00025583 (RR)— rt"mil AYYLILAIIUR
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 46209 Oasis St. 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
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has been sus
4" 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 full force and effect.
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 not more than live hunderd dollars ($500).):
❑ Las owner of 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 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-
j;
Ing that he did not build or improve for the purpose of sale.)
01. as owner of the properly, 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 contractors) licensed pursuant to the Con-
tractor's License Law.)
❑1 am exempt under Sec. . BA P.C. (Attach Cerblicate).
Date Owner
iWORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
..,:cerlificale of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
V';
❑Certified copy is hereby furnished.
❑Certified copy is filed with the County Building Inspection Department or County Department.
APPLICANT NAME (L, F, MI)
ON MARYXANF,
ADDRESS
2 • M E 4
5
CITYICOMMUNITYISTATE/ZIP
JOB SITE ADDRESSISPACE
F1• 12A/1 AVE VELASCO
CITY/COMMUNITY/STATE/ZIP
922530000
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FEE
TRACT NAME
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OWNER NAME (L, F,MI) AS
PHONE p
R'T99'1'= NAME
LICNC M
ADDRESS
CITYICO M M U N ITYISTATEIZI P
PHONE p
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC p
ADDRESS
CITYICOMMUNITYISTATEIZIP
PLAN p
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
BL ZON FSB SSB 1SSB "RSB . OFC
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END
SIDE
Ph: 657.3898 Ph: 342.8271 Ph: 922.2670
pended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted it the permit is for one hundred ($100) or less. I certify that in the performance of the work lot 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: If, after makingthis 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. scaffolding. falsework,
or demolition or dismantling (hereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341.
Title 8. C.A.C.).
El As owner -builder, I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Salety. as noted above, unless such person has a permit to do such work from 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 lot 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 slate
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.
X
Signature of Applicant or Agent Date
Print 8policanVAggnLNamk_,,;,,,,,,__ _
111002
11 0 RMT5 y PS g DATE 147755
TOTAL .
FEE
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COUNTER B.I.
COUNTER L.U.T.
47755
'y APPLICATION FOR �'rRuc;�rul�Al� PERMIT
THIS Iia AN
Nature of SiTus3 Comment -
LEGAL. NOTICE: ISSUED FOR
I FORM 284.208 (11.81) INSPECTOR
A P P L I C A T I O N O N L Y
.,....... — Action Taken ----------- Casae Use No ..� _.
REPAIR CARPORT/REROOF/AWN
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 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. E]
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 F1nal
_ _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
P/L
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