00007319 (SOL)AP7 `7 �f 7 i'1W1: �F. M1AMiJ iV
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- County
of Riverside
Department of
Building .and Safety
4060 Lemon St. 2nd Flom .135 N. Alessandro Rd. Rm. 203 880 N. State Street
-}' %227 North -D" Street 46.209 Oasis St. Rm. 310 160 N. Broadway t
Riverside, CA 92501 .Banning. CA 92220 Hemet, CA 92343
"'�"� sgPerris CA 92370 Indio. CA 92201Blythe, CA 92225 }
Ph: 787-6146 Ph: 849-7312 Ph: 658-4464" -
-.�, - Ph: 657-3898 Ph: 342.8271 Ph: 922-2670 ,
This permit becomes void it work not commenced within .180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days. '
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 lull force and effect.
_'permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit is issued. I f
- e,
-shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
i
LicenseClass ! .� Liic. Number 'a e 442 _
Date Applicant t
Dale_ /2i>+. �� Contractor _, -.�. %f..r r� s / :^ , +-. f% b; NOTICE. TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers' I
forthwith this be
OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt from the ContractoLicense awlor the following
Compensation provisions of the Labor Code, you must comply with such provisions or permit shall ,
deemed revoked. -1
reason (Seca 7031.5. Business and Professions Code: Any city or county which requires a permit to construct. alter,
i
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 to the provisions of the Contractor's License Law (Chapter 9 (commencing
❑I hereby 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
7031.5 for the to
made in connection with work authorized by this permit, and that no building structure, scaffolding, fafsework, or
demolition dismantling thereof, be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec 341, Title 8.
the alleged exemption. Any violation of Section by any applicant a permit' subjects applicant a civil
' penalty of not more than five hundred dollars ($500).):
or will '
C.A.C.) -
0 ' 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 '
t
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law
a ety, as noted above, unless such person has a permit to do such work from that division.
.,does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
❑ Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. If, 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 t
c_ .:
F 0'1, -as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
the work for which this permit is issued (Sec. 3097. Civ. C.). .} ,
Lender's Name
"iness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
a
4. improves thereon, and who contracts for -such projects with a contractor(s) licensed pursuant to the Contractors
Lender's Address
ivt Litense Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
p1Q I am exempt under Sec. . B. 8 P.C. (Attach Certificate),
x
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of I
this county to enter upon the above-mentioned property for inspection purposes.
Date Owner
END
�JWORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
- Signature of Applicant or Agent Date .
a,certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
Kinformation
given is correct. I agree to comply with all state laws and county ordinances relating to building con -
Policy' No. Company
- - -
struction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon +
I
❑ Certified copy is hereby furnished.
the proppgy'1or,wlilch I have applied for this Dermic for the purpose of making inspections.
�/y-1@r..h aT 'f,,, T+�-� y�-:;1 I
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Certified copy - tiled with'the County Building Inspection Department or County Department.
Signa of Applicant orAge Date .—F
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NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
�33,
Ventilation System
I
2
Ftgs & 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
Go,oge Fire Wall
. ,
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
Ej
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.._............._
ADDITIONAL INFORMATION
_.... _.,.... �..._,��..��.-.w. r.._......, .�«w o .. �.�.
--_ -
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior loth
12 Internal Lath
12A Drywall
- 43 Finish Grade_.... .� .- ... __._•...--,_..,�.._ ... .w•-..�....-��._
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 8l
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
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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ADDRESS '
4 CITY/COMMUNITY/STATE/ZIP
4 PHONE N t
LICNC #
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FEE
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FORM 284-208 (2/81)
.y
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
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
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 (Barts)
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
P/L
P/
26 Power Pole
2Z .Conduit
28 Service Entrance
29 Wiring
.29k Grounding Wire
29B, Bonding
30 Fixtures
31 Service '
' 32* •'.. ':Final .*
STREET NAME