENSATION DECLARATION: I hereby allirm that I have a certificate of consent to self -insure, ora
building co)181 cttan, and authorize a representative of the County of Riverside. Department of Building and Safety
to enter pon e roperty'ri which I have applied for th.s permit for the of making inspections.
Certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.).
Y ...- purpPose
+ �•
'.❑Certified
({y
y� ter
copy is hereby furnished.
'` `
„❑Certified copy is filed with the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
hAAP`PL`IRCCA��N»»T NAME (I.,
,((L• F. SMI)
OP
[PTO RS
M780
�q
kknf /�"J.CO�Y /4'T�T /ZIP CA 922530000
Q.$IrT,�,rlsQQRESSISPACE CA 1 E ROSARITA
Fr i'96�1'w P99
iityttyt��l7�llyl
LTW�J OO h(,$-TT,F7ZIP CFA/
Ld 4%.1. 21530000
P4TWN
1 PM2
D BO 1
o
8
C6,60
N
1y
S
4496 V1
ftT
72
%l
lVil
SEI
I
CA
Ti"R}AQ�I@CaiTggJ
OJNr VNTUn
JOINT
WyRN�qt
-PHONEIf
VggNAME
F1g4Y..��WyAf'i S,y'" ORATION
f 2
�$Tf� 1 DR .
�E(~�{IpSENHOWER
� � nt*.
1L." �i`61 IZIP UA 96»2530000
922530000
CW6hp w7 8 564-1315
7
RLDG.INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC B
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN pPLA
xAMI R AOVE D�.TE
(/
CUWVUT-:DWLG & ATT GA f C-3 9
N.
1� AsN
FSB
0 V V
J10
0 J)
RD
ZONEORDN
LOT SZ
END
A H$LDFa
Print Applicant/Agent Name
APPLIPRMT !010.1 0I CH /4�6�
00 5 8 3 W
ESTIMATED- PLAN REV FEE
%l
rTLFEE •
39,01
CA
CW!
NC
CO rNTEFjIB.I. 7
COUNTER L.U.T.
•• PE:RMIT F OR . STRUCTURAL, PLAN REVIEW
TOTAL PERMIT COST IS' $219.001
CONSTRUCTION ESTIMATE (NOTE: Not to be used as property valuation)
Description. FCC Crovp Ty a Sg F't , Rata Valuation -PRIMARY DWLG 10'1 R-3 WO a95 $27,601 $63342
SEFND'RY PRI�AR 43 yw WOO 457 $9.10: $4118
Est Ian Rev F.ee based on ate � e ir>sated Wal ` to of 367500 is % $w19, 05
FA
t
FORM.284.208(11-81) .INSPECTOR,.. y
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Firms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L. 0
43
Final
10A
Fireplace T.O. ❑
OP N
NO.
~-•
ADDITIONAL INFORMATION
•- -
_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
M Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
- -- -
P/L P/
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
l.7.� ..
1�11drytJY�s
pAPPpP4�IeC���N.TsI�AM
780
°O I39111TY�$�gTE21P CA 19225300 0 0
.94ySyEE.q RESSISPACE .,.t AB LE ROSARITA .
MP1L' 4
��1/1�CUU°77�•7un nip
CFJ��7PIi9id22iY530000
ky r
' Wbo
V�Pd
TWN
fl
n
Na
S
UTT449,6 V172
1
U11
SB
TRACT -
N��AggM��1E��•((
pp,,�tto�ryry ��qq yy��••99 .p p^a� pd'
,PERi4UjLAjIA � U.W I N 1 V1: OV�i UR
..NE $1 .
ET.81EMAICIMER 'DR
Ti°O�:!M 1�Q I�A,ZIP i.i Y7 Y "53000,0
PdQN;Eq•� t, /s ,,, { 49-q j.7;
d 7 8 M
BLDG. INSPECTOR
FINAL DATE
'ARC/ENG FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP- -
PLAN N'
PLANS EXAMINER '
APPROVE DATE .
Zs iR b i •n -ATT- GAR$$
F(��,N, ..
,FSB
8tto
on:
a11
.6FA
D.
'ZONE ORD p
LOT SZ
END .0076
25806,
TOTAL .
FEE
CACK `: NC ' . COUNTER B.I. COUNTER L.U.T. - - - }
t+ 1
A�'P�. f':�'ii'1O �'i�F�. a�Ri3C'i'�ik�Ald PLAN Ri::�91�rW
1" IM" v 1 S --A--N -A. 1? L:' A� .x Q
':.
a Yuu must See 'the �fol10 ing Depar�tmenTs (if listed) for concurrence IOC:'i"URE
a Permit can be 3sss<ued i
Dept- to gee .
+lCii.,rJ'-t3OAD, H A1,. TH L.gPdn WSE
;.
�FORM.RM. INSPECTOR (11.87) � •' ,
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Firms
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. C]
43
Final
10A
Fireplace T. 0.
OP'N
NO.
ADDITIONAL INFORMATION
.. t
"
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
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
riPt�J dDA�..iV A '&.�b� Y1
ADDRESS.
` 80
y�+7LyOX
y /+g ley [�./y h
(Y /� 922530000
c P9/CO9r�, I/sT AIZIP CA 7 G 253 0 0 U V
hObSf,TWFIESSISPACE bP'PYILLE RUSAR I,1 A
ETAVV CuuO``��
M9IZIP CA qt,"u ms 0 o o o
BOK
6y3
PAG
PRC
028
:x
C
3"
TWN
_911,
U000
RNG
SE
00
S
.
q:38
UDC 4496 Wi
I2
Iry�
6'Dgp
SBR
CA
NAME
QTRACT
ER �
LJOINT VEN UR
PHONEqWA
:
OlVO(TOy.ORib LIN
XJ6 2
V 1 EISENHOWEs Ali ..
I. wCObA]C♦twiASE/ZIP. CA_ 9,2.-2' 5 3 Ob0 V
A
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC 11 '
ADDRESS ^'; �,�:•. '_ ... '
CITYICOM M UNITYISTATEIZI P
PLAN q
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT, -
�i3NDOe-DWL.G. ATT CAR (G-1)
�L®.
'R 2N
FSB
10,661!
o V �
on
y�p
..f.Fb
ZONE ORD # ,
LOT SZ
END
SIDE
0001)
JAR o!5/2k a -ba 25872
TOTAL .
r FEE
CA
CK'
INC.
I COUNTER B.I.
COUNTER L.U;.'
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.
43 Final
10A
Fireplace T.O.
No
ADDITIONAL INFORMATION
.i
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
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
_
P)
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME