021787 (SFD)'rititinn ArrLItRIIUII
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 "0" Street *209 Oasis St. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning, CA 92220 Hemet, CA 92343
Perris. CA 92370 Indio, CA 92201 Blythe, CA
Ph: 787-6146 Ph: 849-7312 Ph:
Ph: 657-3898 Ph: 342-8271 Ph: 922-2670
I , -
This permit becomes void if work not commenced within 180 days from date of •issuance. OR, 41 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
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
polmit is for ondrhundred ($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' Compensation Laws of California.
Licehse Class Lic. Number
Date Applicant
Date — Contractor
7
NOTICE TO APPLICANT: It. after making this Certificate of Exemption. you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt Irom the Contractor's License Law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter.
deemed revoked.
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 of the Contractor's License Law (Chapter 9 (commencing
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
with Section 70U) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for
made in connection with work authorized by this permit. and that no building structure, scaffolding, falsework, or
the alleged exemption. Any 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-six (36) feet high. (Chap 3.2, Grp 2. Art 2. Sec 341. Title 8.
penalty of not more than five hundred dollars
C.A.C.)
1. asownerot the property, or my employees with wages as their sole compensation, will do the work, and the
yi
As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
Re ety, as noted above. unless such person has a permit to do such work from that division.
s❑fucture s not mended of offered for sale fSec. 7044. Business and Professions Code: The Contractor's License Law
i
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
n Division of Industrial Safety Permit No.
his own employees• provided that such improvements are not intended or offered for sale. It. however, the building or
Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
CITY/COMMUNITY/STATE/ZIP
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
LICNC #
the work for which this permit is issued (Sec. 3097. Civ. C.).
1, a: owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044
Lender's Name
us, nes 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 contractors) licensed pursuant to the Contractor's
Lender's Address
License Law.).
I certify that I have read t . his plication and state that the above information is correct. I agree to comply with all
1.
I am exempt under Sec.B. & P.C. (Attach Certificate)
city and county ordinances andstate laws relating to Wilding construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Date Owner
BL I
(,WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
Signature of Applicant or Agent Date
certificate of Workers' Compensation Insurance• or a certified copy thereol (Sec. 3800. Lab. C.).
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 con -
Policy No. —Company
struction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
L,
Certified copy is hereby furnished.
the Pty, for*whicrtl have applied for this permit for the purpose of makin'Ninspections.
- " . I A
Cerlified copy is filed with'the County Building Inspection Department or County — Department.
_V1
I Signature of Applicant orlAgem _01 Date
Date Applicant
Print Applicant/Agent Name
PLICANT NAME (L. F, MI)
P,
41, P -P
ADDRESS or" G
6? en
CITY/ 6OIC4IvitJkITY/STALP—?v
jorIffiffADOREsSPACE .0
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CIT: iddi4MUWWYfb-rA,?/ZIP
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eece?"
1.P 'tel PRC!f
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105W
LOTM
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SB
TRACT NAME
OWNER NAME (L. F. MI)
cRN�d'TWFRRMMV
ADDR& ';j
CITY/COMMUNITY/STATE/ZIP
PHONE #
LICNC #
ARC/ENG FIRM NAME
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ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE #
LICNC #
USE OF PERMIT
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LOT END
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---I— ____ — �_ - [ _FS _ 1
APPL/PRMT N DATE 021787
TOTAL
FEE
ArP
17
)7S_
lNZIFtIL_lUK'b LUFY
--
021 7 0 -0 -IT -11
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4��17 �/J
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
- BUILDING APPROVALS •
-
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
figs-& 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
10A
Fireplace
T. 0.
°o
ADDITIONAL INFORMATION
---------
,
'
^s
-
I
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
- - ----PLUMBINGAPPROVALS---------------------------------------------------
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
V,
4