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25650 (GRD)' PERMIT APPLICATION ❑ LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- iig with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con- struct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law fChapler 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex- empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- mit subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sate (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 does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion. the owner -builder will have the burden of prov- ing that he did not build or improve lot the purpose of sale.) ❑l, 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 properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- tractor's License Law.) ❑I am exempt under Sec. . B.& P.C. (Attach Certificate). WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -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 filed with the County Building Inspection Department or County Department. APPLICANT HORN, AMDAN County of Riverside F`TMONUTEAD)URT CA 922600000 gft[13RESSISPAC9 AVE CARRANZA ` Department of Building and Safety 7,.74W�#IdtItl 4080 Lemon St. 2nd Floor 135 W Alessandro RdwRm. 203 880 N. State Street t- •' 227 North "D" Street 46.209 Oasis SI. Rm. 310 160 N. Broadway Riverside. CA 92501 Banning. CA 92220 Hemel. 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: 9222670 This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has beer suspended or abandoned for a period of 180 days. wit ❑ LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- iig with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law lot the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to con- struct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law fChapler 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex- empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- mit subjects the applicant to a civil penalty of not more than five hunderd dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sate (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion. the owner -builder will have the burden of prov- ing that he did not build or improve lot the purpose of sale.) ❑l, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- tractor's License Law.) ❑I am exempt under Sec. . B.& P.C. (Attach Certificate). WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure. or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.). ❑Certified copy is hereby furnished. ❑Certified copy is filed with the County Building Inspection Department or County Department. APPLICANT HORN, AMDAN OEM 1638 F`TMONUTEAD)URT CA 922600000 gft[13RESSISPAC9 AVE CARRANZA 61TAPONIMUN171Ci8T'A'LEIZIP CA 922530000 7,.74W�#IdtItl 1704 � �"" W80 Jule Its 'U74$ 0 0 q 14,021 1 wit SB SUV'AT.AO 426, BLK-285 Pl{ fft"ME (L€Y N PHONE N VF'[J4J4 PfJJQ Ni40RN Lro ".5436 1 URs 1638 Pv4`1OrrDVES19re1TPr CA 922600000 IN4'"'568-1 048 BLDG. INSPECTOR FINAL DATE ARC/ENG FIRM NAME LICNC N ADDRESS CITY/COMMUNITY/STATEIZIP PLAN N PLANS EX MINER APPROVE 96TE .T-- 3—r,7— CggY� FIISgLL. g16VArIffiNGp-�390 00 RAN oR'0 OTU gg OVA 10 f�g� TI) p rND ZONE ORDN I LOTSZ 061130 011x(•] CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- pleted it the permit is for one hundred ($100) or less. I certify that in the performance of the work for which (his permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensa- tion Laws of California. Date Applicant NOTICE TO APPLICANT: If, alter makingthis Certificate of Exemption, you should become subjecl to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in Connection with work authorized by this permit, and that no buildingstructure. scaffolding, falsework. or demolition or dismantling thereof, will be more than Mirly-six (36) feet high. (Chap. 3.2. Grp 2, Art 2. Sec 341. Title 8. C.A.C. ). ❑As owner -builder. I will not employ anyone to do work which would require a permit from the Division of In- dustrial Safety. as noted above. unless such person has a permit to do such work from the division. EJ Division of Industrial Safety Permit No. CONSTRUCTION LENDING AGENCY: I hereby allirm [hat there is a construction lending agency for the perlor- 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: 1 certify I have read this application and stale that the information given is correct. I agree to comply with all state laws and county ordinances relating 10 building construction, and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon the h>�perly for which I have applied for this permit for the purpose of making inspections. ' $ naturd" of`Applicant or Agent Date Print ADolicant/Anent Namo TUM720 CTiL 104/267b2 26772 / GRADING FLAN REVIEW FEE 25650 1 TOTAL . FEE 0 CA CIX NC COUNTEW B.I. I� COUNTER L. U.T. 7 f PERMIT FOR GRADING PLAN REVIEW TG'rAL PERMIT COST IS $15.00 of Lour 0 CU YDS -Cuts 0 Fill[ 390 Total Movedi 390 Gradinq Plan Rellif1.ew Fee (based an cubic yds Cut and Filled) ist $15.00 'ORM 284.208(11-81) INSPECTOR NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 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 10A Fireplace T.O. NO ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Loth 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 PSL REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 . Final STREET NAME