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2201 (BLCK)Countyy of Riverside Department of;Bui Ing and Safety 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street ' F.. '+` 227 North "D" Street 46209 Oasis St. Rm.:,10 160 N. Broadway ' Riverside, CA 92501_ Banning, CA 92220 Hemet, CA 92343 ' Perris. CA 92370 Indio, CA 92201 Blythe, CA 97125 • Ph: 787-6146 Ph: 849-7312 Ph: 6564464 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, it 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 perforrrance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subtectsto the Workers' Compensation Laws of California. License Class Lic. Number • Date Applicant Date Contractor NOTICE TO APPLICANT: If, 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, of 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 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. penally of not more than five hundred dollars. ($500).): C.A.C.) © Ias owner of the property,, or my employees with wages as their sole compensation, will do the work, and the p As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial ,arety, as noted above, unless such person tics a permit to do such work from that division. sTruct,ure 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 properly 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 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 Droving 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.). ' PI, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Lender's Name usine:s 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 protects with a contractor(s) licensed pursuant to the Contractor's 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 ❑ I am exempt under Sec. •- .-!` B. &-F: C. (Attach Certificate). city and county ordinances and state laws relating to building construction, and hereby authorize representatives of �.., 7 i/ this county to. enter upon thea.ove:menhorrA properly for inspection purposes. Date, ,✓'.''"^,'. Owner .:..+a3i '",.^r.le WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1'have' ce f cate of consent to self -insure. or a r''--O'�',o*Sgnature_of1AppIicant or Agent Date . certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.). i 1'w CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I :artity I have read this application and state that the information given is correct. 1 agree to comply with all slate laws and county ordinances relating to building con - Policy No. Company °� strfiction, and authorize a representative:of'the Coumy'of Rivers'da, Department of Building and Safety to enter, upon the property forwhich,l• havegapplled Tor lhi ermil for the purpose of making inspections;,- Certified copy is hereby furnished. ❑ Certified copy is filed with' the County Building Inspection Department or County Department,, • {l'`-^'"` '"Signahire�ol<Applicant or Agent - Date . Applicantk f oe Date Print Applicant/Agent Name - - - �--.-:.—r::a�•-n-i�r•�--..+ APPLICANT NAME (L F. MI) ..n-r:.,•..� ��-c-'��-.� =PSD - :EPR 001175 ' a , ADDRES r /-O M NITY/ST f ' _ a •e SIT AW ds SS CE w'4 - f, / O A/1,NITY/STATE/ZIP AVE" r C C TV, W S s S _ LO d ." `MOD SB -10 , I ME UA, ,R M WOOD r rz .O A M11 NAME - - a - ADDRESS v CITY/COMMUNITY/STATE/ZIP - • • ' 1 . '/ PHONE q LICNC q ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP i PHONE q LICNC a USE OF' PERMIT ' -Z FSB'+ SSB. SSB RSB OFC - rA ZONEUR6 4 LTJTt2# END E - '•-,'�' TOTAL • - FEE , 0 011 7"5. TOTAL PWIT COS � x s a h`.".� ,FORM 284-208 (2/81) is NO. OPERATION DATE INSPECTOR, NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Veritilotion System ' 2 Ftgs 8 Frms 34 Plenums & 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 Deice ' • 9 Garage Fire Wall 42 - Commercial. Hood' .. 10 Fireplace. P. L. 43 Final. TOA Fireplace T. 0. °o ADDITIONAL INFORMATION ------------•-------------------------=--------'-- - ' SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 1-2 Internal; Loth 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 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 P/L. REAR OF PROPERTY LINE ELECTRICAL APPROVALS ' P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 298 Bonding 30 Fixtures 31 Service 32 Final APPLICANT NAME (L• F. MI) wyun,.wawwir.w.�, sr•e 1�4tfei / tbl NITY/ST #$X409 J SIT AA SS S CE GA I NITY/STATE/ZIP Avg vitziat C C d T S • d!S vs- .. ~ L MOD SB, 640 6 R rC Y RIYE.. - g ISE 1. F.- I' r NO ANAME' . . .. .ADDRESS • - CITiYCOMMUNITY/STATE/ZIP • PHONE'#. ' LICNC. k .ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP , PHONE p'. LICNC q USE OF PERMIT - -lyzbof FSB SSB SSB RSB OFC :. ZONERORb q - L - ... .' END .. _ o � TOTAL' FEE • ' ^ INSPECTOR'S COPY .4 x 00'11"-lq: y Ut IT, X I s A N A PD L I. C A .0 h' L Y + - .- tit ��•`.:�'�--j; ` ., , ' FORM 284.208 (2/81) NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL: APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & 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.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 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 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., 31Service 32 Final STREET NAME