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00017107 (RER)Ab7WT g4L Fd1W. A?3"Tb E COAST HWY, F' TOW"(.91W!'ii'"'sDZEP MAR CA V262500;00 JYOB`.61'%CfRESSISPACE SAN t I 'CP'HT[. N`M' GG//�G:ll !! SAN Vd,W�«.1`i r F. M3.6i twoP11MUCI8i1C/STq wZIP CA 92253000.0 ' 617-1301 301 V 04 L§ TNN V (POO V O S T AdTo000 VTO09 W11 SB %y'�ilLF 01 ��yRy�.�T�" 1�1(ILdNTA 5 T��tll MESON y J ACKPHONE H- ' CONTRACTOR -FIRM NAME LICNC q ADDRESS CITYICOMMUNITYISTATEIZI P PHONE pBLOG. INSPECTOR FINAL DATE VfJUGC"3lE W MCCOACH %9D42E 7 45M'GAINSBOROUGH AVE E:r'Ly:IM M �s�"Ulps CA 900270000 q PLANSEXAMIINERR- , APPROVE DATE. -PLAN G". RlGUyTTWLi/pLAR DENPADD ATT GAR X80 I R?fN. OZED 1 OJJB, O1813J0`ltlo IF,, ZONEORD# LOT SZ. - .END TOTAL . FEE 107 A% 0610Y 27349 TOTAL . FEE CA ' CK NC " COUNTER B.L. COUNTER L:U.T. - 1.... .1- 273491 APPLICATION. FOR.. STRUCTURAL. PERMIT fir.,, H. ,I S. i S A 'N A P P_ L. I - C 'A T x. O N O N L. ;1`_N-a-tur.q of Situss' Comment - --_-.:-�_ Action Taken _..��..._��.�� Came ilea No -�-- Ft';,NO INSPECTIONS UNTIL. WORI(ME~ S COMP ON FILE s� i, FORM 284208 (11.81) -1 N$r Ems. I oR 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 & 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 Loth 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Wolls (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 tr ironte 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME PERMIT APPLICATION County of Riverside Department of Building and Safety 4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North "D" Street 46.209 Oasis SI. Rm. 310 160 N. Broadway Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343 Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225 Ph: 787.6146 Ph: 849.7312 Ph: 658.4464 �-- Ph: 657.3898 Ph: 342.8271 Ph: 9222670 1 This permit becomes (4jrO it work not cLmmenced Mini. 180 days from date of issuance. OR. it woke Ns 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- pleled it the permit is lot 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 is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa- SE 00 tion Laws of California. , ❑ Date _ Applicant OWNER -BUILDER DECLARATION: I hereby affirm That I am exempt from The Contractor's License Law lot the NOTICE TO APPLICAN T: It, after making This Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith 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 "WNER HOM E 1.7 ' JACK 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 excavation live (5) or more leer in 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- mit subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).): w be made in connection with work authorized by this permit, and that no building structure. scallolding, falsework. INSPECTOR or demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341. ❑ I. 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 work which would require a from the Division In - Law does not apply to an owner of property who builds or improves thereon, and who does such work himsell or permit of duslrial 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. If. however. USE OF PERMIT REMUD DWLG/irNLAR DEN/ADD ATT GARAG 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.) 0SSB ❑I, as owner of the property. am exclusively contracting with licensed contractors to construct The project (Sec. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency lot the perfor- 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. 3097. 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 01 am exempt under Sec. B.& P.C. (Attach Cerhlicale). Date Owner CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state 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. C.). ❑Cerlilied copy is hereby furnished. ❑Certified copy is filed with The County Building Inspection Department or County Department APPLICANT NAME 1L, F, MI) BURGESS CO ADDRESS 2515 E COAST HWY CORONA ISDEL MAR CA 926250000 JOB,.48, E6INDRESSISPACE SAN VIf ENTE ST LAcOi�lLl I �-T TE A ZIP CA 722530000 BOK 617 PAG 301 PRC 004 C 2 TWIN 0000 RNG SE 00 S TRACT LOT 000000 0009 462 TOTAL FEE MOD 011 SB CK TRACT NAME LA GUI,NTA GOLF #1 "WNER HOM E 1.7 ' JACK PHONEN CONTRACTOR -FIRM NAME LICNC N ADDRESS CITYICOMMUN ITYISTATEIZIP 4000 INSPECTOR FINAL DATE t(P�HtO�NEyE�N�v! �� /B'LDG. lI4.iVGLAS EW t� CCOACH MCC 1r�A LII�Nl�,iJ"'t2E ADDRESS a4 GAINSBOROUGM AVE CITYICOM MUN ITYISTATEIZI P COS ANGELES l:A 900270000 PLAN If P E R APPF}9VE pASE /V 7 USE OF PERMIT REMUD DWLG/irNLAR DEN/ADD ATT GARAG BIL 00 RZ N Oft) 0SSB Oaf 077 OND ZONE ORD N LOT S2 END O 0 SIDE I at I e n ormalion given Is correct. I agree to comply with all state laws and county ordinances relating to building conVruclion, and authorize a representative of the County of Riverside. Department of Building and Safety' to enter uppn the property ,tor4hich I have applied for ;hi ,permit for the purpose of making inspections. J31@fIMTe of Applicant or Agent ;Date I Print Applicant/Agent Name 00017107 .Ib 04/2On X 26853 ESTIMATED PLAN REV F•CE $191.75 (NOTE. Not to be used as property Description ECC Group Ty'pa 3rd Ft PRIMARY DWLG 434 R--3 W©OD 462 TOTAL FEE 9 ' CA CK NC I CO ER 8 COUNTER L.U.T. PERMIT FOR STRUCTURAL PLAN REVIEW TOTAL PERMIT CUST IS $191.75 CONSTRUCTION ESTIMATE (NOTE. Not to be used as property Description ECC Group Ty'pa 3rd Ft PRIMARY DWLG 434 R--3 W©OD 462 SECNDRY AIRCON 101 R-3 R 462 SEC:NDRY M'ISC M M 4000 Est Plan Rev wee based an Total Estimated Vtal'tn of FORM 284208(11.81) INSPECTOR valuation) Rata Valua-tion $27160 $12751 �4 Y2 ,20 $1016 *10100 $40000 ►53767 is t $191.75 x NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECIJR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System l 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. 0. E] 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 (Botts) 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 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 Counlyy.of Riverside 1 Department ollBuilding and Safety q rrr ft �� E080 Lemon SI. 2nd Floor' a 135 N. Alessandro Rd. Run. 203 ,, 880 N. Slate Street _- _ 227 North' D' Street 46.209 Oasis St. Rm. 310,,' 160 N B ay M yfd4erside. CA 92501 Banning, CA 92220 + , Hemel CA 92343 r Perris. CA 92370 Indio. CA 92201 Blythe CA 2-5 Ph:' . r' •� = Ph: 849.7312 r Ph: 658-4464 Ph: 657.3898 _ Ph: -342.8271 Ph: 922.3670 • ' This permit becomes void it work dol commenced within 180 days from date at issuance. OR. i1 work has beer suspended or abandoned for a period of 180 days. ' a,,e ♦ t .. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need tie io LICENSED CONTRACTORS•OECLARATION:. I hereby alfirm that I am licensed under provisions of Chapter 9 ( comment-• -pleled 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 Cale, and my license is in lull force and effect. .permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-' _ r lion Laws. of California.. r . - Date - Applicant • �'�'`` , - NOTICE TO APPLICANT:' It. after makingthis Certificate Of Exemption, you should become subject to the Workers' _ OWNER -BUILDER DECLARATION:' I hereby affirm that Tam exempt from the Contractor's License Law for the, , Compensation provisions of the Labor Code. you must forthwith 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. ' slruct, after, improve, demolish, or repair any structure, prior to its issuance,`also requires the applicant for such, permit to file a signed statement that he is licensed pursuant 10 the provisions of the Contractor's License Law "DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: (Chapter 9 (commencing with SectiorT7000) of Division 3 of the Business and Professions Cade) or that he is•ex- empt therefrom and the basis for the:Alteged.ekemption. Any violation of Section 7031.5 by any applicant fora per -r 01 hereby certify thatno excavation five (5) or more feet in depth into which a person is required to descend. will mit subjects, the applicant to a civil penalty of not more than five hunderd-dollars ($500).): x be made in connection with work authorized by this permit, and that no building structure. scaffolding: lalsework. or demolition or dismantling thereof. will be more than thirty - six (36) lee[ high. (Chap. 3.2. Grp 2, Art 2. Sec 341, ❑ I. as owner of the property, orpuy employees with wages as their sale 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 [D -As owner-buitder, I' will not employ anyone to do work which would require a permit Irom 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 r dustrial. Safety, as noted above. unless such person has a permit to do such work Irom the division. .� through his own employees, provided that such improvements are not intended or offered for sale. II: however, - - - - the building or improvernent is sold within one year of completion, the owner -builder will have the burden of prov- - Q Division of Industrial Safely Permit No. - ing that he did IT rbuild or improve for the purpose of sale.) - '� -CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction ❑I, as owner the properly; am exclusively contracting with licensed' contractors to construct the project (Sec. lending agency for the perfor- mance of the .work for which this permit is issued (Sec.. 3097. Civ. C.). 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who - 3097.. Civ. or improves thereon, and who contracts for such projects with a contractor(si licensed pursuant to the Con- • Lender;s Name tractor's License Law.) ' a Lender's Address. _ Of am exempt under Sec. : BA P.C. (Attach Certificale). Date Owner 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 stale laws and county ordinances relating 16 building construction, and authorize a representative of the County of Riverside. Department of Building and Safety WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent tosell- insure. ora , certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.). to enter upon the property for which l have applied for this permit for the purpose of making inspections. []Certified copy I- hIreby furnished. - - igna[ure S„Date �of Applicant or Agent _ QCertified copy is tiled with the County Building Inspection Department or County Department. `.&,tq.+.„ -,Print ADDlicam/ADent Name ,APPLICANT ANIE(L, FLMII- ., -Z), U E COAST HWY CY)W':�1��f 1""DEEl� MAR 'CA 9262!50000 I - .SAN V1i�A L ST 4,,1 VF�d1A�•�EfREE`S((SII7SPPACE AL1 1i9 f' 11"Y•922530000 rE Al -'t ;CiT y �Y �* +1 ,AC!°�JGl1.i.{,i�t 1JIZIP ,. ,�— - .. 2 530000 ' L0.1 7 abs ub � 2 n"N NVQ wo S. '� 1 ,1"1t,1{-li' SON JACK •.— PHONE p CONTRACTOR -FIRM NAME - LICNC o `ADDRESS CITYICOMMUNITY/STATEIZIP F 7 PHONE.# , GINSSPECT,OR FINAL DATE /LWLWWW MCOACH L9d1D„4ZC, 4 W5 FM GAINSIONOUGM AVt' PLAN p • PLANS EXAMINER APPROVE DATE Sj. ° t'i}'T DWLG/ENLAR DEN/ADD ATT G PAG bro. I " R1°N - U• U 0U1� n{/S OT)' 11aD ZONE ORD p LOT SZ END (f6 0 S1D8 t�PUT/I O/ , , . d OA/2: a06� ,.. 2 6 8„4 5•' r t TOTAL i FEE CA CK NC COUNTER B.I. COUNTER L.U.T. ` + 1� APPLICATION FOR ' STRUCTURAL PLAN. 'REVIEW' T H'I I S A NA P V I: ;I G A T.111 U.N Ck'N'L.Y • ' - ez ` !• w ✓ ,_ t, FORM 284.208111.81) ASSE ' RV. r r +• i ,�rtM `, <\ _ 07,01"11 n7 XU 04!2676 26845 TOTAL . FEE CA JCK • - NC COUNTER B.I. COUNTER L.U.T. , r .. APPLI �:A Y.It N FOR' STRUCTURAL PLAN REVIEW AN A -PF LICAI IUN CiNL.Y MMt COAST MWY MR&WsPEEP MAR CA 926250000 14&87YgEfRESSISPACE SAN VICENTE ST f,1%CO%71t,{A' '�'uAlzllP' GA 922530000'. &1- qi Int A it U W y1 TWN o f V o {/ i! S :v:0pL 0q �°e SB CAT 'TNTAGOLF 01 TfTSLDK7paK PHONE0 CONTRACTOR -FIRM NAME . LICNC N ADDRESS CITYICOMMUNITYISTATEIZIP PHONE # BLDG. INSPECTOR FINAL DATE 40lF4 GAI�lSDORE UGH 6AV,E , ,tie, •:70,0210.000. [[CC. �y y 4'6 ffMl 1{`t\ULALEl.S CA" N EXAMINER A�PyPROVE UPLAN yy e + �»p�{PLAgNS p �p�p qq�}`y ATT 14 Efi�n I�J0.i8/T dJWLG/6i.t LAR DEN/ADD. A 67ARAE; �• GAR e 0.0 ' R�" ' 0x:91 005 0 U5 0` 0 2119D 'ZONEORD# •' 'LOT SZ _ END 00" 07,01"11 n7 XU 04!2676 26845 TOTAL . FEE CA JCK • - NC COUNTER B.I. COUNTER L.U.T. , r .. APPLI �:A Y.It N FOR' STRUCTURAL PLAN REVIEW AN A -PF LICAI IUN CiNL.Y 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 IDA Fireplace T. 0. OFIN 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 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 t f ( STREET NAME '`