00016727 (SFD)APPLICANT NAME (L, F, MI) - - �, .•
ADDRESS
44505 :SAN CA6iLOS .•: � v. '
CITY /COM M U N I TYISTATEIZI P
PAL3i3 -DESERT t4 M6000.00
JOB SITE ADDRESS/SPACE - 1 ^ -
B4485 AVE MARTINEZ
CITYICOMMUNITY/STATE/ZIP
LA- Oi.1INTA CA 09;253000
BOK
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Mr.
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TRACT LOT
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012
TRACT NAME -
RQV LAQ 627 BL.K-300•.LOTS AI 12
OWNER NAME (L,F,Mp
PHONE #
MR MRS
.LRIZ,
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITY/CO M M U N ITYISTATE/Z I P
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME -
LICNC #
ADDRESS '
CITY/COMMUNITY/STATE/ZIP -
PLAN #
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT ,
wat m A. r
^FSB
BL
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END,
SIDE
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0000
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
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 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. 0.
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)
128 Ceiling (Botts)
QC Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer'..::.` 4',.
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
92 Final
STREET NAME
E (
NAML, F, MMI))
�A{P,PPLIIC`AyN�Tp
CONS(y t I O
ADDRESS
4.415-05 SAN CARL OS
CITYICOMMUNITY/STATEIZIP
PALM DESERT CA 922600000
JOB SITE ADDRESSISPACE
54485 AVE MARTINEZ
CITYIICOMMUNIITY/S"rATTEIZIP '
LAt rtjdVCA CA 092253000 9 253000
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0,00000 OUAA
ilii
TRACT NAME
SCV LAU, 62'7 IBLK--3U D , L.uTs 11 & A :
j OWNER NAME (L,F,MI)
PHONE p
CR TZ, fiR & MRS
tCONTRACTOR -FIRM NAME
LICNC p
ADDRESS •»
M
CITY/COMMUNITYISTATEIZIP
PHONE# ';:
BLDG. INSPECTOR
FINAL DATE .
ARC/ENG FIRM NAME
LICNC p
ADDRESS
CITY/COM MUNITYISTATEIZIP
PLAN p
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
DWLG & ATT GARAGE
BL ZON
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000
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SIDE
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APPLp
��00016727Ps6
PS
DATE 0
7
TOTAL.T
FEE
CA -
CK
NC
COUNTER B.I.
COUNTER L.U.T. '
1, 670V
APPL ICAT.t,AN FOR STRUCTURAL PLAN REVItW
,H 1 S.., -- x. a A N A P P L. I C A T 1.0 N ®N L. Y
Yvu must 'i;eo the'fal;tawing Depar invents (if listed) for.concurrence 'BEFORE,
'a Permit can be issued c
Dena r ip t i on pep t t a See
HQLD,;� HEALTH
HOLD- ROAD -
.f .
INSPECTOR
FORM zed.zoe (n.el)
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 Defection 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 Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceilft,(Satts)
12C Ceiling (Blown)
14 1 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
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
PERMIT APPLICATION
County of Riverside
Department of Building and Salely
4080 Lemon St. 2nd Floor '' 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North "0" Street 46.209 Oasis SI. Rim. 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: 6584464 Ph: 657-.1898 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 beer suspended or abandoned Ior a period of 180 days.
❑
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter (commenc-
ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and ellect.
El
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 penally 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
structure is not intended or otlered 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 awn employees. provided that such improvements are not intended or offered for sale. 11, however,
the building or improvement is sold within one year of completion, the owner-builde( will have the burden of prov-
ing that he did not build or improve for the purpose of sale.)
❑I, 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 contractor(s) licensed pursuant to the Con.
tractor's License Law.)
❑1 am exempt under Sec. . B.& P.C. (Attach Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to sell -insure, or a
cerlificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby lurnished.
❑Certified copy is filed with the County Building Inspection Department or County Department.
APPLICANT NAME (I., F, MI)
MANDIC CONSTRUCTION
ADDRESS
44505 SAN CARLOS
CITY/COMMUNITY/STATE/ZIP
PALM DESERT CA 922600000
JOB SITE ADDRESS/SPACE
54485 AVE MARTINEZ
CITY/LAC0.4 UI21P CA 0922Z3000
BOK
774
PAG
A'53B
C
TWN
0061006
RNG
SE
1:3
S
0
TRACT
oc��111od011
NT
MOD
011
SB
CA
TRACT NAME
SCV LAQ #27 BLL --•;30 0 , L0TS 11 a 1
OWNER NAME (L,F,MI)
CRIZ, Mit h MACS
PHONE #
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARC/ENG FIRM NAME
LICNC If
ADDRESS
CITY/COMMUNITYISTATE/ZI P
PLAN If
P,v 7VS INER
APPROVE DATE ^j
USE OF PERMIT
DWLG 6 ATT GARAGE
BL ZON
00 R1
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SSB
0110
SSB
000
RSB
000
OFC
IND
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LOT SZ
END
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OV�{?
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted if thy permit is for one hundred ($100) 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' 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 five (5) or more leel 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.).
0 A owner -builder, I will not employ anyone to do work which would require a permit from the Division of In-
dustrial Safety. 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 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 slate
that the information given is correct. I agree to comply with all state laws and county ordinances relating to
building construction, and auth rite a represent five of the County of Riverside, Department of Building and Safety
to enter upon the property or hich I have p�plied for this permit for the purpose of mak' g inspections.
10
X �'. A Air-�`�--/�,�
Sif a re of Applicant or gent" 7 , —Date , 7
Print Applicant/Agent Name
APPLIPRMT pPs DATE 1") A /'�
00016727 i:b 04l20lO2 f/ I GJ
ESTIMATED PLAN REV FEE �YA93,`'0
TOTAL
FEE '
$193. 0
CA
CX
NC
COUNTER B.I/.!f
COUNTER L.U.T.
PERMIT FOR STRUCTURAL PLAN REVIEW
TOTAL PERMIT COST IS $193,70
CONSTRUCTION ESTIMATE (NOTE: Not to be used as property
Description FCC Group Ty a! Sq Ft
PRIMARY DWLG 101 R_`3 V_ 1704
SEGN"DRY AIRCON 900 R-3 R 1704
SECNDRY PATIO 101 M V_N 833
Eat Plan Ray Fare based an Total. Estimated Valltn of
FORM 284.208(1181) HNSPEC VR
valuation)
Rater Vail,uaiion
$27,60 $47030
$2.20 $3748
$54859 lst 4$8193.'70
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE F INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System, -
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Corepressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smo.<e Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T.O. 0
OWN
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 • Finish Grade
INSULATION
r -R-
Thick Value
7A Walls (Batts)
12B Ceiling'($otls)
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
ELECTRICAL APPROVALS
PSL
P/
26 Power Pole
27 'Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
'29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME