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00024484 (PAT)PERMIT APPLICATION it County of Riverside Department of Building and Safety -v 4080 Lemon SI. 2nd Floor 135 N. Alessandro Rd Rm. 203 880 N. Stale Street 227 North "D" Street 46.209 Oasis SL 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: 8497312 Ph. 6584464 Ph. 657-3898 Ph: 342.8271 Ph 922.2670 This permit becomes veto it work not commenced within 180 days from dale of issuance. OR. it work has beer suspended or abandoned for a period of 180 days CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. This section need not be corn - LICENSED ys LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 ( comment- it the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this S ing with Section 7000) of Division 3 of the Business, and Professions Code, and my license is in lull force and effect. 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. ❑ - Dale __-__ _Applicant > NOTICE TO APPLICANT: If. alter making this Certificate of 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 forthwith comply with such provisions or this permit shall be .4 following reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to con- deemed revoked. -,; siruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such ADDRESS to file a signed statement That he is licensed pursuant to the provisions of the Contractor's License Law DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: tj4permil . .(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or That he is ex- 01 hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend. will 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).): be made in connection with work authorized by this permit, and that no building structure. scaffolding, lalsework, ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do The work, and the or demolition or dismantling thereof. will be more than ihirly-six (36) feet high. (Chap. 3.2, Grp 2. Art 2. Sec 341, Title B. C.A.C.). structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractor's License ❑ As owner -builder. I will not employ anyone to do work 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 himself or duslrial Safely. as noted above. unless such person has a permit to do such work from the division. through his own employees, provided that such improvements are not intended or offered for sale. If, however. FSB 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. ,z-ing that he did not build or improve for the purpose of sale.) ❑I, as owner the contracting with licensed to construct the CONSTRUCTION LENDING AGENCY: I hereby affirm That there is a construction lending agency lot the perfor- of properly, am exclusively contractors project (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who mance 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.) Lender's Address ❑) am exempt under Sec. . B & P.C. (Attach Certificate). WORKERS' COMPENSATION DECLARATION: I hereby affirm Ihot 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. ❑Ceniffed copy is tiled with the County Building Inspection Department or County Department. ■ r 'APPLICANT NAME (L, F, Ml) r Tl AAK y LAND GO Allrl'T,��5 1QTyO 0% q ry xj 5/cOk�A�1(J�`(l� 1 T ZIP �•p 7 >�r453 0 Q 0 Q 922530000 4IIE�RESSISPACE AVE CLUB LA QUIN 0T(JC��O}}XTUMAZIP CA 922530000 6 1 S�0 6112 PL/CH& ADJ TWN uNdQ VE0 S T6AJT67$b `��! 6 �� 1 58 TRACT NAME �W"Nrifll AR LAND CO !J PHONEN CONTRACTOR -FIRM NAME LICNC N ADDRESS CITYICOM MUN ITYISTATEIZIP PHONEX E1Log.JNSPtCTOR FINAL DATE ARCIENG FIRM NAME LICNC N ADDRESS AL CITYICOM M UNITYISTATEIZI P PLAN X PLANS EXAMINER APPROVE DATE VEI>:iFf 1UT COVER to RTN FSB 1 0�� QfflV 0` b rAD ZONE ORDN LOT SZ END 0 0 u b CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify I have read this application 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 properly for which I have applied for this permit lot the purpose of making inspections. X C+" Signature of Applicant or Agent Date Print Applicant/Agent Name a0 a4a�. � .� ;162 1140405 CONSTRUCTION FEE *14.55 PL/CH& ADJ $9.37 SMI FEE $0.05 TOTAL FEE s2.3 CA I CK/ NC COUNTER B.I. COUNTER L.U.T. n STRUCTURAL ( BUILDING ) TOTAL PERMIT COST IS $23.92 y.CONSTRUCTION ESTIMATE: (NOTEt Not to be used as property Description FC Group Typa SR1Ft S0 PRIMARY PAT -10 329 M V -N Construction Fee based on Total Actual Valuation of SMI FEE +L/CH& ADJ ■. FORM 284-208 (11.81) INSPECTOR P E R M I T I 4U4 valuation) Rate $4.90 Valua#935 $735 ist $14.50 a so.Q3 III. 3'7 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 Slab Grade 35 Furnace Comport. 3 Steel 36 Inlets 8 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor O6 Roof Deck !-9� 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 ma�y, f2LL ADDITIONAL INFORMATION rpOTJR/9 /may 6/V ".�C �,��C' 1?00;=IA.)� SEWAGE SYSTEM SIZE & LOCATION 11 Exterior LathIV 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R" Value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 -Final /-9 -19>Z Wag 6 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 P/L P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME APPI-IdANT'NAUE LANDMAAK"..""' LAND CO I o 8 o ifolMNYT101, CA 922530000 W94Y.IRESSIS I PACE AVE CLUB LA QUIN t7goViTRYTAZIP CA 922530000* TWN 6,6 60 s TOAF67(36 -1016 1 SB TRACT NAME LAND CO PHONE# CONTRACTOR-FIRM NAME LICNC # 'ADDRESS CITYICOMMUN"/STATE/ZIP PHONg# SLOG. INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNG # ADDRESS. CITYICOMMUNITYISTATE/ZIP PLAN # EXAMINER APPROVE DATE 'VE CoVFR 860 ZfN R FSB loffl) JOV10 loaEb I I rfdd ZONEORD# LOTSZ END I o ovb FORM 284.208(11.81) INSPECTOR APPL'L JAB 109/0SA2 0 TOTAL FEE CA ?K INC I COUNTER B.I. I COUNTER L.U.T. 1 4 U 4 APPLICATION FORZTRUCTURAL PE I s AN A P P L. I CHAT 1 0 N ONLY 403111 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 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.O. 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 ' 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