00012665 (AR)00012665
CONSTRUCTION
Out i %e2
FEE
ADDRESS
7}3�4�y35 SHADOW MTN DR
C�TAj! rU146f jI
I�7OB
y Jai �}(�/►
�s 922600000
CA 7 C. W Q M ii V
SITE ADDRESS/SPACE
�Tt3�tM1Mi SAN TIMOTEO
g�gq
UAICO��,I(NfA f 7E/ZIP
CA 922530000
BOK PAG PARC C TWN RNG SE S
617 :531D
30 0 19
9TRACT LO6 MOD SB 110001001
�#g1JpQi3 00 Ot t
i.ATI T NfJ'6INTA GOLF'
E4FF S 02
PIND T (L. F, MI)
WILLIAM A
�Of�TgACTOR�I��A1.1F_�
1uu'1Wyy�S5 SHADOW MTN DR
PAL��uNDESERT
CA 922600000
P ONE x
514-346-171a
$0,. 68
LICNC x
1149095
1
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE x
LICNC x
l
AbOY STORAGERM 6 EXPEND BININGRM
r` t
40l
t3 t1'.�
oil "!
SB
10
&D
ZONE ORD x
a
STRUCTURAL. (
BUILDING ) PERMIT, �
LOT SZ
TOTAL
1 ♦10
END
SIDE
0440
00012665
CONSTRUCTION
Out i %e2
FEE
� LJ 6 7 r
$80.50
PLUMBING FEE
$14.00
ELECTRICAL. FEE
SMI FEE
$0,. 68
l
Y
STRUCTURAL. (
BUILDING ) PERMIT, �
TOTAL
1 ♦10
INSPECTOR'S COPY
e _ - 0 86
S T R U C 1 UR At. ( BUILDING 1 P E R M I T
TOTAL. PERMIT COST IS 4104.22
CONSTRUCTION ESTIMATE (NOTEt Not to bar used as property v loation)
Duscripti,on FCC Group Type Sq Ft ate Valuation
PRIMARY DWL.G R-3 +VMW SUS $271&0 $7948
SECNDRY PRIGAR M WB 192 $9. 0 $1747
Construction Fe* based on Total Actual. Valuation of *945 iss $80.50
ELECTRICAL. FEE COMPUTATIONS a Por"it Fee (if applicable) FEEL $3.00
No of Units$ t Servict Voltes 0 FEE1 ft.00
;or Irl. tx I _>:;t ;3.61
A D FEI~1 2 q. t. ffl .110 errs �q. �t. F�1~s !1.44
PLUMBING FEE COMPUTATIONS a Parr"it Fee (if applic*bla) FEE $4.00
FIXTURES -Bar Sink1 1 Drinking FoTol 0 Flr Draint 0
A:3 PIPI 8Y TEM- t 5 Gut' 01x12 6 or MI re Quvl*1%1 0 >rFEr fs2. Q
Installation of'aWateraPiping and/orrWW&terFTreatmentaEquipil2 fFEEi $2.50
SMI FEE x10,68
41
FORM 284-208 (2/81)
•''� Yom.
NO. OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
- -- MECHANICAL APPROVALS
1 Set Back O
33 Ventilation System
2 Ftgs & 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
Framing
40 Fire Damper
8 Vents
41 Smoke Detection Device
9 Garage Fire Wall
42 Commercial Hood
10 Fireplace P. L. r _
43 Final
10A Fireplace T. 0. _g
°o ADDITIONAL INFORMATION
6 /� �-a ' L .19 T'e
�1 ` !�• L/� �% ,� -
/T T �[ O y (ra: /lX� I� a 6 / l✓il
V r'
c Ic
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
"R"
INSULATION Thick
Value
7A Walls (Batts)
a✓� �
12B Ceiling (Batts) it !7.
Y� C9 DCS
12C Ceiling (Blown)
14 Final
------ - PLUMBING APPROVALS - - - - - — - -- - - - - -
15 Ground Plumb
16 Water Piping
17 Rough Plumb
v
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
i
i
1
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures /
31 Service
32 Final
! V�
STREET NAME
rcmmIS nrrcmnr run _
County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street 227 North "D" Street 45209 Oasis St. Rm. 310 160 N. Broadway
Riverside .'A 92501 Banning. CA 92220 Kernel, CA 92343 Perris, CA 92370 Indio. CA 92201 Blythe, CA 92225
Ph: 787.8 Ph: 849.7312 Ph: 65B-4484 Ph: 657-3898 Ph: 342.8271 Ph: 922.2670
thnnis permit becomes void if work not commenced within 180 days from dale of issuance, OR, it 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 it the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full 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
CITY/CV))AjJq`ff{W{ �,T/Xp�E/ZIIIP .A 9225,301000
((,,3%.30 jj
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
• License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION' ereDy affirm That I am exempt from the Contractor's License law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter,
deemed revoked.
improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to life 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
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
penalty of not more than five hundred dollars ($500).):
C.A.C.)
❑ 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
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
PHONE 4
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
sw r
the work for which this permit is issued (Sec. 3097. Civ. Q.
P1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044.
PI1,
and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.).
I 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 self -insure, or a
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Q.
Policy No. Company
erfified copy is hereby furnished.
Certified copy is filed with'the County Building Inspection Department or County
Date '"` n Applicant
Department.
AF MI
PPLICANTNAMEPAf 1 e"11k
ADYORES �
i. 55 SHADOW MTN DR
I1Y011UN-169 0 CA -922600000
T ORESS/SPACEr 1142 SAN T'I"O'T'F'O
CITY/CV))AjJq`ff{W{ �,T/Xp�E/ZIIIP .A 9225,301000
((,,3%.30 jj
T7
A 7
h
TWN 0
9RNG 80
61i
S
\7 ii iJ V V a
160419
ITV,
SB
TR
k, I°T 0011-F
DYEEE (L.
ANDY A
MMIII))ky�`
fFF,
i�
�§TOi FA i 1 i+. N
15 SNA00W ."TH AR
i C:lz�. 922600000
fH6q��d.�1+My
} y�ZIN
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 4
PERMIT .FOR STROCTURAL PLAN REVIEW
a
LLIICN@@C
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� �.M Tf OlIAGERM & 17 XP CMD DININ RM
tib
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AR BO
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ZONE ORD p
LOT SZ
END
4 SIDE 01) V
Lender's Name
Lender's Address
certify that I have read this aVplication and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
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 con-
struction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon
the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent D-aatte fry;.
Print Applicant/Agent Name
APPL/PRMT 4
:o 1 PS DATE € o 02/05/02
Tr,G` IMATO PLAN REV FEE
8 5 3 0
$.52.32
PERMIT .FOR STROCTURAL PLAN REVIEW
TOTAL
FEE
sw r
INSPECTOR'S COPY
018530
PENM1T FOR _STRUGTUPAI; PLAN REVIEW
TOTAL 'PERMI'T' COST 18 02.12
CONSTRUCTION ESTIMATE (NOTEi Mot to be 04&,d asp puporty gmiluation)
Description FCC Group Tppw 4 Ft Rate Volooli on
PR:T ARY DWLG 9�z V -Wali 280 $M60 $794113
CCCNDRY PR IGAR M Wx? 192 9.1 A $1747
EST Plan Rom Fete lbaviod on `Fatal �:vtim�ted Wj'tjn of UOS tot 02.32
1
,,/Jif - ,• - Ir/////v y/' '%!/�/(-/-wrQ
J � /
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
Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
Ej
°o
t
ADDITIONAL INFORMATION
-.--------•--- -
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Batts)
12C Coling (Blown)
14 Final
PLUMBING APPROVAL--------------------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water,5ervice
24 Gas Test
25 Final
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
rcmmii nrruLnnun
County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street
227 North "D" 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: 187-6'f Ph: 849-7312 Ph: 658.4464
Ph: 6573898 Ph: 342-8271 Ph: 922-2670
-This permit becomes void if 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 it the
with Section 7000) of Division,3 of the Business and Professions Code. and my license is in full force and effect.
permit is for one hundred (S700) or less. I certify that in the performance of the work (or which this permit is issued. I
SE
00
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter,
deemed revoked.
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
0 I hereby certify that no excavation live t5) 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
made in connection with work authorized y this permit, and that no building structure, scaffolding, lalsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2. Sec 341, Title 8.
penalty of not more than five hundred dollars ($500).):
C.A.C.)
1, 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
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law
Safety, 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
0 0vri
the work for which this permit is issued (Sec. 3097, Civ. C.).
PI, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec 7044,
Lender's Name
siness and Professions Code: The.Contractor's License Law does not apply to an owner of property who builds or
ZONE ORD k
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address
License Law.).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
1 am exempt under Sec. , B. 8 P.C. (Attach Certificate),
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Date Owner
_
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure. or a
Signature of Applicant or Agent Date
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
Policy No. Company
information given is correct. I agree to comply with all state laws and county ordinances relating to building con-
Certified copy is hereby furnished.
struction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
the property for which.l have applied for this permit for the purpose of making inspections.
Certified copy is filed with'the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
Date Applicant
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI)
IOSS PATTEN
1�A35 SHADOW MTN DR
c�Y�.MMu I .SERZI� CA 922600000
fg $ Td &DRESS/SPACE SAN T I MUT EO
CI,jY/��CfM1 (1TATE/ZIP CA 922530000
V
2253„ 0 0 0
ROK
PAG
X330
PRC
017
C
6
TWN
0000
PING
SE
00
S
R'„1p�9T
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7
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7l
Oil
SB
TACT NTA GOLF C48TS *2
F. MI) WILLIAM A
MY
?yJf§TDP F J TTN
P!15 SHADOW MTN DR
922600000
H��ERM`gHT�TRg�+�
iO"1"346"• J�T / i 0
y �yC�A�
i 1490
ARC/ENG FIRM NAME
ADDRESS%
CITY/COMMUNITY/STATE/ZIP
PHONE q
LICNC #
ff "TrURACERM & EXPEND DININGIM
11
R2 N
0
005
0 0vri
01
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ZONE ORD k
LOT SZ
END
.
SIDE
0000
FORM 284-208 (2/81)
APPL/PRMT 4 PS GATEg018528_
APPLICATION POR STRUCTURAL FLAN REVIEW
ASSESSOR COPY TOTAL e
FEE
APPLICA'T'ION FOn STRUCTURAL PLAN. REMW
T M 1 S I S A N, A P P _L I C fA T 1 0 N 0 N L Y.
018 528
ArVLI9,AN,l NAMt , MI)
ROSS PAVi-rewl
ADDRESS .
134Z5 SHAD00 "T" 00
'OT
fflbA.& . RESS/SlACE 'SAN I 41140TIE-0
ACO WAY4 /ZIP
BOK
4.1,7
PAG
330
PRC
019
C
6
N, FING
0040
Do'
s
•
TRACT
000)00
LOT
001
0 1
APKICATION FOR STRUCTURA.. P V4, ItH IT.
1
SB
CACN61
A T .61NtA GOLF CSTS -'02 t
(L, F. MI)
ay p
, _pf ;W,35 -SHADOW KTH DR
IJE 12 1 P.
-ARC/ENG FIRM NAME
I
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE #
LICNC
viNlWaRli
god
o 0%. 01% Ao
f�,
ZONE ORD #
LOT SZ END
SIDE
0.00
APPU HM T N PS DATE 018675
APKICATION FOR STRUCTURA.. P V4, ItH IT.
• T�
�r rw . v �.R ► .. _ -. .r M +. .� � -- 4 ,r - .. _ .... -�- .-r mss... -... -. v -r• »...--�-..-.n+,x--.�r�
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
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
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
-----------------
ADDITIONAL INFORMATION
.
r
------------- --.
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 APPROVAL ------------------
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
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
r '298 Bonding
30 Fixtures
" .31 Service
32 Final
STREET NAME