12-1357 - Fire ReleaseRIVERSIDE COUNTY FIRE DEPARTMENT
IN COOPERATION WITH
CALIFORNIA DEPARTMENT OF FORESTRY
AND FIRE PROTECTION
e� ITX Riverside County Fire Dept.
77933 Las Montanas Rd. Ste 201
'` coUNTY Palm Desert, CA 92211
RIVERSIDES :.,; r
760-863-8886 Fax: 760-863-7072
Inspection Line:
THIS INSPECTION RECORD MUST BE AT JOB SITE
WITH THE APPROVED SET OF PLANS
Owner VS j VJ0 � P's a cP Date 7/% 13
Location 5�- 6 3 o AVev d d Ci Tu n -z d
Case No. [�� 13 _R CIS
Sprinkler Company se FI re
Un and Visual Date Inspector
(Joints and Thru ocks Must Be Expos
Inspector
(200 PSI For 2 Uca.'Prior to Inspection Time)
Irr('er
n Flu h Date Inspector
1Aq, J
Overh d Stat Date Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
4e, c�re-�6 771191276t#
Overhead Final I tbate Inspector
Installer
U erground Visual Date Inspe or
Thrus (Joints an t Blocks Must Be Exposed)
Undergro d Static Date Inspector
(200 PSI For 2 H Prior to Inspection Time)
Underground Flu s Date Inspector
Extinguishing System Insta r
Final Date Inspector
Fire Alarm Installer
Final Date Inspector
Riverside County Fire Department Fire Protection Planning Section
Riverside Office: 2300 Market St., Ste. 150, Riverside, CA 92501 Ph. (951) 9554777 Fax (951) 9554886
Palm Desert Office: 77.933 Las Montanas Rd., # 201 Palm Desert, CA 92211-4131 Ph. (760) 863-8886 Fax (760) 863-7072
Fire Department Clearance/Release
e
Date:
To:t (�[t.c t►.f �i�
Fax:
Tract/Parcel Map #:
Permit/Lot #:
Job Site Address: 61610 XJ�,.r IZA cle.C'4W84
City, State, Zip Z'4-- 0_ "t.47A-
Final For Recordation
❑ Final for Alarm System
Final for Fire Suppression System
❑ Shell Final Only (No Tenant)
❑ Release For Residential Sprinkler Installation
❑ Building Plan Check Fees Paid, Water Requirement Met- if water applicable
❑ Building Plan Check Fees Not Paid
❑ Residential Sprinkler Plan Check Fees Paid
❑ Residential Sprinkler Plan Check Fees Not Paid
❑ Other Fees
❑ Fees Not Required
If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for
further assistance. 11-1
Print Name of Plan Reviewer/Inspector Approved Release
Sent By: Print Name .
Form C—Revised 3/01/2012