TUP 008476County of Riverside
Department. ol Buitding and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State 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: 342-8271 Ph: 922-2670 i\
This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be tomplel,A 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 permit44'ssued. I
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
License Class Lie. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers
OWNER-BUJLDER DECLARATION: 1 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
deemed revoked.
reason. (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct. after,
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 building structure, scaffolding, falsework, or
" 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. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
'penalty of not more than five hundred dollars ($500).):
C.A.C.)
❑ 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 sate (Sec. 7044, Business and Professions Code: The Contractor's License Law
Safety, 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
E] Division of Industrial Safety Permit No.
his own employees, provided that such improvements are not intended or offered for sale. II, 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
FS
build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance of
RSB
the work for which this permit is issued (Sec. 3097, Civ. Q.
I.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec7044.
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 contractor(s) licensed pursuant to the Contractors
Lender's Address
License Law.).
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
E] 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 property 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 state that the
information given is correct. I agree to comply with all slate laws and county ordinances relating to building con-
E] 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 I have applied for this permit for the purpose of making inspections.
n Certified copy is filed with'the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
Dale Applicant
Print Applicant/Agent Name
APPLICANT NAME (L, F, MI)
ADDRESS
CITY/COMMUN(TY/STA I*ZIP
1 j 7' `�
JOB*SITE ADDRESS/SPACE
�2 D
CITY/COMMUKITY/S ATE/ZIP
,rt irl s,'?il
eRCC
B K I PAG'
s
-
TWN
RNG
SE
S
TRACT
-
LOTMOD
SB
TRACT NAME �"
OWNER NAME (L, F. MI)'�
CONTRACTOR -FIRM NAM =✓
ADDRESS
C I TYCO M M U N I TY/STAT E/Z I P
PHONE p
LICNC q
ARC/ENG FIRM NAME
ADDRESS
CITY/COM MUN ITV/STATE/ZI P
PHONE N
LICNC p
USE OF PERMIT
C� ri .- uS.e . S e czo
BL 1
1 ZO
FS
B
SSB
RSB
OFC
ZONE ORD n
LOT SZ
END
SIDE
APPUPRMT q----- -
- PS __s
DATE
008.476
i
T �
1
aja . �t)'da-al
TOTAL
FEE
INarct—IVKJ %-urT
008476
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION DATE
t'r
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
Goioge Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
_ .F
ADDITIONAL INFORMATION
r
—... .� » .�. .». _ .r .., .» ..�._ __r_ _ �.....�.. �r __.....
------- --------. - --
,
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
•1-3 •Finish Grade- — •--- -� _Y _.r. _-s ----+- --... ...___
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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
'P/l
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 1 -
e=
29A Grounding Wire
298 Bonding
30 Fixtures .�' • w' - �`
A
31 Service
32 Final
STREET NAME
I