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26707 (GRD)APPLICANT NAME (L, F. MI) HORN, DAN BoxBox �y 1630 In^ICOyM�MUN7I�TYISTAJ€ IIP�y_ _ 1� .y ^ ..A 1N 11EJc. IR 1 CA 7L2�1 ��V(11f Sf DRESS/SPACE FtiUC C:ACtRANZA CifYICO M nl PTEIZIP I_A leiiffyA CA 922530000 O PAG PRC C Y�4 211 006 TWN itl)40 gNlj 5E S iti] i1 gb o 0 tl V6 2 9 I 16of 1 SB TRACT NAME .3CV LAG 026 1+1-K-205 PB19f l,llE (L@6�,A))N PHONE N , VpRE�SS 16 n Ium1cxoRIlnAsT (IF F NE N.�ct� LG. DINSPECTOR 4 _.. ,.14 SJ _" 04G! B FINAL DATE ARC/ENG FIRM NAME LICNC N ADDRESS CITYICOM M UN ITYISTATEIZIP PLAN N PLANS EXAMINER APPROVE DATE USE O{F PERMITT ^ ry y� ,+, �y r IiIg) L.(, � VI's7RAI/,'y 4) 0 �&Z71'11 !'S AON U G." gE: ZONEORDN LOT SZ Et�D SIDE AF'PLICA1-10114 FOR �:ri�.11f;l"!}li;�i.. C'Li-'40 C L'Vll:.W -T H I is AN APPLIGATION i.') N L f You rust i ee the following Departmentsi 0.f lisied) a Permit can be izsoed: hif1L1? Description_._.�...._._...�.._._�..__....__.,.....,..,_._..__.._,_.___.._....._,.._.._._.._........_.._,._.... 1, 0r)-1) FPRM 284-208 (11.81) INSPECTOR 133d1s 7/d I/d 3NI7 Ala3dond iO aV3a ourlrl-1 I!d )UD1 NOI1VD01 R 3ZIS W31SAS 30VM3S MUM ZE a:)InJaS IC saJnlxij OE 6uipuog 96Z aJIM 6ulpunoJO V6Z 6uuiM 6Z aDu DJlu3 a:)InJaS 8Z Ilnpuo7 LZ alod JaMod 9Z SIVAOaddV 1V71a17313 IDUId SZ ISal SDO 9Z a:)inJaS JaIDM EZ Jaua4OS JaIDM ZZ JaloaH JaIDM LZ lamas 06 IDsodslo a6DMaS 6t SIUM 91 gwnld g6nod Lt 6uldid JaIDM 91 quJ^Id punoJO SL 1 SIVAOaddV ON18Wflld IDUId bl (UMolg) 6uilla' JZL (sIIDB) 6ulIIaJ Ut (stIDB) SIIDM VL anlDA ,.d,. 13I41 NOI1V`InSNl apDJO yslulj EL IIDm/,J(3 VZL 41D1 IDUJOIUI ZL gjD1Joualx3 It NOI1VWbOANI IVN0I11aaV N 10 El •ol a:)oldaJlj VOL I°YId EY '1'd a:)oldaJ! j of POOH IDpJawwoJ Z7 IIDM aJr j 960JDO 6 a:)Ina(3 uoil:)alao ajOWS Ly sluM 8 JadwopaJlj oy 6ulwoJj L aouDJOaID •IddV 6E )had food 9 JossaJdwOD 8E swoag Puog S JIV uollsngwoJ LE sjholg InoJO p slallno 8 slalul 9E laalS E •IJDdwo' aDown j gE apDJO gDIS VZ spno g swnuald K swJj IF s61d 4 walsAS uO!IDllluan EE Tog Ias 1 SIVAOaddV IV71NVH,3W SIVAOaddV ONIQIIAB d01D3dSNl 1 31V0 NOI1Vd3dO 'ON dO1J3dSNl 31VG NOI1Vd3dO 'ON PERMIT APPLICATION County of Riverside �•.. Department at Building, and Safety 4OV0 Lti.�f SL Ind Floor 135 N Alessandro Rd Ran203 Rag N. Slate Street 227 North "P' Street 46-209 Oasis St. Ran. 310 160 N Broadway ' /I 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 This permit becomes void it work not corpmenced within 180 days tram date of issuance, OR, it work has beer suspended or abandoned for a period of 180 days CERTIFICATE OF EKEMPIION FROM WORKERS' COMPENSATION INSURANCE. This section fired not be com- ;EN5ED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (comment- 1 Pleted it the pormn is for one hundred IS100) or IeSS: I Cerllfy that in the performance of the werK far which this with SeclioR TOgQ) of Division 3 of the Business and Professions Code, and my license is in full force and effect a Permit I6Issdr'd, 1 shafk n0I employ any person in any manner so as to become Subject to the Workers' Compensa- i licln Laws of California; 1 Date .___ApplicaM NOTICE TO APPLICANT: If alter makingthis Certificate of Exemption you should become •tilt f APPLICANT NAME (L. F, MI) DAN ADOFIPSS PDX 1638 CITYICOMMUNITYISTATEIZIP PALM DESERT CA 922600000 JOB SITE ADDRESSISPACE - 54120 AVE CARRANZA CITY f COM MU N iTYISTATE0 P LA GUIN'TA CA 922530000 BOK 774 PAG ?11 PRC G 006 4 TWN RNG SE 000 00 5 TRACT 000000 L07 002 5 011 a I TRACT NAME SCV LAQ #26 BILK•-285 OWNER NAME {L,F,AIt) HORN, DAN PHONE N WTOR-FIRM NAME AVON HORN LICNC N 1335436 ADDRESS PDX 16,38 CiTYICOMM UNITY?STATF/ZIP PALM DESERT CA 922600001) PHONE N 714--566-1048 BLDG. INSPECTOR FINAL DATE ARCIENG FIRM NAME LICNC 9 ADOFIESS CITY ICAM MU N ITYI'UTATE tZl P. PLAN N PLANS EXAMINER APnRUVE DATE USE OF PERMIT DWLG :� I ` GpR AGE BL ZON ofR1 FSB SSB SSB 020 010 005 RSB 010 OFC IN ZONE ORD N LOT SZ END it0"o SIDE 01Cf�! Print Applicant/Agent Name APPLIPRMT N PS DATE ` 6 7 0 7 0001 t,730 :: 1)4r 20/8Z:- i. TOTAL . FEE ' CA CK NC COUNTER B.I COU 14TER CUT APPL,IC;ATION FOR STRUCTURAL PLAN REVIEW T H I S I S A N A P P L I C A -T T O IN 0 N L Y You mu%t see the following Departments (if listed) for concurrence BE URE a Permit can be issued; Description Dep HOLD-- R0A� HOLD- 14E.AI..TF��,,� -2. /,F 1264-20e(11-81) ASSESSOR