00017390 (BLCK)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 Oas a St. Rm. 310 160 N. Broadway .
Riverside, CA 92501 Banning, CA 92220 Hemet. CA 92343
Perris. CA 92370 Indio. CA 9301 Blythe. CA 92225
. a Ph: 787.6146 Ph: 8494312 Ph: 6584464
Ph: 657.3898 Ph: 342-8Z11 Ph: 9222670
-y This permit becomes void it work not commenced within 180 days from date of issuance. OR. it work has beer suspended or abandoned for a PerleO of 180 days. ,
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMF_NSATION INSURANCE: This section need not be Com -1
LICENSED CONTRACTORS DECLARATION: I hereby affirm Thal I am licensed under provisions of Chapter 9 (comment-
pleted 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 Code, and my license is in lull force and effect.
�.E
permit is issued. I shall not employ any person in any m. nner so as to become subject to the Workers' Compensa-
tion Laws of California.
Date ALplicant
-
ARCIENG FIRM NAME
NOTICE TO APPLICANT: If, alter makingthis Certificate if 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
Compensation provisions of The Labor Code. you must loAhwilh comply with such provisions or this permit shall be
' lollowing 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
i 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 CERTIFICA-ION:
(Chapte '9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
❑I hereby certify that depth into which person is required to descend. will
excavation five (5) or more feet inand
I empt therefrom and the basis for the alleged exemption. Any violation of Seclion 7031.5 by any applicant for a per-
with n
made in connection with work ed by this pear t. and that building structure. scaffolding.
Til subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).):
2. Art . Sec 41. ,
� or demolition or dismantling thereof, will be more than Ihi,ty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341, .
or of, will feet
C] - I, as owner Of the property. Or my employees with wages as (heir sole Compensation; will do the work, and the
Title 8. C.A.C.). '
1- structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
0 A Owner - builder, I will not employ anyone to do wort which would require a permit from the Division of In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himsell or
dusl6al Safety. as noted above. unless such person ha: a permit to do such work from the division.
through his own employees, provided that such improvements are not intended or ollered for sale. If. however,
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.
1 ing that he did not build or improve for the purpose of sale.)
❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm tha there is a construction lending agency for the perfor-
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
mance1 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.)
z
Lender's Address
�- 01 am exempt under Sec. . B.B P.C. (Attach Certificate).
- — -
CERTIFICAT OF COMPLIANCE AND AUTHORIZATION OF ENTRY' I t'I I h tl th' I' I' d t I
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ma
certificate of Workers' Compensation Insurance, or a cerlified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County Department.
(L, F, MI)
ADDRESS
1@ (367 HAY ST
CITYICOMMUNITYISTATEIZIP
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BLDG. INSPECTOR
FINAL DATE -
ARCIENG FIRM NAME
ADDRESS
I PLAN N
PLANS
DATE
WOOD FENCE 1-0 DWL0
BILOON00 Rz-� FSB !S� o CISJSB_ 0113 O C,�
ZONE ORD# LOT SZ u ENDn SIID
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^ T.vrAt PERMIT.',COST
1.6X50 WOOD FENCE TO D
FORM 284208(11.81) INSPECTOR
cer I y ave rea s app fca Ion an s a e
That the inform tion given is correct. I agree to complg with all state laws and county ordinances relating to
building consirdclion, and authorize a representative of th. Courtly of Riverside. Department of Building and Safety,
to enter upoh the p'roperty.lorewhich I have applied for li:is permit for the purpose of making inseectlons.
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Signature of Applicant or Agent Date
1 269
6X50 WOOD FENCE 1*0 D
$1 0.00
$10.00
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 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.
P'
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