001129 (CSCS)rcnmii AYYLIGRIIUN - -
County of Riverside
r Department of
Building and Safety
9250 Floor N. leCsAsand�ro Rd. Rm. 203 880 State2343 Street
227Rm. 310 N. a92225
`' �~ Perris,
Riivveers de.oCA Bann ng,• et. CA
' CA 92370treet Indio, CA 92201 Bllyyt e, CA
f
Ph: 787-6146 Ph: 849-7312 Ph: 658-4464
Ph: 657-3898 Ph: 342-8271 Ph: 922.2670
• This permit becomes void if work not commenced within 180 days from dale 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 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
CITY/CO UNITY/ST I
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: If, after 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 lot 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, after,
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 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).): Y
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 lot sale (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
M Division of Industrial Safety 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 within one year of completion, the owner -builder will have the burden of proving that he did not
build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of
OWNER NAME (L, F. MI)
the work for which this permit is issued (Sec. 3097, Civ. C.).
I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,
Lender's Name r
usiness 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 Contractor's
Lender's Address
License Law.).
I certify That I have read this application and state that the above information is correct. I agree to comply with all
1 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
ADDRESS
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 self -insure, or a
Signature of Applicant or Agent V Date
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Q.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale that the
PolicyNo. -Comparry
information given is correct. I agree to comply with all state laws and couNy ordinances relating to building con-
struction. and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon
Certified copy is hereby furnished.
the property for which I have applied for this permit for the purpose of making inspections.
Certified copy i.4-liled witty the County Building Inspection Department or County Department.
Signature of Applicant or Agent +�•,•_
ARC/ENG FIRM NAME
Date- Applicant
Print Applicant/Agent Name
APPLICANT NAME (L. F.
-
WbHUN,l, FAMILY_
CITY/CO UNITY/ST I
HWAY
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'9225301100
JOB SITE ADDRESS/SPACE
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CITY/COMMUNITY/STATE/ZIP
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TRACT
LOT
MOD B
TRACT NAME
OWNER NAME (L, F. MI)
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CONTRACTOR -FIRM NAME
'
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE p
LICNC p
ARC/ENG FIRM NAME
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ADDRESS
e
22910
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CITY/COMMUNITY/STATE/ZIP
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RANCUO
PHONE q
CA
- LICNC N
71 .iC
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C-541616
USE OF PERMIT
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END
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APPLICATION FOR STRUCTURAL PLAN REVIEW
THIS •1S AN APDL I C A T 1 0 N 0N1 Y
You rust see the following Departments (if
a Permit can be issued i
1Detcription
HOLD-
HOL D-
lixsted) for concurrence BEFORE
919 Rc;'�
HEALTH
H �
F1/?E
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APPLICANT NAME (L, F. MI)
FAMILY PARTNERSHIPa
CITY/COMMUNITY/STATE/ZIP
LA QUINTA CA 92=30000
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JOB SITE ADDRESS/SPACE1410141JAY
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Ali
CITY/COMMUNITY/STATE/ZIP
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TRACT LOT
MOD I I SB
-
TRACT NAME
OWNER NAME (L, F. MI)
SIMON FAMILY -P
CONTRACTOR -FIRM NAME
ADDRESS
`CITY/COMMUNITY/STATE/ZIP
.PHONE #
LICNC #
'ARC/ENG FIRM NAME
m. gassnuT'0'
"ADDRESS -
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fFITY/COMMUNITY/STATE/ZIP
PHONE 4 LICNC N
714-568-16651 IC -5466- I
USE OF. PERMIT '
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ZONE ORD #
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- END
1 SIDE
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TION FOR 'STRUCTURAL PLAN RE -VIEW
APPLICA
`i 1 S I. AH APP,.'1, CAT X 0 0NLY
Yau a,a t t the f allow ng Depor°toents� (if listed) for Concurrence l BEFORE
a f4l't, can be isuaudd r
4 Q .Y3» l e,sca^lption Department
RgAp .
t L ... 'ALTH
x
001129
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS '
1
Set Back
• •i
• 33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 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
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
loA
Fireplace T.O.
°O.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Loth '
12A Drywall
13 Finish Grade
INSULATION Thick „RII
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
_ ___.,_ ._____ Fi�ih►6iTiGi;FFROJAt� r---------------------
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
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32. Final