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25826 (SFD)r LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. E, OWNER -BUILDER DECLARATION: I hereby alfirm that I am exempt from the Contractor's License Law for 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 I (Chapter 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 ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the i- structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlraclor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov- Ing that he did not build or improve for the purpose of sale.) ❑I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- ; tractor's License Law.) 01 am exempt under Sec. B.8 P.C. (Attach Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, ora certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.). ❑Certified copy is hereby lurnished. ❑Certified copy is filed with the County Building Inspection Department or County Department. NI RIU CTClAMEI- tJ 1& VDRCSBOX 78 0 PERMIT APPLICATION d(]T8�(§LTCryy1AQ�1�R19�lR�TEYS�(S$I'fS�PACE A�DRUGAy„ryArr��g 'Hf'CO AVER�VC» j'j r'7CA Ef LIi� x.1.1. 1�1TEIZIP nn 9422530000 OJ R County of Riverside U92 Department of Building and Safety Me 4080 Lemon St, 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Slate Street 227 North "D" 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: 8497312 Ph: 6584464 Ph: 657.3898 Ph: 342.8271 Ph: 9222670 This permit becomes void if work not commenced within 180 days from dale of issuance. OR, if work has beer suspended or abandoned for a Perlee of 180 days. PEr�N�p: l,•.��{ �y y 11 r7 A r LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc- ing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. E, OWNER -BUILDER DECLARATION: I hereby alfirm that I am exempt from the Contractor's License Law for 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 I (Chapter 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 ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the i- structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlraclor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the owner -builder will have the burden of prov- Ing that he did not build or improve for the purpose of sale.) ❑I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con- ; tractor's License Law.) 01 am exempt under Sec. B.8 P.C. (Attach Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, ora certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.). ❑Certified copy is hereby lurnished. ❑Certified copy is filed with the County Building Inspection Department or County Department. NI RIU CTClAMEI- tJ 1& VDRCSBOX 78 0 tlT(CC ^iTrJVT'T ZIP + A 922530 V N n d(]T8�(§LTCryy1AQ�1�R19�lR�TEYS�(S$I'fS�PACE A�DRUGAy„ryArr��g 'Hf'CO AVER�VC» j'j r'7CA Ef LIi� x.1.1. 1�1TEIZIP nn 9422530000 OJ R M� 0 U92 " Me 00 S W TO V V V Vb5 U i M SB TRACT NAME Jy NNNT V6y4T PHONEpWHERWy WNDENFlCM10ORATION L3'r,�,,5672 419VI EISENHOWER DR Ucot fflywZIP CA 922530000 PEr�N�p: l,•.��{ �y y 11 r7 A BLDG. INSPECTOR FINAL DATE A//RCIENG FIRMfaNAME LICNC p ADDRESS CITYICOM M UNITYISTATEIZIP PLANA La EXA ER APyROVE DATE C/p UYWff-DWLG 4 ATT 4ARAGE l! bo 00Z ! 1ORD FSB VVgii WO OU'D YOD ZONE N LOT SZ END CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be com- pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for which this 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: II. after makingthis Certificate of Exemption. you should become subject 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 leet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure. scaffolding, falsework, or demolition Or dismantling thereof• will be more than thirty-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. ❑Division of Industrial Safety Permit No. CONSTRUCTION LENDING AGENCY: I hereby allirm 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 Lender's Address CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the int,Ormation given is correct. I agree to comply with all state laws and county ordinances relating to building Construction. and authorize a representative of the County of Riverside. Department of Building and Safely to enter up�' A�ropert or wnic ave applied for this permit for the purposeoff making'ns�ctfon� X.......�. ✓C1 �- Signature of Applicant or Agent Date Print Applicanl/Agent Name VOIC1,117005 ESTIMATED CID 1 05 27kT82 � PLAN REV FES 25826 TOTAL . FEE $163.47 CA I CK( I NC COU E I. COUNTER L.U.T. PERMIT FOR STRUCTURAL PLAN REVIEW TOTAL. PERMIT COST IS $163.47 CONSTRUCTION ESTIMATE (NOTEi Not to .be used as property Description FCC Group Type Sq Ft PRIMARY DWL.G 101 irk -3 WOOD 1390 SECNDRY PRIPAR 436 M-1 WOOD 440 East Plan Rev eco based on Total Estimated Val,"tn of FORM 284208 (1181) INSPECTOR valuation) Rate Valuation $9160 $3364 10$4004 $42365 :i s z $163.47 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System I 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 ; 1 I 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 STREET NAME ___