00028425 (PLBG)PERMIT APPLICATION T
County of Riverside
Department of Building and Safety
4080 Lemon SI. 2M Floor 135 N. Alessandro Rd. Rm. 207 880 N. Stale Sheet 227 North "D" Sheet 46.209 Oasis 51. Rm. 370 160 N. Broadway
Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343 Perris. CA 92370 Indio. CA 92201 Blythe, CA 92224
Ph: 787.6146 Ph 849.7312 Ph 6584464 Ph: 657-3898 Ph 342.8271 Ph. 922.2670
This permit becomes void if work riot commenced within 180 days Irom date of Issuance. OR. it work has been suspended or abandoned for a period of 180 days.
Is.
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 ( commenc-
ying with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
0
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
rlollowing reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
struct. alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such
permit to life a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex-
empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per -
mil subjects The applicant to a civil penalty of not more than live hunderd dollars ($500).):
-❑ ' I, as owner of the properly. or my employees with wages as their sole compensation, will do the work, and the
structure 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 property who builds or improves thereon, and who does such work himself or
through his own employees. provided that such improvements are not intended or oflered for sale. If, however.
the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov-
ing that he did not build or improve for the purpose of sale.)
�01, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec.
ti7044, 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 Con-
,ylraclor's License Law.)
❑1 am exempt under Sec. B 8 P.C. (Attach Certificate).
Dale nwner
'WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.).
❑Certified copy is hereby furnished.
_jI❑Certilied copy is filed with the County Building Inspection Department or County Department
ff - — - - —
r,
■ R.
. R.
APPLICANT NAME If., F, MI) A,
N
ADDRESS
52297 EISENHOWER
CITYICOMMUN ITYISTATEIZI P
LA QUINTA CA 92.2530000
_ ffigRESSISPACE EISENHOWER
5, ,`l
CITYICOMMUNITYISTATEIZIP
LA QUINTA CA 422530000
BOK
773
PAG
22
PRC
020
C
2
TWN
PING
000
SE
a0
S
TRACT LOT
000000 9010
MOD
091
SB
TRACT NAME
SCV LAQ *11t BLK--97
OWNER NAME CARNS� MI) AR SLENE
PHONE If
CONTRACTOR -FIRM NAME
LICNC N
ADDRESS
CITYICOMM UNITYISTATEIZI P
PHONEM
BLD INSPECT R
FINAL DATE
�AT
ARC/ENG FIRM NAME
LICNC N
ADDRESS
CITYICOM M UNITYISTATEIZIP
-PLAN N
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
REPLACE GAS LINE
0 Q
1 N
FSB
a16b
ng fl
aS{7BV
png
Q {/Ba
pq
"LIVID
ZONE ORD N
LOT SZ
ENDfoot
aS o
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com-
pleted it the permit is for one hundred ($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' Compensa.
tion Laws of California.
Date Applicant
NOTICE TO APPLICANT: It, after makingthis Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be
deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certify that no excavation five (5) Or more feel in depth into which a person is required t0 descend. will
be made in connection with work authorized by this permit, and that no building structure, scaffolding. fatsework.
or demolition or dismantling thereof, will be more Than thirty-six (36) lent high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
Title 8. C.A.C.).
0 A owner -builder. I will not employ anyone to do work which would require a permit from the Division Of In-
dustrial Salely. as noted above, unless such person has a permit to do such work from the division.
❑Division of Industrial Safely Permit No.
CONSTRUCTION LENDING AGENCY: I hereby affirm That there is a construction lending agency far the perfor-
mance of the work for which This permit is issued (Sec. 3097. Civ. C.).
Lender's Name
Lender's Address
1 �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate)
that the information given is correct. I agree to comply with all stale laws and county ordinances relating to
building construction, and authorize a representative of the County of Riverside. Department of Building and Safely
to enter upon he properly for which I have applied for this permit for the purpose of making inspections. f
I 4
/ Signature of Applicant or Agent Date
._Print AtipticanIZAgent Name
APP 0 21 N
QQQ2t742.5
PS DATE
PP 92/a9/O 55307
PLUMBING FEE $6.50
pll
TOTAL
FEE
`b .
CA
CKX
NC
COUNTER B.I.
COUNTER L.U.T.
P l.. U M B I N G P E R M I T
TOTAL PERMIT COST IS $6.50
PLUMBING FEE COMPUTA'TIONS * Permit Fee W apppl9.cable)
GAS PIPING SYSTEM- 9 to 5 Outlets.l b ar` More Outlets: 0
FORM 284.208(11.81) INSPECTOR
55307
E'E:C: $4.00
FEE: $2.50
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE ' INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs & 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 Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L. 0
43
Final
10A
Fireplace T.O. E]
OP'N
NO.
ADDITIONAL INFORMATION.
SEWAGE SYSTEM SIZE 8 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 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 1Z— 2 42
25
' p
Final L _ 2—
Tank Pit L.Line
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298r Bonding
30 Fixtures
31 Service
32 Final
L
STREET NAME
APPLICANT NAME (L. F. MI)
�}.y�1 `
CARNE MAR WAn LiaNE
ADDRESS -
EISENHOWER
r5 �2�?17 ��p
y {� h
�o p, 922530000
L.. KOWMU�J�jYI�SIWIP CA 725 530000
V)V Efta�RESSISPACE CISENHWWER
ry uCA
f,`TYICOM U ITYIS�TEIZIP
922530000
`/ A�7pW7
AAWG
�71I�bls
o
>�
�N
dN0 V
{7E0
S
Tl! V Q `+ o 0 7)
10
jf j I
I SB
TRACT
01!{(1, BLK�-97
o(E'a�VCV�A MtLAC3M[y��
M r'l l� i�J ) F AAR LIE -N p
PHONE q
'CONTRACTOR. FIRM NAME
LICNC #
ADDRESS
CITY/COMMUNITY/STATE/ZIP z
PHONE#
BLDG. INSPECTOR
FINAL DATE
ARCIENG FIRM NAME
LICNC #
ADDRESS
CITY/COMMUN ITYISTATE/ZIP
PLAN #
PLANS EXAMINER
APPROVE DATE
W4I.��E OP -OAS LINE:
''Y®
RTN
FSB
V#{!
oft
VVb
J1{`I1/
ZONE ORD #
LOT SZ
END
0 oseb
civ 0 8IT 42 AP t an pis? 55306
t
TOTAL .
FEE
CA CKNC COUNTER B.I. COUNTER L.U.T.
is
APPLICATION FOR PLUMBING PERMIT
r.
_FORM 284.208,11.81) INSPECTOR
r
.t
•
�L y
op
h
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & 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 Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O. El
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 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
PSL P)
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME