00007766 (SPIN)ATC&T IWE (L.�OtFJLD
"WOVU7766
fVE/ 13
008803
Atj,teo AVE V�LA900
C
AM,,9VESS/SPACE
CUONIVOT&IMI . P 9ze$30000
W
B17
P16
P"fi,0.
C
TWN
SEO
S
TPOC6 0 id
0�
LOOOO
SB
T
R#UmEa 3- Scv LAQ tio
OIQERCMFAL, F. MI) UJUILDER S
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE # I
J'LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC N
SIP EE C I At,
INSPITN Pee
CIO :pig
GAS TEST
BID
FSB
u
n
pco
of
1"spfcTION ockmil,
ZONE ORD #
LOT SZ
TOTAL .7
FEE -
INSPECTOR'S COPY
008803
I
N S P 0, t';
T 1 0 N. P E. 9. 14
1 T
TOTAL _Pl :g"Xf POST AS
FORM 284-208 (2/81)
NO.
OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE
1,4SPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Figs 8 Frms
34 Plenums 8 Ducts
2A
Slab Grade
35 Furnace Comport.
3
Steel
36 Inlets B 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.
°o�ADDITIONAL I FOR ATI N
11 Exterior Lath
12 Internal Loth
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_-
rtnhut AYryuRIIUn
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 "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: 849-7312 Ph: 6564464 Ph: 657-3898 Ph: 342-8271 Ph: 922.2670
This permit becomes void if work not commenced within 180 days from date of issuance, OR. it work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
witht Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
Lict9se Class Lic. Number
Date _-- Contractor
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 construct, alter,
improve, demolish, or repair any structure, prior to its issuance. also requires the applicant lot such permit to life 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 exempt therefrom and the basis for
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than live hundred dollars (5500).):
n 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 properly 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 proving 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 7044,
us,ness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.).
C] I am exempt under Sec. . B. d P.C. (Attach Certificate)
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No.
Certified copy is hereby furnished.
Certified copy is tiled with'the County Building Inspection Department or County Departr ry�t,oft
Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
permit is for one hundred ($700) or less. I certify 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' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: IL after making this 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: -
I 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, scaffolding, falsework, 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.)
RaAs owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial
ety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I ierM affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name -
Lender's Address
I certify that I have read this application and state that the above inlormation is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
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 can.
sbuction, and authorize a representalive.ALthe County of Riverside, Department of Building and Safety to enter upon
IQ property for which) have applied for this permit for the purpose of makingJpspections.
\/ Signature of Applicant or.Agern`� �� Oates
Print ApplicanllA3ent Name'
I
APPLICANT NAME ((!..FMI),
'SHOE AVe tj9t.'As(:o
ESS/SPACE
AW VELASCO
Bj? Pj' PRd 0
C
T N
01#0
SE
ID
s
T14%
Mwl
SB
TR&T KMEet C 41
O'QER.jrMW, F, MI)
tul
-CONTRACTOR-FIRM NAME
'ADDRESS
Cin'!COMMUNITY/STATE/ZIP
-PHONE #
LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COM MUNITY/STATE/ZIP
PHONE H
LICNC 0
UWVTT;lm$l_p:" 6
Bl�y
TOTAL
FEE
1 *1
FSB
1610
'610
PdB
ZONE ORD 0
LOT'SZ
END
y.
It
FORM �28 4.208 1. (2/8 1 1)
APPUPAMT
A 0.0 7' 6.
DATE . '
00880.2
r.
I N it p it. el Idw,
TOTAL
FEE
w4arct- I VK a t_vr T
0088021
A OL
PEC
I
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 Compost.
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 Detectior Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
'
ADDITIONAL INFORMATION
------
,
SEWAGE SYSTEM SIZE 8t LOCATION
11 Exterior Loth
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 Plumba
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tcnk 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
430 Fixtures
31 Service y -
X32 Final
STREET NAME