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25649 (SFD)County Of Riverside Department of Building and Safety 4080 Lenon S6 2nd Floor 135 N. Alessandro Rd. Rm 203 880 N. State Street 227 North "D ' Street 46.209 Oasis St. R. 310 160 N Broadway Riverside. CA 92501 Banning. CA 92220 Hemel, CA 92343 Pe s. CA 92370 Indo, CA 92201 Blythe. CA 92225 Ph: 787-6146 Ph 849.7312 Ph 658.4464 ' Ph 657.3898 Ph 342.8271 Ph922.2670 This permit becomes vDid if work viol commenced within 180 days from date of issuance. OR. it work has beer suspended or abandoned let a penoo of 180 days Y e 0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (comment- pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. permit isI shall not employ any person in any manner so as to become subject to the Workers' Compensa- y1p! V it tion Laws alifornia. s off Cal aDate --- -- — ---- - --- --- _Applicant -- - -- ------- !MMM E (L,MN 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 Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con- deemed revoked. struct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires The applicant for such BLDG. INSPECTOR permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: (Chapter 9 (commencing with Section 70001 of Division 3 0l the Business and Professions Code) or That he is ex. Of hereby certify that no excavation live (5) or more leel in depth into which a person is required to descend. will empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- be made in connection with work authorized by [his permit, and that no building structure, scaffolding, falsework, mil subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).): or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2. Art 2. Sec 341, ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the Title B. C.A.C.). structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License OAS owner -builder. I will not employ anyone to do work which would require a permit Irom The Division of In - Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or duslrial Safety. as noted above. unless such person has a permit to do such work from the division. through his own employees. provided that such improvements are not intended or offered for sale. ff, however. ❑Division Industrial Salely Permit No. the budding or improvement is sold within one year of completion, the owner -builder will have the burden of prov- of ing that he did not build or improve for the purpose of sale.) ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, 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 contractorts) licensed pursuant to the Con- tractor's License Law.) Of am exempt under Sec. _ _— B 8, P.C. (Attach Certificate). WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.). []Certified copy is hereby furnished. ❑Certified copy is tiled with the County Building Inspection Department or County __—_.Department. APPLICANT NAME (L, F, MI) HORN, DAN VURs 163© rv4121i uW1.A,VRPT CA 922600000 b9t46%I38RESSISPACE AVE CARRANZA VACOIRW1NMT70.AZIP CA 922530000 1211 Y'd 3�gy TWN Y e 0 U9 S �'17�y4 � VYO 00ID Y022 y1p! V it SB UU&I",283 , SCV LAQ #26 !MMM E (L,MN PHONE M J9Jq"AVfffl N"3R N LIS8'3115 436 13ORs 1638 PTAU04WDNl3 S5F_1RPT CA 922600000 7911Y-568— 1 0 48, + N BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC 11 ADDRESS CITYICOMMUN ITYISTATEIZIP PLAN MP EXA I R APP OVE DATE . of $Z I15Ij,9f iRERMI� ATT GAR Ri 0ra.1t R2FN 0:1181 1 0U 5 1 0JIU 0Fflo 4 1D ZONE ORD N LOT SZ 0 515 CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency lot the perfor- mance of the work for which this permit is issued (Sec. 3097. Civ. C.). Lender's Name _ Lender's Address CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale that the information given is correct. I agree to comply with all stale laws and county ordinances relating to llding construction, and authorize a representative of the County of Riverside. Department of Building and Safely Ic .to enter uponerty for w is have applied for this permit for the purpose oLmaking inspecljons. X C c' `z-- r�..._ Signature pf Applican or Agent Date �,.. � Print Applican)/Agent Name APPLIPRMT 11P 00016718 ESTIMATED DAT /� r li A ^ C 04/20x2 (lam Y�tiJ hW /4ljY �JJ PLAN REV FEE 1 / TOTAL FEE ' CA CICx NC I COUNTER L / COUNTER L.U.T. / 7? PERMIT FOR STRUCTURAL PLAN REVIEW TOTAL PERMIT COST SS $151.77 You (must sloe the following Departments (if listed) for concurrence BEFOPE a Permit can be issued t ----- Description ------------------------------------------ Dept to Sega HOLD- HEALTH HOLD- ROAD CONSTRUCTION ESTIMA'rE (NOTE] Not to be.used as property Description FCC Group 'Tyyppe Sy Ft PRIMARY DWLG R-3 401> 1211 SECNDRY AIRCON R--3 R 1211 SECNDRY PRICAR M-1 WOOD 320 Est Plan Rev Feer based on Total Estimated Val'tn of INSPECTOR valuation) Rate Valuation $27.60 $ 33423 $2.20 $2664 $9.10 x/2912 *38999 ist $t51.77 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs 8 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 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. 0 43 Final 10A Fireplace T.O. ❑ No ADDITIONAL INFORMATION _ 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 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 :} PSL P/ ELECTRICAL APPROVALS 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final I STREET NAME