20498 (ELEC)PERMIT APPLICATION
" County of
Riverside ~
Department of Building
and Safety
` 4080 Lemon St. 2nd FIOOr_ 135 N. Alessandro Rd. Rm, 203 880 N. Slate Street
227 North "D" Street 46.209 Oasis SI 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: 849.7312 Ph: 658-4464
Ph: 657.3898 Ph: 3428271 Ph: 9222670
• This permit becomes void it work not commenced within 180 days Irom dale of issuance. OR. it work has beer suspended or abandoned for a Period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN`,ATION INSURANCE: This section need not be com-.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter9 (comment-
pleted it the permit is for one hundred ($100) or less. 1 cer ify that in the performance of the work for which this,
permit is issued. I shall not employ any person in any mann,r so as to become subject to the Workers' Compensa-
ing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
tion Laws of California.
O
Date - Applicant
NOTICE TO APPLICANT: 11, alter 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
Compensation provisions of the Labor Code. you must ldrthAth comply with such provisions or this permit shall be
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con-
deemed revoked.
struct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such
permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIOr: -
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or. that he is'dx-
❑I hereby certify that excavation live (5) or more feet in depth into which person is required to descend, will
empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
with
be made in connection wth work authorized by this permit. end that no building structure, scaffolding, falsework.
mit subjects the applicant to a civil penally of not more than live hunderd dollars ($500).);- .
or demolition or dismantling thereol, will be more than Ihirly-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341,
❑ I. as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
Title 8, C.A.C.).
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
❑ As owner -builder. I will not employ anyone to do work v hich would require a permit from the Division of In -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
dustrial Safety. as noted above. unless such person has a 7ermil to do such work from the division.
°through his Own employees, provided that such improvements are not intended or ollered for sale. If, however,
industrial Sately Permil'Nd.
the building or improvement is sold within one year of completion, the owner -builder will have the burden of Prov-
❑ Division of
Ong that he'did not build or improve for the purpose of sale.)
❑I, as owner -of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm that 16ere is a construction lending agency for the perfdr-
i1 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
mance of the work lot which this permit is issued (Sec. 3097, Civ. C.).
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
Lender's Name
tractor's License Law.)
Lender's Address
01 am exempt under Sec. B.8 P.C. (Attach Certificate).
USE OF PERMIT
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�;�;aONSTOUCTIO��ay srERvicgEBIL :
Date Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certily I have read this application and state
FSB
that the information given is correct. I agree to comply wdh all state laws and county ordinances relating to
WORKERS' COMPENSATION DECLARATION: I hereby alfirm that I have a cedilicate of consent to self -insure, ora
building construction, and aulhorize a'epresenlalive of the C-unty of Riverside, Department of Building and Safety
s
toenterupon,ltie� prope(jft-ty lo,whic,/�tI have applied for this permit for the purpose of making inspections.
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
� f
•j rr2
&i J
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❑Certified copy is hereby furnished.
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❑Certified copy is filed with the County Building Inspection Department or County _ - Department.
Signature ol'Applicant or Agent - _ Date
END -
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI)hA
y yr
i { \NT VNTIARE E
ESS' r. '
Box 780
,CITYICOMMUNITY/STATE/ZIP
.LA QUINTA CA 922530000 y 30000
JOB SIITEADDRESS/SPACE
49992 .AVE VISp A YONITA
CITY/COMMUNITYISTATEIZIP
LA QUI NTA CA 922530000
BOK
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01 "4496 2
4:
Oil
TRACT NAME
NAME
�y'
�L y� }� JOINTVENT
L.FiR QU ,W A� JOIN V'6:.NTUR
�HONEp
CONTRACTOR -FIRM NAME
LICNC 0
ADDRESS
CITYICOMMUNITYISTATEIZIP
PHONE p
BLDG. INSPECT
FI L DATE
ARCIENG FIRM NAME
LICNC It
ADDRESS
CITYICOMMUNITYISTATEIZIP, ,
PLAN d
PLANS EXAMINER
APPROVE DATE
USE OF PERMIT
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�;�;aONSTOUCTIO��ay srERvicgEBIL :
px�EMp
V0
.{S2 ZON
FSB
SSB
SSB000 000
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IND
IND
ZONEORDN
LOOT SZ
END -
SIDE
0000
APPLIPRMT q
its+ idlct
PS PATE
a `y"0 �i i'i
35165 � � 6/1
ELECTRICAL
FEE
$13.00
TOTAL- .
FJE E
CA
I CK
NC
I COTIN,TEERR Ell y{
COUNTER L.U.T:Vt
E L E C: T R i C` A L P E R M i T
TOTAL. PERM -IT COST IS $13.00
.ELECTRICAL FE -X COMPUTATIONS * .Permit Fee '(if applicable)
TEMP SVC-Temp/Constr Svr zY . 'Temp Use Print tN.. Add'I Palest 0
FORM 284.208 (11.81) I f SPECTIOR
FE5FkEi $10,00.
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.
P'
ADDITIONAL INFORMATION
_ 4
'
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
PSL
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
APPLI
LCA4A� I Y'iMl'. JOINT VN14Tf'lRi: r
ADDRESS
BOX 780;. .
CITYICOMMUNITYISTATEIZIP r
LA gi.lxNTA CA 922530000
E ADKRESSISPACE
4 S AVE VISTA BONiTA'
WKS,
C``ITYqIICOM(yMM1U1N''IITyTYISTy-Ay!!TEIZIP �nq� g '
.. 6»Y'i 'ui�1J.6i' C�` 6�w1o7UUU0
BOK
x 31
PAG 'PRC
710
064
C
4
TWN
.
RNG
000
SE
00
S
TRACT: LOT
MODo
ri
SB
,TRACT NAME ,
'L�' + !
�l'9 R'd Y'! J..-�JOSN YItl I U�'RHONEp
_ CONTRACTOR. FIRM NAME
LICNC p
ADDRESS -
I CITYICOMMUNITYISTATEIZIP
i PHONEp ..
i
BLDG. INSPECTOR
FINAL, DATE, . '
ARC/ENG FIRM NAME
LICNC p
ADDRESS
CITYICOMMUNITYISTATEIZIP
_a
PLAN p'
PLANS EXAMINER
APPROVE DATE `
USE OF PERMIT
.•"TEMP' -. ONSTRAJCTION SERVIW
B0
R N -
FSB.,
Ri N
UBilU
.a Bo
A
FRI A/
t ZONE ORD p,
LOTSZ
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-END
aSfPF�
351 6t
Y
1
TOTAL .
FEE
CA, I CK NC I COUNTER B.I. COUNTER L.U.T.
t
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Figs & 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
IDA
Fireplace T.O.
NO
ADDITIONAL INFORMATION
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
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
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