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26707 (SFD)ERMIT APPLICATION County of Riverside Department of Building and Safety 40 ;fSI. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street 227 North -0' Street 46.209 Oasis St 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 '� Y Ph 657.3898 Ph 342.8271 Ph 9222670 This permit becomes void if work not commenced within 180 days from date of issuance. OR, d work has beer alrspended or abandoned for a period of 180 days SE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. This section need not be com- LICENSED CONTRACTORS DECLARATION: I hereby afllrm [hat I am licensed under provisions of Chapter9 (comment- e pteted it the permit is for one hundred (5100) or less. I certify that In the performance of the work for which this Ing with Section 7000) of Division 3 0l the Business and Professions Code, and my license is in full force and effect. 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. Qk Dale ---- —----Apphcant ---------- 000 NOTICE TO APPLICANT: II. after making this Certificate of Exemption. you should become subject to the Workers' OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law for 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. strucl, 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex- 01 hereby certify that no excavation five (5) or more feet 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- mit subjects the applicant to a civil penally of not more than live hunderd dollars ($500).): be made in connection with work authorized by this permit, and that no building structure. scaffolding, talsework, ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art 2, Sec 341, Title B. C.A.C.). structure is not intended or offered lot sale (Sec. 7044, Business and Professions Code: The Conlraclor's License OAS owner -builder, I will no[ employ anyone to do work which would require a permit from the Division of In - Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or dusmal 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 no[ intended or offered for sale. If, however, ❑Division Industrial Safety Permit No. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prbv- of ing that he did not build or improve lot 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 properly who builds or improves thereon, and who contracts lot such projects with a contractors) licensed pursuant to the Con- tractor's License Law.) 01 am exempt under Sec. __ B & P.C. (Attach Certificate). Date _—_—_—Owner__ _ 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. ❑Cenified copy is filed with the County Building Inspection Department or Counly ____ Department. APPLICANT NAME (L, F, MIT HQRN� DAN ADDRESS BOX 1638 CITY/COMMUNITY/STATEIZIP, PALM DESERT CA 922600000 JOB SITE ADDRESS/SPACE w. 54120 AVE CARRANZA C I TY I CO M M U N I TY I STAT E IZ I P LA QUINTA. CA 922530000 BOK PAG PRC C TWN RNG SE S 774 ?11 006 A 000 00 TRACT LOT 000000 oo / MOD 011 SB TRACT NAME SCV LAW f26 ItLK-28 F ,E (L, AN OWNER HORN, (CONTRACTOR PHONE# -FIRM NAME DANAVON HORN LICNC If 335436 ADDRESS BOX 1638 C ITYICOM M U N ITYISTATEIZ I P PALM DESERT CA 922600000 PHONE# 714-560-10413 BLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNC N ADDRESS CITYICOM M UNITYISTATEIZIP PLAN N PLANS EXAMINER APPROVE DATE USE OF PERMIT DWLG 6 ATT GARAGE BL 00 ZON R1 FSB 020 I SSB 010 SSB 005 RSB 010 OFC IND ZONE ORD # LOT SZ END 0050 SIDE 0100 CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the perfor- mance of the work for which this permit is issued (Sec. 3097, Civ. C. ). Lender's Name —-----_-�---_—__M__--_ Lender's Address CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate that the information given is correct. I agree to comply with all stale laws and county ordinances relating to building construction, and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon the properly for which I have applied for this permit for the purpose of making inspections. X Signature of Applicant or Agent Dale Print Applicant/Agent Name APPLIPRMT NPS {W` DATE �1 0 00016730 XE'3 0A/20/Eic S, TOTAL . FEE CA CK NC I COUNTER B.I. COUNTER L.U.T. APPLICATION FOR STRUCTURAL PLAN REVIEW T H 15 I S A N A P P L I C A T I O N p N L Y You must see the following Departments (if listed) for concurrence BEFORE a Permit can be issued i Dostcrip t i on --------------------------------------- Dep t�o �+Se MOLD- HEA17 �/ .,0 FL 284-208 (11-81) ASSESSOR ' APPL1I;CAaaN�T NA_ME�(L, FF,{MI) H13R 14 D'i4N ADDRESS X 1638 Ly8 PALM u SESWT CA 922600000 "�109STE�DDRESS/SPACE AUr CARRANZA /ZIP :ICONpWA CA._ 92 ; 3 V fl 0 0 PAG RC C - TWN RON G SE S iR�cU tf 01� D92'V ff i I SB TRACT NAME SCV LAQ -026 Bi.:i(^ 285 vp,E IL6.XpN JJN��,,Y'EE'JbR PHONE # N7wp E d►AXt'kT?Y6FT N �N-C ua�i W f,436 . 96TSS 16 38 CA 922600000 48 BLDG. INSPECTOR FINAL DATE S ;ARCIENG FIRM NAME LICNC # 4 ADDRESS CITYICOM M UNITYISTATEIZIP PLAN # PLANS EXAMINER APPROVE DATE US OF PERMI I2 i.6 � Ai`T GARAGE 60 R SON . q Li q Sal q S 0 r YFAD ZONE ORD # o LOT SZ ©ff 4� `4 0100 SIDE APPLICATION FOR STRUCTURAL PLAN REVIEW T H I S I S A h A P P L T C A T 1 0 N 0 N L Y You gust see the following Departments (if listed) for concurrence BEFORE a Permit can be issued _.,....­ Description Dept to HQLD-� HEALTH 1 FORM 284.208 (1181) I NNSPKTOR 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 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 Loth 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 P/L 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