09695 GradingP• . �rcnmrr•nrruonrrun. - - - , .• - �,a .
County of Riverside
Department of Building
and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street
Riverside, CA 92501 Banning, CA 92220 66�Hem2393 et, CA 9 "'
Carrier
a 227 North 'D" Street 46209 Oasis St. Rm. 310 160 N. Broadway
Perris, CA 92370 Indio, CA 92201 Blythe, CA 92225
Ph: 787.6146 Ph: 849.7312 658-4q(al; ,.�-.i•-
-R,
Ph: 657.3898 Ph: 342-8271 Ph: 922-2670
This permit becomes void if work not commenced within 180 days from date of issuance, O if 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 full force and effect.
permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit is issued,
License Class Lic. Number
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
Date Applicant
Date Contractor
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from 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
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 of the Contractor's License Law (Chapter 9 (commencing
❑ 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 7000) 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 (5500).):
C.A.C.)
I, as owner of the property. or my employees with wages as their sole compensation, will do the work, and the
sTruclure is not intended or offered for sale (Sec. 7044• Business and Professions Code: The Contractor's License Law
p As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
,a'eN, as noted above, unless such person has a permit to do such work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
0 Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. 11, 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
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 (Sec. 3097. Civ. C.).
I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
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 for such projects with a contractor(s) licensed pursuant to the Contractors
Lender's Address
License Law.).
I certify that I have read this apptication and state that the above information is correct. I agree to comply with all
1 am exempt under Sec. . B. 8 P.C. (Attach Certificate).
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. i
Date Owner
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 thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
Policy No. Company
information given is correct. I agree to comply with all state laws and county ordinances relating to building con -
struction. and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon
Certified copy is hereby furnished.
the property for which 1 have applied for this permit for the purpose of making inspections.
0 Certified copy is filed with'the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date .
Date Applicant
Print Applicant/Agent Name
_
APPLICANT NAME(LF. MI AP PL/PRMT a PS DATE _
( �C+�� gg ��99 }� ��'ee c,}ppNN����
�yiICANT AME (7 � LrT4 f1T.i WRd M+ 6,0'00941913 6t 1 fix /cIA 010532
ADTe/�/c�Q��9 0 I I I
GRAD � �it� }' � AN 1f E�+ � E �i F k� ��
�t!�pyyWY1yj-pp
CI SYr ►vt..iIT}i� 1'ff
JO7�wSCI���SS/SPACE
it 0
CrA
912'2* t
.BO .� PAG07 PRC}, 0, C TWN (� SE S
�j
-
TRV 1r -5 PP � i LOT 0 � . MO,0` I ' SB
�y
TRACT NAME
I
O iit ii i"'� FFMI"'f ! �"iL77w �b i.a NSe p�
�p.��p �^y�46.JCE�C"
CONTRACTOR -FIRM NAME
r^'�
ADDRESS
4
I
C ITY!COMM U N ITY/STATE/ZI P
hOf
PHONE # LICNC 4
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0 LICNC #
usURhiV:6N0, Irl,?T- -70 100 l~ 1t„t,.""41 S6
-
T OF ``
{
BL ZQ�1 FSB S$¢�ij� R4S ii
�,�
��r yy� � �x� � y� �yy� ` PLANREVIEW 't y+�q
PER, t�.R I r'm EMI"Id7V4W' 1�:!' N `�E VIEW
ON �jqqa q LOTSZEND SIDE
P °� ciO
TOTAL
t3 Cl,
i015
FEEPCWMIT
010532 I,
FOR CRAPING
PLAN
,,. ,;TOTA4
PWIT COST 19
$90.00
r 5 ?5
Kr,1 ,• �•�,...
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 & 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
••
..
-------------
,
SEWAGE SYSTEM SIZE & LOCATION
11. ., Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick ..R.
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
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 t
24 Gas Test -
25
Final
Tank Pit L. Line
P/L
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
i-t — --------------
-X6
— r
.X'6
r ., .. .. ,-. _ . .. ...... .. • nCr11Y11 II;
�CIYI111Yn. .. .. .. .. _ _ .. . _
. 1
• Count f
ounty o
Department Building
v
Riverside •• •
Safety'
of
and
y
- -14080 Lemon St. 2nd Floor 135 N: Alessandro Rd. Rm. 203 880 N. State Street
227 North "D" Street 46-209 Oasis St. Rm. 310 160-N. Broadway '
Riverside. CA 92501 Banning, CA 92220 Hemet. CA 92343
Perris, CA 92370 Indio, CA 92201 Blythe. CA 92225
" Ph: 787-6146 ', Ph: 849.1312 Ph: 658-4464
Ph: 657-3898 Ph: 342-8271 Ph:, 922-2670
a
..
This permit becomes void if work not -commenced within 180 days from date of issuance, OR, if 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 full force and effect.
permit is for one hundred (5100) or less. I certily that in the performance of the work' for which this permit is issued. 1'
-
shall not employ any person in any manner soas to become subject to the Workers' Compensation Laws of California.
License Class Lic. Number
Date Applicant
Date + 'Contractor
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from 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
[—] I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be.
with Section 7M, 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 live hundred dollars (5500).): -'
C.A.C.)
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
Q
p As owner -builder, I will not employ anyone to do work�which would require a permit from the Division of Industrial
has
is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law
,a,elY. as noted above. unless such person a permit to do such°work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
C] Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered lot sale. IL 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
' buildor 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 (Sec. 3097. Civ. C.). -}
1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name
.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 Contractors
Lender's Address '
License Law.).
I certify that I have read this application and state that the above information is correct.I agree to "comply with all
1 am exempt under Sec. . B. 8 P. C. (Attach Certificate),
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of r
this county to enter upon the above-mentioned property for inspection purposes. ±'
Date Owner
_
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
Signature of Applicant or Agent Date .
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. Q.
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 ,
0 Certified copy is hereby furnished.
the property for which'I have applied for [his permit for the purpose of making inspections.
Certified copy is filed with' the County Building Inspection Department or County Department.
Signature of Applicant or Agent - Date .
.. Date Applicant
Print Applicant/Agent Name
APPLICANT NAME (L F, MI)
APPL/PRMT 4 PS DATE
®10
t H6�taLIT 'HAVER A Av���
4, 5 31
- --.
ADDRESS
CITYICOMMUNITY/STATE/ZIP
f
r
Io-
CITY"J Q4_•LYNITY/STATE/ZIP
. �Arr;Pr..*tf'
BOK PAG PRC C ; • - TWN RNG / SE S
1 94 I . r:.. .J4 r vlr , 111 Al
TRACT '�• t' LOT
T11 .'ME U b
OWN•i MSI Qp .ts MI)y 0001, 01.1 +
CONTRACTOR -FIRM NAME. ,`„�•„
ADDRESS
PHONE p LICNC q
ARC/ENG FIRM NAME- '
ADDRESS
PHONE p I I LICNC n
USE OF PERMIT
,3.
BL ZON FSB SSB SSB.
ZONE ORD p.. • LOT SZ
OFC
END SIDE
o
x
TOTAL
FEE
•� �+FOR r
�'1
- r ,
FORM 284-208 (2/81) y`• 1.
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 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
toA
Fireplace T. 0.
°o
ADDITIONAL INFORMATION
i
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 -A-PP-110V L:S-------------
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
e
Tank Pit L. Line
REAR OF PROPERTY LINE y
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
`• .1yylj(� Qj(•�!T��NfJJ�sy,�f�;C Il ) ''-p��y •}^+y �pe.�� }�alp}ry�,
I...�\.qi �3i VI:�,WSF` .4.lYjrvlSsfW ' `
{-
�r
�P`, ■Vh�PgM�p �n
'�-W EAi.t:I
`BS
;47':�
p y� ,/• DgpT ..s
.�S+i�(.��:�$ - fo:, •
2 .3r A.
s-
.
ai9 "'# 0DRESS/SPACE. .:WAw Y d. SW a1.t'7,
�C�Qt�Aypl}IAI INTE/ZIP .' fri7 ,YIiaL7i7 YJisJE -
-
IQR,C�.
�C
TWN •IJ��ii
Y✓'`/.
S
rY4.;Fjp�Na��t�.
100
SB
{ TRACT NAME
MAP((�� qq uu �yy!! qq•. yy�� f¢� pp�� - p��!. �`
iql.iZ�'{PE �..Yl�rIHMe-F+,�,�..
'CONTRACTOR -FIRM NAME
-
ADDRESS
4t -0ITY/COMM6NITY/STATE/ZIP -
-
-PHONE q
J
d.
4
LICNC q
'
ARC/ENG.FIRM NAME
}
ADDRESS
CITY/COMMUNITY/STATE/ZIP
`�•' PHONE.q
LICNC #
..
-
Y -
f
..pprr� yy��.
q.,�:o3a►IP'i�ha'�",g�
'�td6�RINT"d�}W�4'"'�
3Q y
1� n
Z N
t
'FSB
S
qW�
S
-e
R B.
Q1!
F
IU
ZO. FF,,..,,O,RD p
!j
a t
LOT SZ
'END,•
SIDE
_
' TOTAL
FEE
-
K
INSPECTOR'S COPY �
_, � .-� � � � r #•:, - - 0 219 0 n
Ila:t�i It p.lti'
I
I FORM 28b2C! (2181)
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs d Frms
34
Plenums 8 Ducts
2A
Slob 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
r ;
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts) --
12C Ceiling (Blown)
14 Final
�.. _ _„_•_.--£L;.'A4�?l�:G^FfOYALS-------------
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
1 I 1 1 ----71
1 1 STREET NAME
° 2ffDRESS/SPACE e- r
ua
CI,1;V/Cptylj.•1,11�yjrT�TE��21 [P r, a ,M
2f�..7A1x11A��;�Vq V{q�:6k •.
TWN 0 {R V 6P iV •` S
Intl
TRACT NAME '
}," _ � •fir. `•
r
'CONTRACTOR -FIRM NAME .1
'ADDRESS -
r
C ITY7CO MM UN I TY/STATE/ZIP '
PHONE # -- LICNC q
� a
d
3'1OS C@1S' 4u ,1' 4e Fa r ��,� o b"iD g
:1
MICROFILM jf�f l� �lz a
ARC/ENG-._FIRM NAME
G
County of
Riverside
'
Department of Building
and Safety
?�• '� c 4080 Lenon 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 -
r.. Ph: 787.6146 Ph: 849-7312 - Ph: 658-4464
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, if work has
beensuspended or abandoned for a period of 180 days.
-r
4
LICENSED CONTRACTORS DECLARATION: I hereby affirm that'I am licensed under provisions of Chapter 9 (commencing a
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 full force and effect.
permit is for one hundred (S10g) or less. 1 certify that in the performance of the work for which this permit is issued, I :^
r y-
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. A'
License Class -'• "- - Lic. Number
-
�-
F
Dale Applicant i - -
ti
"Date Contractor "o
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 from 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;'
deemed revoked.
-reason Sec. 7031.5, Business and Professions Code: An cit or count which requires a permit to construct, alter,
( Y Y Y eR P
t'.
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 Contractors 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
❑ 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,Lalsework, 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.,T
penalty of not more than five hundred dollars (5500).):
C.A.C.) .,;
Q I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the❑
As owner:builder. I will not employ anyone to do work which would require a permit from the DivisioiEof Industrial
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law
Safety, as noted above, unless such person has a permit to do such work from that division. i
does not apply to an owner of property who builds or improves thereon,' and who does such work himself or through
CJ Division of Industrial Safety Permit No.
his own employees. provided that such improvements are not intended or offered for sale.- If, however, the building or
Applicant ` . r<'
-
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
°Date
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 (Sec. 3097, Civ. C.)..
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec7044,
Lender's Name r'+•
9usiness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds a;
_
improves, thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lender's Address r.
'License Law.). ,
I certify that I have read this application and state that the above information is correct. I agree to comply with all �,-
Q' 1,am exempt under Sec.. t• . B. 8 P.C: (Attach Certificate),
city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of -e
.
this county to enter upon the above-mentioned property for inspection purposes.
Date '-• Owner
- WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. or a
Signature of Applicant or Agent Date .re
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the
'
Policy' No. r Company
information given is correct. I agree to comply with all state laws and county ordinances relating to building con•+;,,
struction, and authorize a representative.of the County of Riverside, Department of Building and Safety to enter upon A.,
the property for which 1. have applied for this permit for the purpose of making inspection s.„3 `
Certified copy is _hereby furnished! -
Q."Ceryilieocopy is filed'with'the County Building Inspection Department or County Department.
. / Signature of Applicant or Agent - `�,.P. •,', Date .: •
Datei °' 3 t Applicant
" Print Applicant/Agent Name v
t
41� �..
F
..
9.0 4
°^� 0°i+
"ppF�pp41F�. 7�jjijj� l '
Ai,
r
i149, PRAM p .
I"OVy74f
921_�hi:1
pi q �gJ�a��j4�►4$(�
�YiSM �7vo.lYxT,T,•.
° 2ffDRESS/SPACE e- r
ua
CI,1;V/Cptylj.•1,11�yjrT�TE��21 [P r, a ,M
2f�..7A1x11A��;�Vq V{q�:6k •.
TWN 0 {R V 6P iV •` S
Intl
TRACT NAME '
}," _ � •fir. `•
r
'CONTRACTOR -FIRM NAME .1
'ADDRESS -
r
C ITY7CO MM UN I TY/STATE/ZIP '
PHONE # -- LICNC q
� a
d
3'1OS C@1S' 4u ,1' 4e Fa r ��,� o b"iD g
:1
MICROFILM jf�f l� �lz a
ARC/ENG-._FIRM NAME
G
- .ADDRESS ..
cti
•� - - ' . .
ix CITY/COMMUNITY/STATE/ZIP
y
PHONEytt Lo�.i' - �� LICNC 8 •
.7
k
'+
�PA�Q�AL"
1.R
•1�J`.(s �tr�e'('�.
, YSi.Gn, ..,.43•i7 !'�f i1.'`.,
L�I
r ,
FSB $$}
li 0�
4
' y ri
1 r� 4
RD p.« LOT S2. END sub
»' 0
,i
/ TOTAL F
..
• .. _—
COR rs
*`�
021904
6
.3c 4
i VAJ YiiS^^C6 1i 7195.4
.V ..
i
F -411-9N,g3(3
'•'
i:�i^'Yi
c: "f.iU�t �a R,
%fi VATIt No f , ti �rfv l .
�1 l� Pat' :,. t�f 'i �' •' ?
i3���
x3p9�j
ta' � � 60 � � t; 4 7iao . 9 n ;�: obIt�' �tdS, ��k.t a" � 1 6?0? . A�S'i=
, t�'LANDSCAW"
-TIE
S L./ •r
1' � • ^ � , � f �
1�,�
Nth...
i
a
.� CFr_.•r..rr ,.
7• '
,
`FORM 2d0 208 2/91)
.. ,- •. r�..,-: -. - ,. _.y�.y.. •l,"�-.. .;:+. ,_ ...-:... y. .:.,Kr.<. a ..r :: .,, ... ;:i4 ..•ass-". a(..J..r ,f ar �.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs d 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
Gaioge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O.
°o
- -
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 (Batts)
12C Ceiling (Blown)
14 Final
PPROVALS
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