00023957 (SPIN)PERMIT APPLICATION
Count yv of Riverside
Department o1 Building and Safety
4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street r�
Riverside. CA 92501 Banning, CA 92220 - Hemet. CA 92343
Y4 '< Ph: 787.6146 Ph: 849-7312 Ph: 658-4464
k.
This permit Oecomes void it work not commenced within 180 days from date of issuance. OR. it work has beer sus
:.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc-
lh, with Section 7000) of Division 3 o1 the Business and Professions Code, and my license is in full force and effect.
OWNER -BUILDER, DECLARATION: I hereby affirm that I am exempt from the Contractor's license Law for the
lollowing 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 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 -
k% empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
;g`mil subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).):
-❑
I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
'1_ ucture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
d -- Law does not apply to an owner of property who builds or improves thereon, and who does such work himsell or
;.I ,through his own employees. provided that such improvements are not intended or offered for sale. H. However.
1 the building or improvement Is sold within one year of completion, the owner -builder will have the burden of prov-
�t ing that he did not build or improve for the purpose of safe.)
lljs� ❑I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, -Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
ibuilds or improves thereon, and who contracts for such projects with a contraclor(s) licensed pursuant to the Can-
lra'ctor's License Law.)
rr,01 am exempt under Sec. . B.& P.C. (Attach Cerlilicale).
1 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. C.).
- ❑Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County Department
'_ R', TT'U e1ONAL, SAVINGS & LOAN
QRESS
:ye' —055 EISENHOWER UR
.�°°ry1,y1�1iJIfY,I�T T�YE;IZIP CA 922530000
�(jB�jT 20411ESSISPACE CAE.LE NOGAt Edye
//T �w. L9 (2
CllOryl�tlUJjJ11 �T�(�7�T IZIP
C4A/4lU
�y �g �}nn
LWM30000
./, 3.1'sjb�41
—2
M i2)
0
TWN
47
UNdo
Vo
S
TCoo() �'�t'�i2
w 1
SB
Ash
-/14gL
CEV����AII
Qp plQe.1��UF��A��ry4�115, /�tBI—K
r �y
V0A.ri }EV l.i 1 I47f7AL{ SPYVdr�4��iT
�M [� (� �t
PQI°NT...OAN
CONTRA TOR -FIRM NAME
LICNC p
ADDi ESS
CITYICOMMUNITYISTATE/ZIP
PHONE p
BLDG. CTO
FINAL DATE
ARCIENG FIRM NAME
v .
LICNC p
ADORE SS
CITYICOMMUNITYISTATEIZI P
PI -M&
PLANS EXAMINER
APPROVE DATE
IAL INSPECTION -FIRE DAMAGE
D 0
R iN
FSB
I out) JOUb
JOUb
I I
AAI}
ZONEORDN
LOT SZ
END
00 y o
.4
227 North "D" Street 46209 Oasis St. Rm. 310 160 N. Broadway
Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
' Ph: 657-3898 Ph: 342.8271 Ph: 9222670
pended or abandoned for a period of 180 days.
.� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com••
pleled it the permit is for One hundred ($100) Or less. I certify [hal in the performance of the work for which this
permit is issued. I shall not employ any person in any manner so as t0 become subject to the Workers' Compensa-,
lion Laws of California.
Date - Applicant
NOTICE TO APPLICANT: If, alter making [his 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 five (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. scallolding, lalsework.'
Or demolition Or dismantling thereol. will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341.
Title 8. C.A.C.).
E) As owner -builder. 1 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 10 do such work Irom 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'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 Salely
to enter upon the property for which I have applied for this permit for the purpose of making inspections.
1
u
Signalure of At icaril br"Ageht Date
Print Applicant/Agent Name
fJPPC ORCI 75 P Q
40214
O TC , r17,155+ c 2 am . -T i
—2
/ ril v L
lL
_
• '3
�l
SPECIAL INSP ` TN FEE
$30.00
TOTAL
FEE
$30.00
CA
CIS
/�
NC COUNTER B.I.
r
COUNTER L.U.T.
r
S P E C I A L I N S P E C T 1; O N P E~ R N
TOTAL PERMIT COST IS $30.00
S,,
:P".
INSPECTOR
FORM 284.208 (11-81) � .' 1
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS —'
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34 Plenums 8 Ducts
2A
Slob Grade
35 Furnace Comport.
3
Steel
36 Inlets 8 Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
43 Final
10A
Fireplace T. 0.
NO
ADDITIONAL INFORMATION
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
,20 Sewer
21 Water Heater
6`2 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
P)
Power Pole
V27
`27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
APPLICANT NAME )L, F, MI)
,CONSTITUTIONAL), 3AVIN09 LOAN
' W—Es 55 r-ISENNOWER 'DFS
(' CO LiH ,{Izip CA 928530000
QpRESSISPACE
k�f" �V LLE A+OGALES
k f"! M't
UACO i TWIP CA 922530000
V
n4.
91"a
s0
TWN
uAtl.0•
eol
S
r cif �l A 0 0 Vb
1 c"',
I
I WIT 1
SB
yy �N �`� ,q, �q ,p, '(y / V sly
ia�3LrVA b.Y' Q 0155 BL.K-1 41 .
fi �g9 jpy�� Ap {�_I�p�rp y���q/ !, �} 6 p�q�!
1E�L L.V� 1 '�1.-TONAL, SAVINGS PjWNlU Ajq
CONTRACTOR. FIRM -NAME
LICNC N
ADDRESS
CITY/COM MUN ITYISTATEIZIP
PHONE#
BLDG. INSPECTOR
FINAL DATE ,
' ARC/ENG FIRM NAME
LICNC N
ADDRESS -> ,
CITYICOMMUNITYISTATEIZIP
' PLAN N
PLANSEXAMINER
APPROVE DATE
/:. Ui'hL, INSPECTION-FIRE
INSPECTZON--ZRE DAMAGE
�TN
FSB
gi
„$l
0®Y9.0
Fq $q
-
�• ZONE ORD N
LOT SZ
END
U'0
�AyPtPLI((PaaRMTg�krr
(P'S�
t',1 r} DATk
4 0 210
d
TOTAL :
FEE
CA
CK
NC.
COUNTER. B.I.
COUNTER L.U.T.
AF'PL.IC.A`i'IW FOR 'SPEClAL INSPECTION
i•H..I a I S ' A',N A.PPL.I.CAT'x ON 0 N L Y
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
17 DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 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. 0
43
Final
10A
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
P/L 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