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HomeMy WebLinkAbout15073 DANIELLE WY_ i • CITY OF LAKE ELSINORE CONSTRUCTION PER. IT or Prolerof Addnu Applicant to fill in all spaces except those within heavy.border lines and sign all appropriate dec*rat' Assaslor's Paff W No: Owner's NOR$ Zt n ��" S`L' Phone PERMIT TRACT N0. LOT N0. 7UNIT N0. 1 t Addresa /sU-3 Direr -:y ` 76 ! Atch/Eng.- f ...License No. —_ TYPE OFCDNSTRIKT101F NEW ADD CL TERATION ❑ REOAIR - CONVERSION DEMOLISH OT--RER L41 A.P. # Zone 4cldre'-s - DESCRIPTION OF WOFK/LiSE OF BLDG � 6 �- S Main Building: tl ,��( , I"Accessary Building:. Contractor's Name Phone E Z Address(mailing) __ -- TYPEOFPERMIT '�f.RADMG FC:WDATION ` STRUCTURAL T Front - — O TENANT :')LFCTRICAL 9WWBING D MECHANICAL 8 Rear N City License No. --- OTHER A --.-._ -- I 1 LICENSED CONTRACTOR DECLARATION "--�`""� _ Right N (commencing PROTECT DESCRIPr* .2, S Tr !i Occupancy K- - -- G I hereby affirm that I am licensed under provisions of Charter 9 commencin Q D c1 with section 7000) of Division 3 of the Business and Professions code,and G:'ist u h 1. b ^ if11iC Actes - g Left - _ my license is In full force and effect. tJe "' -�.. R Valuatlonl Ping. Ref.# Parking keq./Provided i E Incense Class - ucense No. _ Date Signature - -- Remarks Planning Notes (Q *OR KERS'COMPENSATION DECLARATION - _ - •__- - - I hf rally affirm that I ifave ve a a certificate o1 consent to self-insure Ora certificate - T of workers' COmpenptidn insurance• or a certified copy thereof (Section 3800. Lab. C.) - - ---- - _ Policy No. _ Company -- - _ - - '❑ Certified copy is hereby furnished. --�- - iJ Certified copy Is filed with the.city Building Division. r _ �. Date _Applicant - --- "-' - - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION fThifSection need not be completed If the permit is for one hundred($100)or - t�ss). vsertify thst in the pertormance of the wink!or rvmcn this permit,s ss-aed,f � � shall not employ any person in any manner so as to become subject to the PLUMBING- FEES ELECTRICAL FEES MECHANICAL FEES AMT p GRADING FEES - Workers'Compensation Laws of California. i Alter, Re air- Generator C0.5KW❑5-15KW Brifer Date Signature -____ --_-_- � --- Cut-----_cu.yams NOTICE:If,after making this declaration,you shoulm become subject to the Auto Wash Construction Pole Sab. Duct-Under Ground Workers' Compensation provisions of the Labor Code, you must forthwith - --T- Fill _—_ -cu.yard° comply with such provisinns or this nermil sheil be deemed revoked. Backf low Pre.-... _ ; _ Cookin Uqit Ouct-Structural _ _ CONSTRUCTION LENDING AGENCY BackfIOYJIrsI anon Poleht _ fan Ventilatin 3tb033Tn PiaeCneckFecS I hereby affirm that there is a construction lending agency for tire Co.formance -�---- - 3300-3,11: Pe'mlt Fee S of the work for which flits permit is issuetl (Seeticn 3097 Civ. C.) Clarifiers Dryers Coat).0Elecinc Exhaust System -'- Lender's Name ---- - Total Fees $ ' D�sflwasher Fan_ Evaporative Cooler Lender's Address "-- ------ - - '- - -I•— OWNER BUILDER rECLARATION ' Fixture Traps ea. �_ �_F.A.U. -; Heating System&Ducting I hereby affirm that I am exempt from the COAtfFC:or'S License Law for the _Floor Drains _____ Fixtures 00.100.000 LTU❑100 000 BTII following reason (Section 7031.5 Business and Professional Code: Any rrty ur _- - !. County which requires a permit t0 construct,alter improve,demnhs".or repair Il1aQv3t2 Summary of Permit rats any structure,prior to its issuance•also renunes lice apptira for sues permit Floor Sinks _ �OtlUeis �Kjod or Caropy Q to file a signed statement that he/she is licensed pursuant i,the provisions of Gas Service Outlets Switches e 1 U Type II ❑ L he Contractor's License Law(Chapter 9(commsnarr.g with Section 7300)of _ - �- - Building SDivision 3 of the Business and Professions Code) or inat ne;one is exempt Interceptors ~Mete!u uP 200 ampS frigeration System Plumbing $ therefrom and the basis for the alleged erempiion. An" violation of SCclinn I-- -- - --T--- ----- 7031.5 'y any applicant for a permit Subjects the applicant to a civil P•Trap Meter�7 over 200 amps ❑0.160.000 BTU ❑100,000 BTU -- Electrical -S - pinaity of-of more:hen five hundred dollars($500). -[4 ----�'- Roof Grains Soh anal Firen1lFact.Blt.ICBO # I, as owner of the property Or my employees With wages as their sole I'- M?ttanlGal -i compensation, will do the work,and the structure is not intended or o:fered Trailer Sewer 0 15.50KW System R?pair/Alteration f for sale (Section 7C44, Business aid Professional G.de: The cowracirr's - ----••- ; transformer `1d 233 Other -S *'moo License Law does not apply to an owner of a property who builds or improves Sewer Cap ;__ 0 EO+KW Fire Dampers_ --7�'O thereon, and who does such work himself/herself or inrow;n hu or her i,wwn - ---L--- — —� CMIP Res S employyees,piovidnd tr.at such ,mprovemenls are fin; ,n;enrlen n• �•+rend rr;r I Sewer Connection•Bldg. J Motors i 0 1 HP❑1h 8 Re istP,is 1I0i3i sale. I1,however,the budding or improvemen: is solo witn+n uric rear of coin- -- --- -- plalicle.the owner will have the burden of proving he;Snc did not owin rir im• Solar Piping teclor. Inc. Solar❑9.15 HP Ct 1 B-15+ Incinerator t I0 232 SMIP Gem 1 prove for the purpose of sale). 7 --- Pipi r ---�- Sin /Fam.Res. Mite. Summary ❑ 1,as owner of the property,am exclusively contracting with licer.sed con• p g +--• g --- i360"33,0 SummaryolPtsnChetkfe2f tractors to construct the project(Section 7044,Bi+smess and Pfnfess•rns Colo: I Solar Tank_ ' Multi•Fam. Res. The Contractor's License Law does no; apply to an nrnner of property who -t - ---�--- -t--- Budding S r hobos or improves thereon.and who Spntractf Inr such project' With a con. ! SWIRImm POoI/S'+a I Swimming Pool/Spa - ----- tractor(sl license pursuant to Ina Contractor's License Law). I am aware that proof o their worker's Compensation insurance should be provided to file. Water Heater I — Issue _` — Plumb'rg S -.—_-•,-- ❑ 1 am exempt under Secflon P.C:for this reason WatP.r S rvICP. ' Elecnccal - - -t'----_ Mechanical $ ogate wne - DE/EIOPMEN)SERY R RE fe eby cortily that I have read tills application and state that the above MSG. _ Other $ ormation is correct. t agree to comply with all city and county ordinances -t~ y srlMgApprortdB)_ —_,gate �a ~ and state lrws relating to building construction,and hereby autnorize repro- Building , • 3360.3315 Planning S .�-.. ./_-_-- sentatives of this city t onto$ poll Ina a Ovo•montlnned property for ( gAp(lrosedBy - inspection pur �i,� � � 99��1 ,cp Application Issued B;' to < 0 II Signature-���el�LTSa.7�fl, - - - Dato-+'s_�7.�' L_ ISslie - `IV!,i ` Drivers'LlCenu or ss fP — Total Fells Otte S 11 I�_ White-Building, Green-Temporary File Copy.Canary-Assessor. Pink-Applicant.Goldenrod-Accounting • 11 ' I � 1 ! ! 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G I ° 1 i I I m c U 1 o _ f I z LL f I > ca C \ z _ eZfl z �� m f { I O U I I R I c a J� w c a+ c O L of } W y 1 0 o`r C O Q O Q r9 ri c l ? c c t7 (R `L E f e( m c l c J �p C J `Co ? aS c t L cn F F- > io LL c r Q �_ , Cn O y I T ` •OD y 'O I U G chi U U Of j C G C y I 67 0� a; O C LL C c� y Gh Q5' c G Q f a ._ C c o rn I o _ Q i a' ° I ti ,� a+ = y V J W c O o J E m c c LL Vf :� J I n° c a n �, a 1i Q > O c V 4: c .d m •� = al c 2 a ; r� E E w d F- o `O a w W w = > ° r d aS o _ 1- a' ar m o ? O o o F n c Z n rn rn o1 os a'.I vS •u_ N U u e n O M I w = t7 0 ° i c°� H J Q 2 CC y y en a O O .A •ei•• 00 G 7 J 7 7DD U rn $ O O tEa N H T O _W C_ C_ L: C I u _N Y Y a J •p 0 m M 0 0 m m O O O O o O O 7 m . 0 0 m L m p m m Gm U Q F" fn LL W to C7 LL C u. m � cr a Ir a .0 CrI U 'LC F- LL J O 0 W iL LL LL = LL (J UJ m m I y w C ( W (� CITY OF LAKE ELSINORE BUILDING DIVISION ' O W N E R - B U I L D E R V E R I F I C A T I O N ' r A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of an owner-builder verification. Attention Property Owner: An "owner-builder" building permit has been applied for in your name and bearing your signature. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. XYes No 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address Phone ( ) Contractors Lic. # 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address Phone (714) Contractor's Lic. # 5. I will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work (If additional space is required attach subcontractors lint.) I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have complete the above information to the best of my personal knowledge, in compliance with this State Law. Signed: Date: ` Name: (Printed or Typed) Drivers Lic. # or Soc. Sec. # , .1 41 '��;• � ,fl i ,jr- �' '' '!. ',M✓. cTi- 'L _ �J `�`i: J , ., .:t. w .. � �f'��' i Pill " .. / is ► ; , r ol. i. . .41 wal jsnow � ,. F yam. o ; ' r� a d� I NEUIBM� / / I r / Unit _ 7, 94 y Mom, 7 t t I �L.i1�+G � �•1iP ' � �y 1'631 f 1teOVED a 1 �. ..... ........ . .._ . • AS REVISED OUR ing Dept. y a 1__ . ,C[T"—F LAKE ELSINORE BUILDIN(6AFETY DIVISION Date: f�_Z NOTICE u Stop Work P' Correct Work Job Address ! �� r i�ju C_L Permit Number R� ra- Qcsr -- Division Inspectcr _ SOIL and TEEMING ENGINEERS iNC. COACHELLA 16a 7 W.OPANGETHORPE a PLA�CENTIA.CA 92670 VALLEY [ ) �710A NTRY�.#5 118S4 fTER WEST.a SURE 365 714 524-9130 SAN BERNAiDINO.CA 92408 (619)34543M (714)381-3528 REPORT OF COMPRESSION TESTS FILE NUMBER: 8842196 DATE: 6/1/89 JOB: O CONCRETE Steve Gallina - James O MORTAR ADDRESS 15073 Danielle, Lake Elsinore ! CLIENT: O GROUT ARCHITECT. Adams j;GUNITE ENGINEER: O LIGI•:TWEIGHT CONCRETE CONTRACTOR: Owner CONCRETE SUPPLIER LOCATION IN STRUCTURE: wall SLUMP.in inches CONCRETE TEMPERATURE AIR TEMPERATURE: rw• RECIt1i1Ea r UNIT WEIGHT. V I nQ AIR CONTENT: CEMENT MIX N0. ADMIXTURE. JUN 161959 TIME IN MIXER,MINUTES: FINE AGGREGATE.COARSE AGGREGATE: WATER ADDED.GALLONS TIME FABRICATED: ' FABRICATED BY. Steve Gallina TRUCK NO: TICKET NO: LABORATORY NO: 2691 I MARK: Set 105 ! DATE MADE: 5/12/8 9 1 DATE RECEIVED. 5/19/8 9 DATE TESTED. 5/2 6/$9 DIAMETER.INCHES 6.05X12.1� AREA SO.INCHES 28.75 ! MAXIMUM LOAD.LBS.. 72,000 I COMPRESSIVE STR_PSI: 2,500 AGE TESTED.DAYS: 14 REO'D PSI AT 28 DAYS: 2,000 UNIT WT/CU FT(PLASTIC): I DISTRIBUTION. Sample delivered to lab on 5/19/89 by Steve Gallina. (3) Steve Gallina SOIL and TFETING ENGINEERS INC. REVIEWED BY: --W Pro;R!fA{dre,s j�U73 j a� CITY OF LAKE ELSINORE CONSTRUCTION PERMI - Ass"sor s Parce! o._ _ Applicant to fill in all spaces except those within heavy.border fines and sign all a c Qw� y's Name r r • - - --- -- g appropriate declarations �• Phon� FRIT N0. TRACT N0. LOT NO. UNIT N0. y ` Address /_�73 .�un%G C !e/a� IArch Eng.>�!'�61� 1�7 License No. E OFCONSTWION f_?•NEyy ADD q(T�(�.71G(� Address �' ,5�` G _ CONVERSION DEMOIiSH fJ OTHER _, �!1 •-�--f _••sue ` REPAIR - -" _ ESCRIPTION OF WORK/USE OF BLDG Contractor's Name_•—__ _Phone Adcrew:mailing) - .:.TTPEOFPERMIT r, _ _ y S am Building: _ Accesso►y luilding: lane GRADIN_ i FOUNDATION TRUCTURAL E _ City s.,cense No. TENANT-. CTRICAI T Front Z ! LICENSED CONTRACTOR DECLARATION :: OTHER �,..-ffE _..+�PCUMBING C' MECHANICAL B _ U ¢•et•e ,N,rm that I am Cconsed under - A Rear - - N Provisions of Charter 9 (commencing -PROJECT DESCRIPTION S' Ft. _ •wit . " 1:1 7000) of Division 3 r•f the (Business and Professions Code,and Occupancy _ C' Right I mY he a ism full force and effect. Toust!uct,ofl•type - Zone K License Caa Act es - N f _L,cense No. - Valuation j :_ p�. - - - S Left - C I Date Signature _ PCN 'O - f WORKER_ :OM NSATION DECLARATION Hernia Filing. Ref.$� Parkin Req./Provided R h¢reLy offing that I ve a certificate nl consent to self-Insore or a certificate Planning NOteS _ E Wo4e,5' cornrensa n Insurance. or a certified cop ]hereof �, Q 3800. Lao- C.) Y (Section Policy No om an Cert•f,.!u COPY is her fur . P Y - ..- - - --.. .. - ,� -` IT Cert,lir:COPY is'fie with the it s in - �. T �1 S Date._ 9 Division. - -=-------�-- -- _ - .Lti �-;47- - APPI:Can EXEMPTION FgpM WORKERS'CO ENSATION DECLARATION (Th ;section need not be Coml-Idea if t - ress). Pe.-mit!s for one hundred(s)o0)or - - - - - I certify that !, Rte P¢rfrrmdn Ce nt the wa . for .:hich;his permit:s issued,,-- - �_-- Sh211 n Cmp:gy any person in any n,anne H, ,s to become SublfCt to file - ' na!, •s' C0^,pensetion Laws Of r,l;enr,,;,• PLUMBING- FEES ELECTRICAL __ Dare ,_-- _ _ - -- -signature _ ___ _ - Alter, - �--- FEES _ MECHANICAL _ FEES NOTICE::, )fr,;i inal.,cg fills rieciarar,on,Ynu Sho „i become wb:cct to file _ Repair _ Generator f_ 0.5KW C 5.15KW ACCT.@ Weir:ers' CG,nndnsatfon pruvisio;:• 0f the - - BOIIEf GRADING FEES ?> .:,: .uch pr ov,S,nns ,• t.,,s Ulf)-b.:r c: Auto Wash - ! C611SIrUCtiOn Pole Sllh� ` Con: e, •-: mist fur thwith •---- - Cut ___ ___ CONSTRUCTION LENDING AGENCY peen„t Shall he cetrnec n.vok¢d. _ Backflow Preventer ---- --- _Duct_Under Ground___ .--.Cu yzrdS I re'ec t ' Cook in Unit __I Durt-Strul:(ural -_--"---- TIU _ r a h•"I lhat Inerc is, cnnstnuti ,n IenC,r' I Backff_oty Irrigation �'-'� - o• Tile i k for which thK perrmi is isfuedi9'•r,Cy r th±perfCrn,anCe gatlon - (SCCI,n 3097 Pole Li ht _cu yards I Lroder'; 'game _- -- C,vVC.) —_Clarifiers _ --�- ----____ fan •VentilatinV�- 33603170 Plan Check Ires` . _ — Le,,r,!'i :,avc•ss , _ , Oryerss vGas �Electnc - ------ 1.- Dishwasher Exhaust System j 3300-33!2 Permit Fee S OSVNER BUILDE)t UECLARATIUN -- ---- -- --- -- -- I F811 ---*'- -�- ---- ------ - I nere^, ay.­, trial i ,,,; ¢xe,nPt fr„r„ file ! Fixture Traps ea. -�;F.A U. --' ------ i Evaporative Cooler T_ inlal Fees f - 1t f•';�•.+s rf.l s.ln L'OnirdC Nir'S License Lava for file Fixture - �f I c •. (S:C"inn 7o31.S pS,an�rsS ann P:,)fe st,.-,n,i: Code: Any ufy ur ; FIOOf Drains - �� I'----- ------ : Heating System& Ducting I --- —` h .:I, reU Un¢f a nc,mit to CbnstrpC'..;i,Cr inn c.•Jr,c'.den•.,i��s or iePd,; '--1-- __ Fixtures i ans `• :*,;%, prior Io .15 ,Ssudnce,also re'uun,3:i,e apniic,r:t fc, Such permit Floor Sinks �` -- -------_- [10`100 OOU BTU Q100�G;00 BTU sit�'eC statement Cnt trial he!shc Is hrensCd ou,suan: file orov.$rOoS of - _ I Ol1IIETS --- N,.:�.,,^:,3cf:,r'S L.,Cense Law(Chapter 9(cnmmenc;rq r.,;n Sec;,Or, 7000)of Gas Service Dutlets -- `�--- ! Hood or Canopy -r 3300.3312 Summary of Permi:Fees D•. vo,• 3 +f the Business and Profession, Cude) or that :,e;sne is exempt �� _ SWIICheS j trtcrP'•:•,+ and ICr nas:s fcr the alleged Pxenlptr,.-.n. An Interce tors __ r--• Type it " Y v,.,Iicjon of SCcB:On p ___ Meter EJ up to 20U amps ----�-Type�__�� yp J f 7031 nv any ae than ' for a permit oubll Ctf Silo .applicant :0 a civil Refrigeration System Building $ p�- genaitY c• not more than live hunnr¢d dgllari(asool. P_T rap _ _-_ _- _M_eter it � ---` ;I. ,s „%nee ll the Over 200_ amps - i r]0 100.000 BTU C7100 000 BTU Plumbing $ �� r-,6 property n, lily ernph,yce: w•th :.arcs ds then sole Roof Drains ) 531c f cc wall d,4 file wnr;, dntl file StruUurf �S noI rn -__. _--_ fr,• sa�r: ISect,On 70-i4 pusmeis and Pro'�'f,o-.al C�, tended or offered _ Trailer Sewer -~ -{ - ._..._ __` Fire _I/Fact. Bit. ICBO # Electrical j License de: Toe Contractor's ❑ 15 50KW '••' apPIY tr,an 0wncr of a nrupCrt,v .vho buffos or,mprcvas _ Sewer Cap Transformer t System Re air/Alteration ---�-� Mpcnanlcal j _ I R•C•J dr• .v Ider' Ci sorb •gim h,m5¢Ir,ttnrsell :, tnro„iq n:r r. her Own - ._---- ---•- - --- _--- --�`---_--p- -- i ---- -~ 6 ondc f tr:,t such nnprhvcnn:nts:n¢ n„i :ntentl4d or arfr..• 50+K _ Fire Dampers - $ .ev±r,file bwldmq nr,mProvemen:is S,Id v.ithir,one Ye,r :r corn'. $Et4'er Connection• Bldg Mntnr$n O.1 HP�'i " ----- lie•�dS Olhel I q!Oven,•rc u.vn¢r Will h,vC file aurdUn of proving hC/Stir-tl,d not build or tin• --rSOlar CCIIECt0f5�--- - - _ 1 n•B RCglStef$ 11D23I Prove ;hf aurp se t,f sale). _ _ Inc. Solar;]9 15 HP- - —- - _ iMIP Res S 9� i - I,as •'J.ncr of U,C Prn crt 9 -t---_.. - __.- -__ - _. �1f_15*:. _._ Incinerator _. ,.- ---- 'iD-232 _ -_ w . t,acfr P Y.am°tUus,vc,y rnnt,actm v.rtn I,censen con- _: SOlar Pipin_g� g/Earn. Res. SMIPCon T tnnSl n,Ct tot pro,CCf (SCCt,00 70.14,dustless and Profess-ins Code• �` MISC. The C.,ntraclnr', L:CC•115e Law tloCf ih=t dPPIY in a.. rrWrlCr pf 501.r Tank f`-" - -- --•--- , rmprrsvez thorcnn,and wn0 rural-acts h,r such p,ole..it:wfintn con - @lulti•Fant.Res. -- �_ -- - •-'-'-- 33603310 Summary of PtlO Check Flea _•' _ I:Ce rife Purf uant 14 thn COnlydClnr'S License Law). I ,.m awa,e that Swimming Pool a -� X -------t _ -- -- •- -'--_.�__1_--_ prnr,r ,r tre,r vdnrker's COmPeoSal,on insurance should n,t ----� Swimmin�PoDl/S a '--- -- - ( � prov,tled to me. Eta:P.f HP-ofe7 '--'p I an,c.Cmot undef Sect Ion ... -- -• Building �- __ Lg ¢�j .•..-.� ..©.�yd P.C.for This r¢asnn Water r_YLce �•�`- Issue '� S Date f�u/--tifUwne, /7Q G,-S .-_ ITC Stem- {_ .._ -- - - Plumb:ng ereny c¢'Mfy that I ha,° road tn;s apphcatlnn r,no state that the above -� - -- niat:on ,s cr+rrect. I agrsc to comply with an city and county onimances �Mi _ DEVELOPMENT SERVICES REQUIREME aria stave laws r.:lat,ng to b.uld,n9 Construction,and nCrObY dllMoriaC r Mechanical j a sera;a:,ves n' this ply to enlor upon tilo ahovo•rnenttnned of)PC I. f �- _ �'�RAPPf�BI- -----•— �-( �I DthPr S insPeu:nn pun sc -- B@dfinAAppreredB) _ S,gnatu,C ��,y�]-. _ f� - -��y-' Drat@ _ __ 3360.3315 Planmr.�. Drivers L c¢n_ Ss 2l/ - __�Flaro IssuE Aiplicalbnla@IdBI __ -. ',4 ���: -�� �P ,�( 8 fC or _-///.---.ill_'. y� White-Building. Green•len.poraryFde phcant:Gnldenrcd•Ac;oum ng T/yl Fees DI/ E -...�� ;5 law � 1 WusC7I LU Z Z T W W -' lu cc At Lu to }t 7 � o` 0 j F W ° c t1 Q n. w w o LL a O s : y a� _ts :- n G ' LL E c H Q H °� o F: v ; J , ]L I 1 c3! 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O O 7 7 7 1 7 7 U l w O O .+ _ O m to to to 0 m -o O w r p to to O o O G J O O O etf O o .. q� pp U Q F (0 6 W N (7 LL Q 1!. :� S cc � cr O I 0 c(. C: � F- lL ..1 � 0 O W LL LL I LL S LL � J y LL O. W C7 r s CITY OF LAKE ELSINORE BUILDING DIVISION 0 WX E R - B U I L D E R V E R I F I C A T I O N A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of an owner-builder verification. Attention Property Owner: An "owner-builder" building permit has been applied for in your name and bearing your signature. M building _permit wit hg issued until t2 _s verification is received. 1. I personally plan to provide the major labor and materials xf r construction of the proposed p::operty improvement. Yes . No 2. I (have/have not) z— ad signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address Phone ( ) Contractors Lic. 4. I plan to provide portions of the work, but I have hired the following person to coord-inate, supervise, and provide the major work: Name Address Phone (714) Contractor's Lie. f 5. I wi11 provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone "y a of Work (If additional space is required attach subcontractors list.) I hereby affirm that 7 have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have complete the above information to the best of my personal knowledge, in com fiance with ..his State Law. Signed: Date: 5/� �7 r Name: an2E'S p4rinted or Typed) Drivers Lie. # or Soo. Sec. %�� SOIL and'1'E13Tii1VS ENSIMERFM Ir3C. OAl�pOt��1NnJ1► COACM 0 VNtia11 am NERNAOA3M .67 W.ORANGETHOAPE @ PLACENTIA.CA 92670 79-607 COUNTRY CLUB.95 1894 COMMEFK ENTER WEST,s SUITE 305 f7-4)524-9130 BEfiAM OUNES,CA 92201 SAN BEFNARONO.CA 92408 [619)345-8869 [714)381-3528 [—REPORT OF (COMPRESSION TESTS FILE NUMBER: 8842196 DATE: 6/1/8 9 C CONCRETE JOB: Steve. Gallina - James 0 MORTAR ADDRESS: 15073 Danielle, Lake Elsinore 0 GROUT CLIENT: R GUNITE ARCHITECT: O LIGHTWEIGHT Adams CONCRETE ENGINEER: CONTRACTOR: owner CDDlCP.ETE SUPPLIER LOCATION IN STRUCTURE: Wall SLUMP.in inches CONCRETE TEMPERATURE AIR TEMPERATURE: 1 UNIT WEIGHT CEMENT. AIR CONTENT: ADMIXTURE: MIX NO. FINE AGGREGATE TIM,;N MIXER.MINUTES. COARSE AGGREGATE: WATER ADDED.GALLONS TIME FABRICATED. I FABR!CATE08Y Steve Gallina TRUCK NO: TICKET NO. LABORATORY NO: 2691 MARK: Set 105 DATE MADE 5/12/8 9 I DATE RECEIVED. 5/19/8 9 DATE TESTED ! 5/2 6)/8 9 DIAMETER.INCHES f 6.05x12.I AREA.SO.INCHES i 28.75 I + I MAXIMUM LOAD.LBS.. 72,000 II I COMPRESSIVE STR_PSI: 2,500 i AGE TESTED.DAYS. I2,000 14 I REO'D PSI AT 28 DAYS: 2,0 0 0 I I UNIT WT/CU FT{PLASTIC). DISTRIBUTION Sample delivered to lab on 5/19/89 by Steve Gallina. (3) Steve Gallina I SENT TO BUILD. DEPT. BOIL and'T'EEMNG DATE �7-�9 ENGINESIRIS I VC. REVIEWED BY: -JEA I 100.6/86 1- • �"=' -Y.Bi is Y Zyrkx i •r �4 a,a RE. L, EAS,E FORM n . Q LM EI&INORE . FI �EPHT to i6sue Green'.Tag:, and Certificate of Occkpancy. pROJECT ADDRESS: /� �7 - .TUOT,Ti47.6.1. *e.� .,vr a ASSESSOR"S PARCEL #: The above referenced project has met all the requirements of the Finance Department .and can .be issued a Green Tag. and Certificate_ of occupancy. FINANCE DEPARTMENT: RATE: - Comments: -10-88 .ny�w �•,- .�, �F'� .; i ' } -i,+�C'� - a' � s. f' .+.x,_ _ }bji�: L� Jni. .. ' _;�a„�,f