02005 (SFD)APPLICANT NAME (L F MI)
APPL/PRMT #-
PS
DATE
/� ^
'�• " a.�'as rii ,:� ms..µ°.. �/ +v
k !
1 „•�.
.n
.� . -`r .:
0h0 �},(J �•J(
O R
�X
,
J010,19"E ..
A
v ITV/STATE/ZIP
C
..
TWN
S
If�
'OTU.
+
T A 4•�'..
MOD
SB
..
-
.
O R- F 1) -
EDWARi CAC NAME
WAY
:.P .. .. ....
LICNC q W...
,�
ARC EN t FIM'
ADDRESS -
1, CITY/COMMUNITY/STATE/ZIP .. . .
�rPHONE p
LICNC q
'
..USE OF PERMIT
FW
ZON y
'FSB'
- SSB c „
- SSB
-RSB ,•a
OFC'
-ZONE
LO
-
- END
•.
(
-
L.
_.
}
FEE—
EESPECTORSCOPY
INSPECTORS
--r--CQPY
T
0803:
�■y' s■�p1,.�y gyp /p�� ,,/.y/.. () p■ � ®
t : f •�� ;!FM Fr wI .Pl. �. F !Ru' {�•' • �I ill •`�'
t{•• �y,�{
ftl"',, p
NJ' tV. •..
S
a
t fiE'M��•
;W'y.
FORM 284-208 (2/81) 3
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION -
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROV,AtS
1
Set Back
33
Ventilation System -
2
Ftgs 8 Frms
34
Plenums & 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
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
--1----- - _..... PLUMB= -A-'nrP.OVALS----------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents , 1- 1-
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
298 Bonding
30 • Fixtures
31 Service
32 Final
STREET NAME
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 "D" Street 46.209 Oasis St. Rm. 310 - i60 N. Broadway
Riverside; CA 92501 - Banning, CA 92220 Hemet. CA 92343 Perris, CA 92370 Indio, CA 9.201 Blythe. CA 92225
Ph: 787-6146 Ph:• 849-7312 Ph: 658.44F,4 - Ph: 657-3898 !` Ph. 342-82:1 Ph: 922.2670
.This permit becomes,void if work not -commenced within 180 days from date of issuance, OR, 1. work has, k -n suspended or abandoned for a period of 180 days,
LICENSED CONTRACTORS DECLARATION: -1 heieby affirm that I am licensed under provisions of Chapter 9 (comme5cing CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA-IONINSURANCE: This section need not be completed if the
'With Section 70D0)'of Division 3 of the Business and Professions Code, and my license is in lull force and elfect. permit is for one hundred ($100) or less. I certify that in Ott performance of the work for which this permit is issued, I,
v' shall not employ any person in any manner so as to become subject to the Workers' Compensation_ Laws of California.
License Class Lic. Number _ Date Applicant
Date 'Contractor NOTICE TO APPLICANT: If, after making this Certificate pf 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 for_hwith comply with such provisions or this.perinit shall be
•
reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, deemed revoked. . 1
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 fee-, in depth into which a person is requiied to'descend, will be
with Section 71000) 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
thealleged exemption. Any violation of Section 7031.5 by any applicantfor 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.) -
' - As owner -builder, I will not employ anyone to do work which would p
I, as owner of the.property, or my employees with wages as their sole compensation, will do the work, and the D Y Y quire a permit from the Division of Industrial
structure is not intended or.offered for sale (Sec. 7044; Business and Professions Code: The Contractor's License Law a efy, as noted above, unless such person has a permit !o do such work from that division.
does not apply to an ownerof property who builds or improves thereon, and who does such work himself or through ❑ Division of Industrial Safety.Perm_ it No.
his own employees. provided that such improvements are not intended or offered for sale. If, 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 these 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 property, am exclusively contracting with licensed contractors to construct the project (Sec7044. Lender's Name
uand 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 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. 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. -
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;lhereol (Sec. 3800, Lab. C.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTFY: 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-
------- slruction, and authorize a representative of the County. of R:verside, Department of Building and Safety to enter upon
F. Certified copy is hereby furnished. _. the property for which I have applied for this permit for Ih purpose of making inspections. ,
Certified copy is filed with'the Cotinry Building Inspection Department or County - Departmedl. �Jy�y Signature of Applicant or Agent -r,.- gate.
Date �' Applicant
` PIcLIC��.,.T NAME I'. F. es --Fs .�:tt�{w_e•�: --.r..r.--e-sr�W:-� = .rYrs^-, YPr , A` t Na r. •+, .__..;
in plic t/Age m
APPLICANT NAME (L F MI) I ^ APPVPRMT q : - '^' -'PS` d•AT '
- „�'n � - r% , v -� _ 0010 6
ON
o. ,�� `�:. a �•` :y,� "
WIN Int NIT.Y/STATE/ZIP - r. q -
IRACY L MOD
92%1 IA
i NEHW A E L. F..M L..r
2ur
CO RA T R- M NAME • - -
4.
14 (3P44
E
trots A A go
wr
LICNC 44,
AR /E G HAME''
ADDRESS. - -
CITY/COMMUNITY/STATE/ZIP -
'PHONE f! . - -LICNC'.p
USE OF PERMIT
"IONE FSB SSB - SSB' RSO, OFC reno 4. AL
L END A I'M.v -
Aiftol
,
FEE
' INSPE COPY
CTOR'S.CO
001064
TON"fpSTINA�� (;A�t��'E Not ,ta pe user!` 'as g��r�c���� v€�auation)
tib► 6� i Int QI fD � µ up VDvOcripf*drs Fee or- ,I Q OFCP
is S A £'3 it ii
� �tYr�A1R N 04 1 !� .� c a
sit. F1n,32:+w r4afr��! °inn Ta'i Irit''+;�d t�.�:`'tn'. df..�®,D�..s�9'.S
r - 1
41
FORNI 284-208 (2/81)
:
i
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 (Botts)
12C Ceiling (Blown)
14 Final
�-- __---------FWMWNG–kFFROVAL---------------------------
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
00 .