011157 (BLCK)APPLICANT NAME (L. F. MI)
Countyy
of Riverside
Department oT
Building and Safety
J 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street
227 North "D" Street 46-209 Oasis St. Rm. 310 160 N.Broadway
Riverside. CA 92501 Banning, CA 92220 Hemet, CA 92343
Pgsris, CA 92370 Indio, CA 92201 Blythe, CA 92225
Ph: 787-6146 Ph: 849.7312 Ph: 658-4464
d Ph: 657-3898 Ph:• 342-8271 Ph: 922-2670
This permit becomes void if work not commenced within 180 di's from date of issuance, OR,1if work has beensuspended or abandoned for a period of 180 days.
q.1
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Ohapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
' with Section 7000) of 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
CONTRACTOR -FIRM NAME
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: ll, 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 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.
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
[:) I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
with 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 buildin structure. scaffolding, fatsework, of
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (hap 3.2. Grp 2. Art 2, Sec 341, Title 8,
penalty of not more than five hundred dollars ($500).):
C.A.C.)
Q I, as owner of the 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
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law
a ety, as noted above, unless such person has a permit to do such work from that division.
does not apply to an owner of property who builds or improves thereon, and who does such work himself or through
Division of Industrial Safety Permit 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 Droving that he did not
bold or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.).
I,s owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name
.Sine: 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 Contractors
Lender's Address
License Law.).
I certify that I have read this application and stale 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 properly for inspection purposes.
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
Signature of Applicant or Agent Date
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale that the
Polic No. Company
Y D y
information given is correct. t agree to comply with all state laws and county ordinances relating to building con.
Certified copy is hereby furnished.
struction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon
the property for which) have applied for this permit for the purpose of making inspections.
Certified copy is tiled with'the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
Date Applicant
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
ADDRESS
YUCCA2101
CITY/COMMUNITY/STATE/ZIP
9263 0000
JOB SITE ADDRESS/SPACE
70670 BOTTLE BRUSH JQR
CITY/COMMUNITY/STATE/ZIP
LA QuINTA CA 929530000
BOK
61
PAG
1
PRC C
03
TWN
PING SE S
084J i)
TRACT LOTMOD
00000 003
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SB
TRACT NAME
OWNER NAME (L. F. MI)
SAUNDERS ROBERT I
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
-
USE OF PERMIT
DWLG ATT GARAGE
BL
U
20N
FSB
02
SSB
Ott
SSB
00
RSB
02
OFC
D4
ZONE ORO N
LOT SZ
END
00r
SIDE
01A
APPUPRMT NPS DATE0000917P9. 1 is p 1115 7
3+' V FEE $169.32
PERMIT FOR STRUCTURAL PLAN! REVIEW Cal
TOTAL
FEE
$1
INSPECTOR'S Y
PERMIT FOR STRUCTURAL.. PLAN REVIEW
TOTAL PERMIT COST 18 $169.32
CONSTRUCTION 'ESTIMATE (NOTEt Not to be used at proporjty valuation)
Description FCC Group T}► a Sq Ft Rate Valuation
PRIMARY DWLG 0001 R -3V_ 1+472 *27.60 $40627
AECNDRY PR LIAR 0012 M WD, 3 7 $9.1 $3248
SECNDRY PA 1_0 0012 M QPCP 2 0 $4.9 *980
Est Plan Rev tett• ttasod on Total Estimated VallTn of $449515 tat $169.32
2_g•V�y
a�e #I
NO. OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS.
1 Set Back
33 Ventilation System
2 Ftgs & Frm%
34 Plenums & Ducts -
2A Slab Grade
35 Furnace Comport.
3 Steel
36 Inlets & Outlets
4 Grout Blocks
37 Combustion Air
5. Bond Beam%
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
-
,
:-------=----_ _----.-:�.
f -
,� r•
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%AE'PROVALS-----------
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 y
Service Entrance
29 ,`'�1
Iiring
29A r
�t'Giaunding Wire
29B
tBonding
30
Fixtures k
31
Service
32
Final
e