00002214 (BLCK)County of, Riverside
Department of Building -and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880N. Slate Street
227 North "D" Street 43209 Oasis St. Rm. 310 160 N. Broadway
Riverside, CA 92501 Banning, CA 92220 Hemet, CA 9943
? Perris, CA 92370 Indio, CA 92201 Blythe, CA 92225
PW 767.6146 Ph 9137312 _ Ph: 658.464
Pk 657-3898 Ph: 342.8271- Ph: 922-2670
This permit becomes void if work not commenced within 180 days from date of, issuance.�OR, i1
'work: has been suspended or abandoned for a period of 180:days.
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter (commencing CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
with Section 70110) of Division -3 of the Business and Professions- Code. and my licenseisin full fora and effect.
permit is for one hundred (11100) or less. I certify that in the performance of the work for which this permit is Issued: I
•
shell not employ any person In any manner so as to become subject to the Workers Compensation Laws of California.
License Class. Lic. Number
Date Appilrant
Date Contractor
NOTICE TO APPLICANT: If,raffer making this Certificate of Exemption, you should become subject todhe Workers
OWNER -BUILDER DECLARATION: I hereby. affirm that I am exempt from the Contractor's License Law for the following Comport provisions of the; Labor Code, you must forthwith comply with .such provisions or this permit shall be
deemed revoked.
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 for such permit to file a DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
signed statement that he is licensed pursuant to the provisions o1 the Contractor's License Law (Chapter 9 (commencing E] I hereby certify that no excavation live ((5) or more feel in depth into which a person Is required to descend, will be
with Section 7000) of Division 3 o1 the Business and Professions�Code) or that he is exempt therefrom and the basis for made in connection with work auNorized by this permit, and that no building structure, scaffolding falsework, or
the alleged exemption. Ami violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil demolition or dismantling thereof„ will be more than thirty -sol (38) feet high. (Chap 32. Grp.2, Art 2, Sec 341, Title 8.
penalty o1 not more than five hundred dollars ($500).):
C.A.C.)
� ,1, as owner of the property, or my employees with wapesas (heir sole compensation, will da the work, and
the ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
from
`sticture Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law SSaftety, as noted above, unless such person has a permit to do such work that division.
does not apply to en,owner of property who builds or improves thereon, and who does such work himself or through Division of Industrial Safety Permit No.
,his own employees, provided that such improvements,are not intended or offered torsale. 11. however, the building or Dale Applicant
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.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
-
the work for which this permit is issued (Sea 3097, Civ. C.).
lLas owner of the properly, am exclusively Contracting with licensed contractors to construct the project (sec. 7D44. Lender's Name
usiness and Professions Code: The Contractor's License Law does not apply to an owner of property'who builds or
improves thereon,and who contracts lovsuch:,projects with a contractors) licensed pursuant to the Contractor's Lender's Address
License Law.). I certify that 6have read this appplication and state that the above information is correct. I agree to comply with all
city and county ordinances and stale laws relating to building construction, and herebyauthorae representatives o1
P.C.
I•am exempt under Sec. B. 6 P.C. (Attach Certificate),
Date _ Owner s✓.
this county wenter upon the above,memjpotgkpro for Inspection purposes. -
WOR")'COMPENSATION DECLARATION: I hereby affirm that I have rt ata'oMcoOten to self -insure, ova `x-�"Stglialff olMolicanl-or Agent Date N
certificate of Workers"Compensation Insurance., -or a certified' copy thererif•(SeL 3090, La . C.).
CERTIFICATE OF COMPLIANCE AND, AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
.-r^
Policy No. Company'
information given is correct. I agree to comply with all state laws and county ordinances relating to building con -
strilebon and authorize a. resentative lite' Department of Building and Safety to enter upon
rep y- fo(mty of Riverside,
Certilled copy is hereby furnished.
y
the property. for which 1. have plled-ldrp'.permil'for the purpose of making hgpecflons. Al '
- 1��
n Certified copy is filed with the County Building Inspection Department or County Department. �`' oft ureipl.Appliconl or Agent Date
Date Applicant
Print Applicant/Agent Nama
- APPLICANT -.NAME (L.. F, MI)
APPL/PRMT N
PS
DATE
r
0.0117 9
�nft,_T A CE CA 9ags;sooeo
1 NITYISTATE/ZIP DURANGO
C C S
LOVP MOD SB
w
F..
BLK 32
NAME
ADDRESS
-CITYICOMMUNITY/STATE/ZIP ,
PHONE N LICNC N
ARCIENO FIRM NAME
ADDRESS
PHONE N LICNC N
USE OF PERMIT
Z FSB SSB SSB RSB OFC
ZONE N L END-
V R 14 x T• -Raft WOOD FENCE
TOTAL PE.RHX7 C013T IS
All
1 FORM,294.20tr (2181)
ein
_, TFEE OTAL
00117'
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Figs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 6 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.
°o
ADDITIONAL INFORMATION
,
--------------------- - -
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade.
INSULATION Thick "R
Value
7A Walls (Botts)
128 Ceiling (Botts)
12C Ceiling (Blown)
14 Final
-------- -- - PLUMBING' APPROV-ALS----------------------------------
15 Ground Plumb
16 Water Piping
1.7 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
R
EAR OF PROPERTY UNE
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
APPLICANT NAME (L. F. MI)
I NITY/ST
MYSITMA190SAPACE CA 9221934900
I NITY/STATE/ZIP CALLS OWANGO
C I C S
LOT MOD SB
TRrc,7
Ina
OLK me
E F;
O A NAME
ADDRESS
CIT1'.ICOMMUNITY/STATE21 P
PHONE a
LICNC'a
ARC/ENO FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC a
USE OF PERMIT
IWZW" FSB SSB SSB RSB OFC
11'1'W
we ZONE a L END
z '00117�
APPLICATION FOR WOOD PENCE
T+1 1 8 X S A N A P P L i C A T Y 0 H 0 0 L w
j FORM 281.208 '.(2181) 0
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
Ftgs 8 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;
El°o
ADDITIONAL INFORMATION
-
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown):
14 Final
_ . LUMBING-APPROVALS--------
PLUMBING-APPROVALS---------
15
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