001814 (SOL)TE/ZIP
BOK-
PAG RdC [P
.TRACT_ -1 1 LOT
TRACT NAME
OWNER -NAME (L, F, MI)
/,A If
CONTRACTOR -FIRM NAME
44
ADDRESS
'CIT)'!COMMUNIfY/STATE/ZiP
PHONE
NAME
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TWN RNG I St
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LICNC 0—
ADDRESS
i CITY/COMMUNITY/STATE/ZIP
PHONE # LICNC #
USE 0 P�E.-I_
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Countrof.Riverside
06p6rfifierff o Building
andSafety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Am. 203, 880 N. State "S�' et}A"; :
227 North "D" Street 46-209 Oasis St. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning, CA 92220 Hemet. CA
R
- Perris. CA 92370 Indio. CA 92201 Blythe. CA 92225
Ph: 787-6146 Ph: 849-7312 Ph: 658-4464
'u
Ph:. 657-3898 !h: 3421-8271 Ph: 922-2670
I OR: work has:been
This permit becomes void it work not commenced within 180 days from date of iss if
nce'
suspended or abandoned for a period of 180 days.
"IICENSEO CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comme'incing'
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
Section 7000)'01 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, I
'License
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
Class 'Ilq Lic. Number
Date Applicant
4aleContractor
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption• you should become subject to the Workers'
NER-ILDER 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.
,.I prove. 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 Contractoes License Law (Chapter %(commencing
1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
,;' ith 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
feet high. 3.2. Grp 2. Art 2 Sec 341, Title IL.
the allege exemption. Any violation of Section.7031.5 by any applicant for a permit Subjects the applicant to a civil
penally of not more than five hundred dollars (M).):
demolition or dismantling thereof, will, be more than thirty-six (36) (Chap
C.A.C.)
1, as owner ol'thi 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 Division of Industrial'
Work
S ucture is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
'structure
Safety, as noted above. unless,such person n has a permit. to*do such from that'division.
not apply to an owner of property,who builds or improves thereon, and who does such work himself or through
E) Division of industrial Sifely,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,witfiln one year of completion. the owner -builder will have the burden of proving that he did not
.FORM 284-208 (2/81)n-1
build or improve 16r' Ilia purpose of sale.). •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
�1, e"
the work for which this permit is issued (Sec. 3097. Civ. C.).
'Fn 1, as owner of the property, 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 contfactor(s) licensed pursuant to the Contractor's
Lender's Address
,wcense Law.).-..
I certify that I have read this application and state that the above information is correct. I agree to comply with all
am exempi,under Sec. B. & P.C. (Attach Certific ale)
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
COMPENSATION DECLARATION: J hereby affirm'that I have a certificate of consent to sell -insure, or a
Signature of Applicant or Agent Date .
-certificate of Workers' Compensation Insuiince, or a certified copy thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certily I have read this application and state that the
.- - . .1 1 �
information given is correct. I agree to comply with all state laws and county ordinances relating to building con -
Policy No. I Company f�? PP�....—�� Kr".,t ,
copy is furnished.
struction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon
the property forwhich I have applied for this permit for the purpose of making inspections.
. I —
hereby
I 'the County Building Inspection Department or County Department.
C rti ie copy is led with
''Certified
Signature of'Applicant or Agent Oat6% I
1 ate Applicant
Print ApolicantfAgent Name
iT.APPL APPLICANT (L. F. MI)
DATE �01
itN 7-21 IE��
ADDRESS
TE/ZIP
BOK-
PAG RdC [P
.TRACT_ -1 1 LOT
TRACT NAME
OWNER -NAME (L, F, MI)
/,A If
CONTRACTOR -FIRM NAME
44
ADDRESS
'CIT)'!COMMUNIfY/STATE/ZiP
PHONE
NAME
'R
a
TWN RNG I St
mot)
SB
A
LICNC 0—
ADDRESS
i CITY/COMMUNITY/STATE/ZIP
PHONE # LICNC #
USE 0 P�E.-I_
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RSI1
IEND
TOTAL
FEE
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4
.FORM 284-208 (2/81)n-1
�1, e"
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAN-APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums & 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
Goroge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
-
`
-------------------
ADDITIONAL INFORMATION
-
- _
y ',
-
'
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
-----•------- PLUMBING' APPROVALS -------------------
15 Ground Plumb
16 Water Piping
•J D
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Q S
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
r .
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner. Q Architect __ _ Contractor_
AI/h/r0 Address___ Addressv S'ft�✓�
ddress�aa� __—_ 4�
S�
ty_p
Gty City--- c�1��
r q�
'C.�9— .
Phone ��=g� Phone _ Phone —
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
oC
W
Z
Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
3
shall not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W
O
without an encroachment . permit.
NOW, therefore, it is agreed that I (we) -will not occupy said property and will not cause said property to be occupied until I (we) have -
'
complied with all laws of the County of Riverside and the State of California governing said property.
DATE /� ��-C-II/ -- SIGNATURE OF OWNER AND/OR AGENT --
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
�q� I SPACE NO.
//
�/ j� / 1 USE OF STRUCTURE
Ave
3"je(A Aa 1'
JOB ADDRESS SINGLE FAMILYDUPLEX
r,
LEGAL DESC O OF PROPERTY —? lf✓
f
ZO
_�_—z
J� APARTMENTS AGRIC.
W
_ '�—
INDUSTRIAL C
Q4a44(OMMERCIAL
S
COMMUNITY . ALTERATIONS
_>
G
Z
NO. OF SUBMITTED PLANS — USE OF PERMIT 04F ft
us Q
CASE NO.
Z
NO. OF PARKING SPACES REQUIRED — — NO. OF BUILDINGS NOW EXISTING
Q
ZONE,9�Z —% SETBACKS: FRONT SIDE REAR
J Co
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATE /D oSIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: YES O NO. ❑ NO. OF FEET— -
,u-
CURB AND GUTTER REQUIRED: YES O NO ❑ STREET
H
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
cc
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
J W
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION — REMARKS
rn FLOOD CONTROL
F
W AIR POLLUTION
DIV OF HWY
H
c cc YOUR PROPERTY MAY BE SUBJECT TO
—
Lu =a FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD:
284 199A 9/74 CANARY—FILE, PINK—APPLICANT