00018957 (SFD)APPLICANT NAME (L, F, MI) ,
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; QB I DRESSISPACE AQF- MARTINEZ,
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CONTRACTOR -FIRM NAME
LICNC #
ADDRESS '
CITYICOM M U N ITYISTATEIZI P
PHONE#BLDG.
INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC q
ADDRESS
CITYICOMMUNIT.YISTATEIZIP
PLAN #
PLANS EXAMINER
- APPROVE DATE
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TOTAL :
FEE
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COUNTER B.I.
-
COUNTER L.U.T. '
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. 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 (Botts)
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 Hedter
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 Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North "0" Street 46209 Oasis SI. 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: 658-4464 - Ph: 657.3898 Ph: 3428271 Ph: 922.2670
This permit becomes void it work not commenced within 180 days Irom date 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 com-
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comment- pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this
' ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect, permit issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa-,
tion Laws of California.
OWNER,BUILDERDECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
slruct, 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 dx-
empl 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 live hunderd dollars ($500).):
❑ I, as 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-
f ing 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, Business 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 Con-
tractor's License Law.)
h
Of am exempt under Sec. B.8 P.C. (Attach Certificate).
Date 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 certified copy thereof (Sec. 3800. Lab. C.).
;. ❑Certified copy is hereby furnished. ,
❑Certified copy is tiled with the County Building Inspection Department or County Department.
Date _ Applicant
NOTICE TO APPLICANT: If, alter 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 cerlily (hat 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 Ihirly-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 d0 work which would require a permit Irom the Division of In-
duslrial 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 allirm 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 1 have read this application and state
that the information given is correct. I agree to comply with all slate laws and county ordinances relating to
building cons(ruclion6•and authorize a representative of the County of Riverside, Department of Building and Salety
to enter upge-the prop ttDfor vlhich I have pplied for this permit for the pur ose of making Pspections.
Signal 0le of Applicant or Agent Date
I
Print Applicant /.Agent Name
oAR 1 N ,NAM1z MMRS
'PSwisaIT8957 05/ ► K!!« 2 035 3r
Z34V85 Av MARTINEZ
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PLAN CHANCE $15.01111
-CONTRACTOR-FIRM NAME
LICNC 9
•. .ADDRESS
MICROFILM 7'•E $0.45
CITYICOM MUN ITY/STATEIZIP
PHONEN
BLDG. INSPECTOR
FINAL DATE
-
ARCIENG FIRM NAME
LICNC p
ADDRESS
CITYICOMMUNITY/STATEIZIP
PLAN p
LAN&EXAMINER
APPPROV2AT E,`
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COUNTER L.U.T.
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$15.4
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• P C R M 9. ! FOR PLAN
TOTAL PEIkMIT COST IS
FLAN CHANCE
FORM 284.208(11.81) INSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE IiJSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 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.
43
Final
10A
Fireplace T.O. Ej
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 (Botts)
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
;ank 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