00020828 (SPIN)LICANT
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PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITY ICOM MUN ITY (STAT EIZI P
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
6
LICNC #
f ADDRESS
I, CITYICOMMUNITYISTATEIZIP
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PLAN #
PLANS EXAMINER
APPROVE DATE
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284.208 (11.81) INSPECTOR
APP41CATION. FOR' REINSPEC'T ION
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. 0.
FI
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 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
' Count of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North •'D" Street 46.209 Oasis St. Rm. 310 160 N. BtoaCvay
Riverside, CA 92501 Oanning. CA 92220 Hemel. 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
This permit becomes void it work not commenced within 180 days from date at issuance. OR. it work has beer suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc-
ing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in lull force and effect.
i ❑
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
struct. alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such
permit to lite 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-
empi 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 (55001.):
❑ I, as owner 01 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 at 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 at prov-
ing that he did not build or improve for The purpose of sale.)
` qI, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
44. 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 lot such projects with a contractor(s) licensed pursuant to the Con-
n tractor's License Law.)
.;L 01 am exempt under Sec. B.8 P.C. (Attach Certificate).
it%Date Owner
,t,_
WORKERS' COMPENSATION DECLARATION: I hereby alfirm that I have a certificate of consent to sell -insure, or a
1. certificate at Workers' Compensation Insurance. or a certified copy Thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
i ❑Certified copy is filed with the County Building Inspection Department or County Department.
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PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP /70 r C�•l/�jo AJ
PHONE 0 INAL D
ARC/ENG FIRM NAME LICNC 0
ADDRESS
CITYICOMMUN ITYISTATE/ZI P
Ifp-
PLANS EXAMINER
APPROVE DATE
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LOT SZ
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted it The permit is lot one hundred ($100) or less. I certify 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-
tion Laws of California.
Date Applicant
NOTICE TO APPLICAN 1: If, 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
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certify that no excavation live (5) or more feet 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. scalfolding, lalsework.
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.).
❑As owner -builder. I will not employ anyone to do work which would require a permit Irom the Division of In-
dustrial Safety. as noted above. unless such person has a permit to do such work Irom the division.
❑Division of Industrial Safety Permit No.
CONSTRUCTION LENDING AGENCY: I hereby alfirm 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's Address
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 construction, 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.
"iSignalure of Applicant of Agent Date
Print Applicant/Agent Name
QITOP _te 9213 P06/29V02 VO2
3534 4
1
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TOTAL
!^1 FEE
CAX
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COU__NTERB .I. `` /
COUNTER L.U.T.
REINsE-tT I0tV
To'fAL PERMIT COST IS
t, .
L,FORM284.208(41.81) INSPECTOR -
V^
P E R M I T
$15.00
A
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
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
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. E]
43
Final
10A
Fireplace T.O. Ej
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
r
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