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Project hddrass CITY OF LAKE ELSINORE CONSTRUCTION PERMIT
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At Sesser s Pnrrtll -„-_ Applicant to fill in all spaces except those xithfn heavy border fines and signal!appropriate declarations_ a "=vner's vane �s� e p - PERMIT NO. TRACT tll0. LOT NO. UNIT NO.
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Address ti-r_�__... .Site jr? � ( I
Arch-Eng,��__._ i License,.b- 1yPEOFCONSTRUCTM ! NEW `- ADD A:TERATION 7 REPAIR
Address - CONVERSION - DEMOLISh __-, OTHER _ _
Contractor's Name- DESCRIPTION OF RIlt11S OF BLDG.�1�_, bC�t0 ` AP. # one
.-Pnone � 1-K 3-5-- 10 C�(1�� -- E M9in Building: ry ding'
Addressifrailing) - TYPE OFPERM:t , GRADING FOUNDATION -1 STRUCTURAL T Front Z
City License No. _ IENFNT ELECTS':A1 PLUMBING - MECHANICAL 8 Rear --��� 0
LICENSED CONTRACTOR DECLARATION , OTHER � �'T � A _ —�F
I hereby aflJrm that I am licensed under provisions or Charter 9(commencing PhUIECT DESCRlP:10N' Sy Fty�-_ _G.cupanty - - - C Right - N
with sertlon 7000) of Division 3 of the Business and or•o'essions Code,and K�'�'�--
Constru:bor type Iwo Acres - o
my irr-ensr K'1 tun force and effect. � ..,�-�- _ --- - g: L.ft � -'� G
License Class License r.+c_
Valuation jx T7 x g PIrt .Ref.#. R
Date Signature_ _ Parklnq Req./Provided E
Remarks
WORKERS COMPENSATION DECLARATION —^ T Planning Notes Q
1 hereby affirm that 1 have a Certificate of Consent to self+nsure or a Certificate. "-'- ---- M
of workers' Compensation Insurance, or a certified copy thereof (Section --- - _ _ T
3800. Lab. C.) S
Policy Na. .- Company '- - -^----•.�— _ -
GCertified copy is hereby furnished, —'
Ll Certified copy Is filed with the city Building Division. -.—`- '-`- -"- --- -- •-- - _
rDate. Applicant_ - _ - _
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION
(Tnis section need not be completer,if the permit is for arse rwridrea($100)or
less;
1 cer;lfy mat in the performance of the work for s+h,eS;hrf Permit is issued,
chats not cmptay any person many manner so as to Become subrct to the PLUMBING FEES ELEM31CAL FEES IBECHRNICAL _ _FEES Y:
workers•Compensation Laws of California. - -- - AMT.N' GODINC FEES
Date Signature__- Alrcr,Repair I__+ Generator 010-5KAl F� 5 15KW Boiler
NOTICE:11.after making this declaration,you shourd become sub;ect ;O the AUTO Wash -�- Cu! _Ld.yards
Workers' Compensation provisions of the Labor Code, __ i Construction Pole Sub.y'du must fdrthwi;h Duct-Under Ground F,Ir
rbmply wrlri SUCK Dro„srOrls CI this permit sha'I tw deemed revoked. BackffewPfeventer_� Cookin Unit _ I Duct•Struciurat y Cu.yards
CONSTRUCTION LENDING AGENCY BackfleWlrri __ 7 f 336U-3310 Pta:EtieckieeS -
r hereby affirm that there is a construction lending agency for ih�lerformance gation Pole LI fit Fan •V!'nti{atinn or the work for WhrGh Tnis permit is issued (Section 3097 C,v. C.) Cla_ifiers Dr ors OGas 13Electric _ Exhaust S stem PAuiti le 33U033t1 PH7„tFee j
Len der•s Name ,� rs 0_--__-- -_� p—�
Lender•:Address __-__ Dishwasher _-j__ Fan Eva Evaporative Cooler_ T!tatfees j
OWNER BUILDER DECLARATION Y- ---- - --i- --
Fixt� ore Traps ea. _ -L _ F.A.II. 1 Heat�ny System&Ducting
nertby affirm that Ian. oxempt from the Contra•::�r's L,rcn se t_aw iqr,he '
toucw.ng reason (Section 7031.S Business and professional Cade: Any city or �FIOOf Drains_-__ FiXtUfeS _ i f ❑1�•1QQ,�000 BTU!.�100 QGO BTU
I
county which requires a permit to construct,after,,mr;OVP,Ctm a•xn Or repair - - -*- �
any structure,prior to its issuance,also reouires file spa, rot for suer,permit Floor Sinks Outlets 336033J2 5uamaryotPermitTees
to file a signed statement that he!she is licensed pwrs'.A-t to the arov,sr,ns of -----1I-- --�—� Hood or Canopv
the Contractor's L'.cense Law(Chapter 9(tonnefur:;,.,t� Section 7000)of Gas SP,rVICe DUtIeIS T $yyj(f;lygg Y� II Type 1 C,^ T ue 11 E ' r _ Q'��f -yam
D on 3 of the Business and P(oloss,ons Code) c• :hat he/;he is exc,npt Interco tors t U t0 1GQ am S J * boding
therefrom and the basis 'or the alleged exemption. Ar.y-viola;tan of S4r-;ion .�— Meer ? p _ Refrigeration Systen: t
7031.5 by any applicant for a permit subjects ire apprr:ant :o a Civil p-Tra j Meter Ucver_1QO am s I _ r t r+ t �0'"w"a $
penalty of not more than five hundred dollars($500). - — _ ��- -�n0.100 m e r._,t:;,u00 BTU
I, As owner of trio property or my employees ✓.•in wager. a, their solo- __Roof Drains -r� Sub panel -__ Firepl/Fact Blt. ICBO }11 Electrical j _.._...� -
COmoensaGOn, will do the work,And the strurlure is nnl .ritendife or Offered ----"-'-1--"- ..L
Trailer Sewer r "" Mechanical f
for sale (Section 7044, Gusiness and Professioca. Code. The Contractor's r .-I} ❑ 15•5OKW _System Repair/Ahefati0fl `-
License I.aN dues not apply to an owner of a properry moo buitcs or,,11proveS SetereP Cap' I� Transformer .--_.
tGtre^n, and who does such work nim5tlf/horsal, Or :n,ough firs a her awn _ "TTII _ _U 50+KW_( Fire Dampers •. Other j
amp by ees, provided that Such improvemen!s are not ntonoed or offered tilt _ _S_e_wer Conneetior,_• I r T- - -- �T
sale. If, h-)wever,the building or improvement is said✓.•tr„n o-.e year r•,f cam. _ __ Bldn. _ l AofOrs f�Q-1 H?,=1 i�i•8 I ka iSters T10131 SiAIP f
rie:iO n, :he owner will have the burden of proving h^_/sr,e did not build or irri• Solaf C'11!°C(Gfs — --- IRc. SOIu(❑�15 HP I]1G•15+
prove•or Inc purpose of sale}. ---• _-_._i-.��.r _ Incinerator +
as owner of ilia property,arrM exclusively ennt•ac;,na, with i.ccnsed con- _S_olar Pipiag I Sing,IFam. Res. MISC. _---' -{- -f- - ----- 3360.3310 Summmy of Piro Check Fees
f fiats Cls tL cjO Uet the protect Section 7044,BYNcesf and?r O fels.rinl.Code: ��S01ffi�Tank Muiti•Fant, Res.
The Contracto•'s Lrrensit Law Goes not apply Io ar awrar Of pronerty wno !
Ds,iat or ,mprovCs !hereon,and who conlrar,ts for ;uCn protects ✓ntn a on - Syyimmin PODIf,St1a y Swlmrning.PoovS a __ f7u11d�Og f -F ��Qa
9000t(s) license ptir;uant to the i;nntra Ctoi'S l_reenye Law).I am awar6 that - '�^- c----N}
pLfGOf of their worker's Compemsation insurance %Mf'd.a be ofn,lded to me. _ Water Heater Issue
y `— plvmbin( j
L t Am exempt under Section_._- Sy d P.t:,1nr!his tendon -
_ r- Water S twice �r Eiec(rlul j -
��,o r _ -3_..------
Date Owne -Sr!- 9 -. .�— Srs fir Sale kkihaniFa! j _
1 hereby ce+hly that I nave road this application avid state Ira, trio above I UE1iEt(1PI�ENiS£Rllt: +'
rnform at fin is Co,recl. I agfe lr.<mnPly WTth alicity and county i,dinances �1R,y and state Taws rolatrn tctt _ Taft ,y_ / - r ''� ••• � __.OaUf)tt.r9 Tfig ctrr,�tlon .r.r)tteteby autnoriie repro• d18AD71o►inspectio pr afi•s city ton-tr�rr u n tl abpve�nentidned properly for V' "�-"'�`- "` ByR�ngAlFCrowdOy ~�� - 3360.3315 Planning 3
inspection ion purppsaf• / _ �M,4 7%e7Sigret,�rn'�^ _��✓�� j)Jfc �f'•f�1 Ap(dkDt1011(StY9dBy J
! ssue
Drivers' License or SS yr .-_ �.ld_Gl'i-J_ �. . -._._.._.�-_._ _ ^^�..•--•_-_ 1WlFOpOW f _/ *O._Q l�
P/tate-Bvilding, Green•lemporary file Copy;CsinarpAssessor; Pink•Appirc2nt:Goldenmd•Arcounifng 1