00024490 (PAT)County of Riverside
Department of Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street 227 North "0" Street 46209 oasis it. Pin 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 Ph849.7312 Ph. 658-4464 Ph' 657.3898 Ph_ 342.8271 Ph 922.2670
This permit becomes void it work not commenced within 180 days tram date of issuance. OR. it work has beer suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby alfirm that I am licensed under provisions of Chapter 9 ( commenc-
ing with Section 7000) of Division 3 of the Business and Prolessions Code. and my license is in full force and effect.
13
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 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 nor more Than live hunderd dollars (5500).):
❑ I, as owner of the property, 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.)
Of, 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 properly who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to The Con-
traclor's License Law.)
01 am exempt under Sec. . BA P.C. (Attach Certificate).
Dale 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 cerlified copy thereof (Sec. 3800, Lab. C.).
[]Certified copy is hereby furnished.
❑Certified copy is tiled with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F. MI)
LANDMARK LAND GA
ADDRESS
BOX 1000
CITY/CLAO QUA, NTfTEA/21P CA 922530000
AVE CLUB LA QUIN
J4F��SIIdVESSISPACE
tr`ryTY G�OM u.N.wRT, /ZIP CSA 922330000
631
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0167'86 0020
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PHONE N
CONTRACTOR -FIRM NAME
LICNC N
ADDRESS
CITY]COM MUNITY ISTATEIZIP
PHONE X
BLD SPEC R
FINAL DATE
49
L
ARCIENG FIRM NAME
LICNC N
ADDRESS
CITYICOMMUN ITYISTATEIZIP
PLAN N
PLANS EXAMINER
APPROVE DATE
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted if [he permit is for one hundred ($100) or less. 1 cerlily 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 APPLICANT: 11, after makingthis Certificate 01 Exemplion, 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 leet 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 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 from the Division o1 In-
dustrial Salely. as noted above. unless such person has a permit to do such work from The division.
❑ Division of Industrial Safely Permit No. _
CONSTRUCTION LENDING AGENCY: I hereby affirm That [here 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 1 have read this apptication and state
that the information given is correct. I agree to comply with all stale 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 lot this permit for The purpose of making inspections.
X -
Signature of Applicant or Agent ' Date
Print AoDlicant/AOent Name
APPLIPRMT N PS DATE
g002449�4 PTR U9/0�/82
CONSTRUCTION FEE
4 0 418
�►�..► r u
PL/CM & ADJ
$16.15
SMI FEE
$0.10
TOTAL .
FEE
$41.25
CA
Cllr
NC
I COUNTER B.I.
COUNTER L.U.T.
y
STRUCTURAL ( BUILDING )
TOTAL PERMIT COSI' IS $41,25
11FILMnA11661111
CONSTRUCTION ESTIMATE (NOTE! Not to be used asp }property valuation)
Description FCC Group Typa Sq Ft Rate Valuation
PRIMARY PATIO 329 M Vwt� 286 $4,90 +1401
Construction Fee based on Total actual Valuation of ►1401 iss<s $25.00
SMI FEE $0.10
PL/CN & ADJ ♦16.15
s
FORM 284.208(1,-81) !NSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION
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 � q_
39 Appl. Clearance
7
Framing 9
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.
No ADDITIONAL INFORMATION 7� 1
.Z F�0�7/L19 I�S�IdN -'M6111116 Q/V
`y
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall��
13 Finish Grade
INSULATION Thick 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
STREET NAME
APPLICANT,NAME(L, F. MI)
LAN,,µARKt LAND -CU '
ADDRESS
BOX 1000
1.«AcO tuffa AZIP CA 92253000O
JQYIjE
YE. (
R•�yTEySySg7I�SgpPA�CE AVE— CLUB LA OUIN
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CA 92,1 30000
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TRACT NAME
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PHONE qWA(MAN
CONTRACTOR -FIRM NAME
LICNC q
ADDRESS
CITYICOMMUNITYISTATEIZIP '
PHONE#
BLDG. INSPECTOR
FINAL DATE,
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITYICOMMUNITYISTATEIZIP '
PLAN #
PLA1NS EXAMINER -
APPROVE DATE
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APPLICATION . OR STRUCTURAL PERMIT
T I I:3 AN AP P S,» I C:Ai.I0N
maiKilipmoail
0 N L. Y
D
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. C]
43 Final
10A
Fireplace T.O.
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 (Botts)
12C Ceiling (Blown)
14 F1 of
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
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P)
26 Power Pole
27, Conduit
28 Service Entrance
29 Wiring
29A. Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME