00017251 (RPL)'PERMIT APPLICATION
County of Riverside
Department of Building and Safety
4080 Lemon Si 2nd Floor 135 N. Alessandro Rd. Rm 203 880 N. State Street 227 North "D" street 46.209 basis 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. 787-6146 Ph 849.7312 Ph 658.4464 Ph 657.3898 Ph 342.8271 Ph 922.2670
This permit becomes Vold If work net commenced within 180 days from date of Issuance. OR. If work has beef' 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- pleted it the permil is for one hundred ($100) or less. I certify that in the performance of the work for which this
j ing with Sect on 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. Permit is
w issued. I shall not employ any person in any manner so as to become subject to the Workers' Campensa-
lion Laws of California.
El
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
slrucl, 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 to the provisions of the Contractor's License Law
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
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 live hunderd dollars ($500).):
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
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
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-
ing that he did not build or improve for the purpose of sale.)
01, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec.
r -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 contracts for such projects with a contractor(s) licensed pursuant to the Con-
tractor's License Law.)
❑I am exempt under Sec. _--- —_ .- _ B 8 P.C. (Attach Certificate).
Dote -- --------Owner---— - -----
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
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.
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CONTRACTOR --FIRM NAME
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PHONE N 8 SPECTOR FIN L
ARCIENG FIRM NAMELI NC N
ADDRESS 01
CITY/COM MUNITY/STATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
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Date -- -- - ----- - - - - - --- -.Applicant - - - - - - - - -- -- —
NOTICE TO APPLICANT. If, after makmgthis 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
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certify that no excavation live (5) or more feel in depth into which a person is required to descend, will
be made in connection with work authorized by this permit, and that no building structure. scaffolding, falsework.
or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
Title 8. C A.C.).
0 A owner -builder. I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Safety. as noted above, unless such person has a permit to do such work from the division.
❑ Division of Industrial Safety Permit No
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor-
mance of the work for which this permit is issued (Sec. 3097. Civ. C.).
Lender's Name -- - — -- -- -- - - - - - - -- - -- -- — -
Lender'aAddres5
CERTIFICTE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have reatl This application and state
that the i Or ation given is correct. 1 agree to comply with all slate Taws and county ordinances relating to
building c Ilion, and authorize represents a of the County of Riversitle. Department of Building and Safely
to enter u e proper �for,.w�hi Ithavey a(ip d/forthis permit for the purpose of along inspectionns.s
Xl 1 ✓V�/; ll- 'Y"^ �'`...... �� 113 L.+^
Signature of Applicant or Agent Date
Print Applicant/Agent Name
VPVFdlT�GJ1 k- _10412t78?
CONSTRUCTION FEE
26902
su.
PLUMBING FEE
$10.00
ELECTRICAL FEE
$21.00
PERMIT
COST
ADD POOL EQUIP, FEE
$9.00
Valuation of
$0 ist $0.00
SMI FEE
$0.00
TOTAL
_5 / S FEE
$40.0 d
CA
CKX
NC
C R B
r<
COUNTER L.U.T.
5 T
R U C
T U R
A L
( BUILDING ) P E R M I T
TOTAL
PERMIT
COST
IS
*40.00
CONSTRUCTION ESTIMATE
ascription
(NOTE: Not to be
FCC Group
used as property
Type Sq Ft
valuation)
Rate Valuation
PRIMARY MISC
M
M 0
$10.00 $0
Construction Fee based
on Total Actual
Valuation of
$0 ist $0.00
ELECTRICAL FEE COMPUTATIONS * Permit Fee of applicable) FEE:
No of Unitss 40 Service Volts$ 0 FEE,
Service Amps -It 100 Service Amps --2s 0 Service Amps -`3: U rF_"E:
PLYMBING FEE COMPUTATION * Permit Fee cif applicable) FfEt
nstallation of Water Piping and/or Wate reatmient Equiptl F :E:
Lawn Sprinkler System, Including Backflow Device: 1 FETE:
SMI FEE
ADD POOL EQUIP, FEE
FORM 284.208111.81) INSPECTOR
$3. off
$13.00
*S.OU
4,00
*21000
$3.50
$0. 01111
49.0"
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATEINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
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
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. ❑
OP'N
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 BondingAj
30 Fixtures'
31 Service
32 Final
STREET NAME
-APPLICANTNAME (L�, yF, Mll) P
ADDRESS •�
.5, 0040 CiALLE OAXACA
CITYICOM MUN ITYISTATEIZI P
LA QUINITA CA 22ssQ000
JOB SITE ADDRESSISPACE
U 040 CALL E OAXAC A
CITYICOMMUNITYISTATEIZIP '
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,QWNER NAME
T'IO DEN(I. ' COR
PHONEq
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP
PHONE#- .BLDG.
INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN #PLANS
EXAMINER
APPROVE DATE
USE OF PERMIT
,1_00 AMP SER LIC :)/lk'RXC /P00L EQUl
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NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33.
Ventilation System
2
Ftgs 8 Frms
34
Plenums 6 Ducts S
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
IDA
Fireplace T.O. C]
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 Pllifib ='
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