HomeMy WebLinkAbout15049 LARSON RD_
OF LAKE F@ SINORE CONSTRUCT ION PERMIT
CITY I
L deciaratiolls /)
- Meant to fill in all spaces exceat tir�se within heavy border and sign all appropriate
1_f1 uSGnJ iZ I?-- - - - Applicant TRACT N0• LOT 7 N- I UNIT NO.
2 2 �� — Lone
Project Address �SDy PERM)fi'N�� ��� p REPAIR -----~'�
-- ,q/N__PhoneERATyON _r A.P A;,rossnry Building: z
Assessor's Parcel No S -� - Cl NEW i ADD y�(c r - - -� O
Name sy4 R --_--� TTPEOFCORSTRUCTION OTHER - T - 5 iAain Buildirrg;�_-
Owner 3 15 A 2Sa N DEMOLISH L. E _ _.__- 1
-___- - ;! CONVER510Y �_--- F Front - ----�`
Addreu License Ltd• -- DESCRIPTION Of WORK/USE Of BLDG - -- •. �- - - N
- G N' SAL g Rear ------- G
Arch Eng. -- (rS�� � FOUNDATION A
7E S _Phone bZ TYPE of PERMIT �i GR IRI UMBING L1 MECHANICAL _-_� C
Address t Dear Ra 9-13,00 ' TENANT CTP.ICAL -✓Y� - - E
ttame_.X' ��Q-� -. __ ----'- S Lett (Provided D
(pnuactor' ,ter --- - Parkin Req
2 OTHER Occupancy - ly,
Address Imarhngl -�- Ft..:2 s'L- Acres .f =
' PROIECTDESCRIPTION. SA tone _ - Ping. Ref.`, -- --~-� T
t Vicense rio. _ CLAP o commencing Ci,•' - �_ --
O Y 0 CLA Charter ( anU ClnSttUCIICn type` / _.---
CONTRACTOR io".s of Plamllny iilOtes ---
LICENSED rn IiCenSed under proviS Professions Code, Yaluanoni_--�i-�� ��--�'--
ebY alhrm that 1 a the Business and q l _`�,r..�• _ --_--_-�__��-`----
t ner n 7000) of f)ivisi on 3 of _- ----i- -� -
yv,ih SeCi,O r effect. ---�- -_�_.-----
mv license is in tett ort� utensa.f o. Remarks
G —--� Jet - -
nz;Cla:s-9�--Signature -.IZ
_•¢_o__;Z --- ---
fconsent to sClfin Su��tpfCot e(SCCt On - --------- f--_
.PORKERS'COMPENSATION DCcLA t consent
copy --_�----�- __ ---�- -�-—
t..Crrtiy that I have a tnsufance,00r a
., .,peers' Compensation / �-
n! ... 111..1 _
3800, tab.rC.1 -- -- C:ompanY —_�
�. 6 y]- -----`- FEES ACCi.p I ro�GRADfg6 FEES
VaLC. rJ.•.( ;,,r•.shed. J- _ ----- _._��-'-- u --- -- 5
c-,py;s here by gu,uhn. v,sron. MECHANICAL -�-- Yards
cu.
here wr; ;'•[. ut.i ,-f-__� _ -_-_--- Yards
`e,ttt eo copy s m ��-- FEES C t ru. ar
_� - n:'r 'c''- '�" ON DECLARATION. ELECTRICAL -- _
t - rL-.�--- h,:nd,co(S:oo)or FEES Boiler _ -
fa•c - JORKERS•COMPENSAT fnr one - -- -6KNI (-1 5•TSKW ',
XESd PT17N FROM'>i cons e1C,,f the Dern„t rs ernrt 5•sst:ee.I PLUMBING Generator��-- - Duct•UndeI Ground sdUl I•P:ar(heck e5 ---
11-hS-.eGiOn --
cc tin! C - to the _ - - - - J -�- _
res;,t• r,f th^_wn,K for�5"�o'oecomc 5ub�_CI ! Alter,Repair Consto�PPole Sub_..- I I)slCt•$trUCtural ���- P,rT,e.fee s
1 crrUll ;t,;• •r, the terinr r,,�nce -- ----..._- _ -- 3225C_ -� —�-_�-
77 ,n any n,anncr so _
ti• n,.,.i .n,pin� :n•I Pe f Canto,n,J• I,OtO Wash Cookin Ulllt Fan�Ventil_ sting—.--=�- ; j ,:
ec; to the g Stem S
e;,,• compCn;'rt tun La;ge •Dist Ure -t n—vnu sno„id recome sub,ro tn•.vitn - Barkflow Praventer Pale Light_ Exhaust Sy - -
Ca'r - r C"e": Vol. nu,st <v.�''. o. - --- OOler
• NUTiCc:Il,aver r•,a�r„,1 tills GeU;rat'tne Lano deemed - - EVaP0FlI e C__ m ry t ermtFe
r^°`s'n 3, �:tit P Backfiow l- sri att,L-ion_ 0. ers❑Gas Cl Electri.-__�____-
it rnne'..:,t tin p ermit span ne _ j r ers Ducting !
rI"L'; .,,,U, arnvrs,on; ��' q„rnance _ System t
:,:t', ACENcv encY?nr the Der crv• c.) I Clarifiers fad--f --- � Heatinn SY 0,000 8TL'
Sem e e p l es�� J C U
r..'r t.•.. ry LCNDING nslruC[inn lendnl9 a9 r o 3o97 00 BTU,-_.-
CONS-f RUCTIO is Issued (Sect o _ __ F.A.U,�_�.---------- - �0-100 0 -
s� I retec; ;Illrn,U„t In .,is is a'-o crmR _----- - ` - - DlshWas -T J -
I tl.c .v Gr4 for which lots C------'_` ---- _ Hood•Jf CanOPY ' 322U bca0�ng� S
Name Fixture Traps ea. 1 ixtur,_ es _- T pe II -- I o c pm $
I nd(r. - .-- to,the I Floor Drains utiets _-- Tyke 1_C ..--Y --- 3211 u 6
`71 Le r.drr•,,Address - EC LARATION ,cense Law - �--- - ----- --- stem !
1. _ Any city or Refrigerat ca
I ,r OWraER BUILDER U from the Contractor's L FIOOr Sinks- Switches ion Y- -- ••n,exernPt t' 1,5s,ona' - _ 100 Q00 BTU 3?22 P.ectn _
t nef¢"Y JIli.m tnt�lCUlon 7031.5 Bdsiness a^01ter,tmP10ve.demr,'tsh or eerrolt LjUiletS Nleter CJ U t0 200 am S []0.100 000 BTU ..
a u ^7�hcanl for`uch P
,c re:anti (` rni:l to r.^,tstrUCt' rJv,stons U1 Gas Service _ 200 amps - ----
f nuo::•' I a!sn re9uues the apD - _ Fact.Bit-ICEC= a on --
rr uni./ :ehlr 1, fell, atpe s,.uancC' licensetl pursuant to the C 70001 of - Meter 0YC___.._ FI(E Imo-- '
_ 3'l2 =
pnor to [ Intefi'P.plOrs -- i22y :a' nS
, he'she ,s nc,nc with Section -._� airlAlteration
v[ Chapter !,(comma Cf that nui5he ,;ex��ion - Sy SIC- rT1-Rep --.- ._'1 MIP Res.
•/tee .t:,9ncrl 5t atemCnt that nrotcss�ons Code) v,olation n SC etv,l i -} $Uh anal _ -•--- 230.
�hc C.,>ntrJCtnr•s uccr,sc La ( d exemption. AriY licant to a _�-- -_ 1^ _ _.__-- ------` m CfS -•, I -`----
nt the B,:s,ness and allege• r e apP rains [J 15-50KW Fire 0a P _-_ IP l.0 -
p,�„n,^ 3 ,,as,s for lnc Roof 0�,- Transformer []50�-KW --- --1-' —_ - 2
t I'll" folly'
soil , a r•,r a Penn,t subl✓�OOIt-� their sole ' _ --_ e _ ----
t,y a,.; aaPl,cant nundred dnrlars l es as --- _ I Register -
�----- }-- 73U' `'M m
7n"S1.', with I , of )ffcfctl Trailer$eVYCr --- - H1 P C 1'/,•B - 32 _ p N
;,en altY nl tint nr,re lha,�flue nr nrY emptnyees ^$ewer Cap Mot'?rs n 0- Incinerator 1 2° I
t.t S
opCrtY llie siruClurC rs not intcnd��nnt,aclur's __ _
I, as nv[nraf „f the l ort'..ul rde: The rove: - ,•Bldg. _ HP[J16_15t - -- -
thew an Profess,o, Como ,ru,lcis or imp 9-15 Ii Se�marye o li Chet,
,omper.sat,on. °,^' nova, Busmess nI a property n his<,• her own Sewer Connectiol - g• Inc. :;olar U __-r- --- Misc. 3 U _
sale (5r:[tn,n n nwncr r it jq or tiller^d fq, _ 1 - ---•- ! g �I�mg S
I not 10D1Yn wort. h,rnsec*n11' sclt„ot ,mended nl coin• solar COIICCtOrs --! - Res.-_-__-_.._-- _ ---- _ "G lU tin r -
t,cans¢ l_ew dr,Cs r,,,es sue __ SinglFam. _ I P n hmg
r,pprnvC menu ale -.,t builtl or im- - -�� - , 1!
-rrcnn, and w,o n, Y,provcntent is sold wi'ttll l�tic year Solar Piping 14ulti-Fam.Res.__ 7pj
rmpto YCCS, Pr^v'dcU tell SUCK t ending tie/: a _.-.--
;a,e. 11, hnv[tver.the Uuntl•r,9 urdCn n P �� -- - .-._.-.._"_ nif,ll -
;he owner wiu have the P w;tn liccnse;l ion- SOIai Tan U Pool/spa
a [ Issue_-
e ftp1(r I S
p•.etwn. urposc rl Sale) cnntractlo , SWImm10 �-�- _ _n -
pfOve 10r lnC P excluSrvclY Pr nre55rons Code: In P� ,�+� "----- T
.,1 the Pr^pC':Y.(c a4 BusmCSS-Inc'. t rOPCrIY $wl.nm�__-_..� /,t`� , S
as owner ro act (SccUnn 70 n an nwnern ecP with a con- _
w does not aPP'y�fur Such D t tl(Det $
�•aciorsto construct Ince e f nrltract5 I ant aware that Wate;Neater _ { _---
Tic Contractor's License La License Law l- rov,ded to Mo. / �' 34!'- 1 planning S
tl,an who r or's
,;,leis or improves stem he Contractshould tie P atgr Service - .
Pursuant tot -- G'
I tractnr(s1 license, - -- B.&p,G.tpr this reason w Eit1 i1TS: �- -Date
( $eptic�stem -- -
proof o their Yort er's cc.n npensatian insurance - is - -- -+
DEVELOPMEFIi SERVICES}
:under e c - -~'-" - - __ - _--- Wine Approved By /� 1 _nab io►ar fete Dire S J
• •J 1 am cxemP _ -
_--- U`vncr _ - --that the a r I-•J_.. .
�IIiSG---- A d B r
bnvC OYe 1 _ -
•--"'_._ �_' Jtlon an state ._---- BUilanA VD<
---_. -_ - ills aDPtI 2 or finances _.,_,.---
date nave rLatl t. f va,t all city and counthorizc roPre• -_.. ApnlicalionlswedNg ..
I hc'CPy certify that I ree to I ofilp y n,and hereby npC,ly for __�- -GL•C•'�'j
to burltlmn construle, t•y'y C)p IIsue•�_ •,
mtnrmJl,In is correct tag =�
Issue-—
and state taw'. rc.lal,n9 to enter upon rile al2itve•me°tinned p'
• I,V-5 of tills City +� -LDJIe .[/•-�
sen.a uses - S -
' Inspection t� -
. pignature
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Im1i
CITY Of LACE ELSINORE JUL 0 9'1990
BUILDING DEPARTMENT D01t. of f;Idg F, i8faty
Special Inspector Report for
Swimming Pool Construction
Project Address: 15049 Larson St. Date: July 2 1990
Owner's Name: Eriser Permit BPE 9186
Contractor: Sandpiper Pools _ License #: 431997
Contractor Address: Temecula Phone #: 245-1642
I hereby certify that the pneumatically placed concrete for the
above spec?fied project was continuously inspected by me and
appears to conform to the approved plans and the Lake 'Elsinore
Building Cade requirements applicable thereto.
Cement (sacks) : ic-r� Sand (Tons/Yds.) 42 Pool Size 16 ' x 337 '
Number, of Test Cylinders Taken: 3
Test Lab Name and Number: Twining Lab. Long Beach
Remarks: (include comments regarding special structural design,
water table, fydrostatic valves, hillside construction, sur-
charges, expansive soil, no-deck. detail, etc. . . . )
Checked Permit, plans, steel & ,bonding. B,C_ adams plan w/ no
structural changes. Pool. a normal dry dig in none doby soil.
flea,-.,, d some loose debri & reblocked steel where necessary. Pool
w/ 7' spa &• 8" dam wall. Plan shows no deck detail- or hydro valve.
All work cowplei-ed' in a satisfactory manner. Eldr, r —`nt .
Further, I certify that I was in the employ of Deputy-self employed
Rep. city/owner for the purpose of continuous inspection of this
project. r
inspector's Signature:
Registraticn # 1154 O.C. 594 ir. v_ Agency— None
Note: This form must be submitted to the City of Lake Els_nore
Building Department within five (5) days after completion of
concrete placement.
bp/6-89
ys TvvW Lahrat Hev of-soub1m to CaGfovaa, ffnc
3310 Airport way 1514-D North Susan Street -
(� Lang Beach,CA 906M Santa Ana.CA 92703
Weil:P.O.Box 47,90801 (714)554-2645
(213)426-33CS FAX(714)554.4960
TESTING (714)428.6432 FAX(213)426.6424
Compression Test on Ganite
CUSTOMER: VOLDEN ELMER G EXAM NO: 90--1-051560
14509 DALWOOD AVE DATE: 07/13/90
NORWALK, CA 90650 JOB NO: 00713002
PERMIT NO:
JOB NAME: SWIMMING POOL - ERISER OSH PD:
OSA AP #:
ADDRESS: 15049 LARSON ST RILE #:
LAKE ELSINORE, CA PAGE #: 1
ARCHITECT: CONTRACTOR:
SANDPIPER POOLS
ENGINEER: SUBCONTRACTOR:
B C ADAMS D-J GUNITE
-------------------
SAMPLE FROM: North wall & floor.
MIX: 4.5 : 1 SPEC. STR. (PSI) : 2000 SLUMP: ---- CAST: 07/C2/90
--------------------------.-------------------------------------------------------
DATE TESTED 07/12/90
SPECIMEN NO 1-A
AGE (DAYS) 10
TOTAL LOAD (LBS) 102250
LBS PER 5Q IN 3620
SPECIMEN SHAPE: Cylinder SIZE: 6 x 12 AREA/SQ IN: 28. 27
-----------------------------------------------------------------------------------
COMPLIANCE: 10 day test Complies with specified strength.
Lab #5861
SPECIMENS BY: Britch DELIVERED LY: E. Vol-den RECEIVED ON: 07/11/90
-----------------------------------------------------------------------------------
DISTRIBUTIONS:
VOLDEN ELMER G, 2
LADE ELSINORE CITY OF, 1
ZA
Jahn Sr.
ALL REPORTS ARE SUBMITTED AS THE COrIFIDENTIAL PVOPRRTY OF CLIENTS AUTHORIZATION FOR PUBLICATION OF OUR REPORTS.'CONCLUSIONS. OR E%TRACT'i FROM OR
REGARDING THEM IS RESERVED PENDING OUA WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENT;; THE PUBLIC AND OURSELVES
10
3t3L — ? 3 —.9@ MON 1 2 :'34 + P e 1 �
1> I -- -�IY/ltf1'�O!'�l��Y'1el� �.t �flctn C�ar�f17tr1id; - w
i 9310 Alr�al Way 1514-0 I'Jorth 9u?a�irtdet a
Long Sows.C 806 A 90 Sent$Ma,CA 92;!13
1V1:P.O.BOX 4'i.9(. I M4)554-2"5 r
(213)42633SS FAX(714)654-•1860
;` `• StiNCy (714)828-6432 FAX(213)426S424 i L'
)
ii
t {
Compression Test on Cunite
CUETOMERt fat;�,L'FEN ELMER G EXAM NO 9b-; 051660
• :-14y09 13AJ,W00D AVE NowDATES: 01/13/80
g4O14WALK, CA 90660 JOB No: 09713002
s jUL PERMIT NO: ;
8 NAME; ;'SW ';MING 1POOL - ERISER gyp, of Bldg. & S�{ OSA PD.
03A AF #:
ADDRESS; 1kjr�49 LARSON ST FILE 0:
IA ELSINORE, CA PAGE
CONTRACTOR: ;
SANDPIPER POOLS
OINEER: SUBCONTRACTOR:
6 C ADAMS ` D-J C UNITE
: --------------------•-----•-•-- -------------- --------
SAMPLE ' North erall & floor,
MIX: 4 .5 : 1: � SPEC. STR. (PSI) : 2000 SLUK?: ----- CAST; 07 '02/90
-------- —•------ —_—_—.----_---.-.-----� �....�...--_._--_--- —_—..�.—...� ---_ — --------- •.
TE TESTL 07/12/90
LCIMEN NI? 1--A
E (DAYS) 7 10
TAL LOAD,;(LDS) 102250
S PER SQ!IA. 3620
.z CIMEN SE{AP11 Cylinder SIZE: 6 r. ] 2 _- - - ARY-410 Illt: b8.27 . :.
------------ ........................................ ............. - -
` COMPLIANU-1 h0 day test complies with G.necified srr-:�r,gth.
t �ab #t5861
SPECIMEN$ '` by; Britch DELIVERED BY; E. Bolden RECEIYEd UPI. 07/11 90
1,. -- -------------7 -
STRIBUTI&
LDEN ELAP i5, 2
E ELSINGHL' CITY OF, 1
r s
i
i John M, VeX`ic3CG:1 ,` Sr.
REPORTS AP ;0 ►s THE CONFIDENTIAL PRODF. ry OF WENTS AUTHOPI7ATION FOR 09VAOCAV10N Or DUN AC;00"s CONCLU�1�% OA gx1FkACT; FROM.
0[OAAOINO THEM IS• f[AVIO PENDING OUR WRITTEN AP►AQVAL 4S A MUIUAL PROTIVION TO CLIENTS THE PUROC A%cO OV"W Lv1& t
RELEASE F O R M
,1= -QE LAKE =
EINANCE DEPA 'j' M
to issue Green Tag and Certifica�z of Occupancy
PROJECT ADDRESS: ���C<<� r-t V
e
Laf j TRACT
ASSESSOR'S PARCEL
The above referenced project has wet all the requirements of the
g'inance Department and can be issuad a Green Tarp and Certificate
of Occupancy.
FINANCE DEPARTMENT: DATE:
Comments:
l;)-88
�i CITY OF LAKE ELSINORE(CONSTRUCTION PERMIT
Projacf Addras -'� A;lpliCaat;o fill!in 21t spaces except those within heavy border lines and sign all appropriate declarations
f►ssauoe i Fofewi N - --- TRACT NO.
LOT NO. U'y 0.�^
ER •IWO
��.s%X-ne -�Y �r7 0 r
I Addrsst L� -Cj- IY_ T" OFCOFtSTRUCTIOid ❑ NEW ADD C' ALTERATION REPAIR
Qrcl+-=•n;- _--- -------License No. - ❑ C014yER�'!ON �� DEMOLISH IE
A P_ # Zone
",L�lAccessory Budding:DESCRIPTION 9F WOP E OF BtOG- -7 -��GL/,/ E Main Building-- _ -I 0
-Phoie - �1- ` T Front )N
�'•!t:rxtU'f rya.-^� _-.-.--
_ TTPEOFPERMIIT � GRADING i�' FOUNDATION TRUCTURAo t
adcssew!^r a Ii g --- ---'- TENANT };.�ECTRICAL t R1UlARING c<-MECHANICAL A1(-Rear - _-- - N
(> OTHER -- - V_ C i !ht G
I.IC SED GONI'R C CTOR DECLARATION yR0)ECT DESCRIPTIO4 sr,.Ft._ _.Occuparry K Left _ I R
r ha• rNnm that I am licensed under provisions el Charter 9(commen and r,Cnil Uft!on type __ Zone - Arxa -- S E
vattt+ ;r io^ 7000) of Division 3 of :he Business and Protessions Code, r PrH /,Z �' l Ing. Ref.# - Parkin Req./Provided Q
is in fun fcace and effect. 1'aillawn S_l��L- - AA
License C: , - License == - --- — - Planning Notes -
Date \\_ Signature Remarks _- p _ g
1r1PE,4-ATION DECLA.RA..:��+ a C r.., -
t WORKERS'
1 Rer eAo afl,.f that I have a certificate of consent to seif•intufe or a certificate
nsation insur Inca, or a certified copy thereof (Section �1q/
Of
__ Ce^.'•^_0 =nP1 is•rerehy furn:Shed. - - _- _-_.- ------ -_-
._ Cr•:r?.et:copy Is tkea with the city
Builtlg Division. --- -
Ga'e Applicant_-__-- ---_ --
ION
EXE,atPTIC'l4 FROM
ba1r,,O E eted`fMhC Pe permit s for
one hR dred(Si00)Or �,�
. s !_.c MECHAiUII'AL C►GS ACCT p GRADING FEES
'..s<'. PLUhlEiidGFEES ELECTRfCAL I FEES ---- -4
.7zrS•v ;•,rr to r'te perf0:ntonCe Of the work for v+hirh this permit �S�f SPetl,! .._._ Boiler __-- -- Cut -Cl.'.yards
eT.w/ .7•�Y D¢rson.rn any manner so as to become subject to lne I Ali21ff?pair -�Cenerawr 00.5KW C 5.15KW
v.c.�.•s' Ccmpentatrcn Laws Bt.California. --- s __--f- - - �- DULL Under GrOUnd = = Frll -__ ---Caya!ds
�•t --- - ----Signature ------ AutoWash _ tC�f+ctn�ctianPoleSub. -_
IaOTICE:_',offal ma;ong this declat ition.You Should becon'ie Sub
to the - COokln Unit
Duct-Structural -_ 3401 Plan Check Fees
[r,mpen;allon provisions Of,the Labor Cod¢, you MUSt 1prthwith _ J all .tfgnjlla)IR� __C. _ :�cn provisions or this cen»it snap be deemed revoked. BaCkfi�W Preveuter -- Prole tLiU9hf _--- j--- 3225 Permit Fee S
CONSTRUCTION LENDING AGENCY Backllow lrrl UPn_- _� [XhaUSt SVSlPr1t _--..__.----�--
i-rF_y z'I^m that there is a construction lending aeency for the Pe N.ormance - ( Dryers El L)El eCtric _-_�_-. - Total fees f ------
J' t'c wort: for which this permit is issued 'Sect. 3097 =-++• C-3 Clarifiers - ! Fan _-_- _ - Eva orative Cooler �.
.,e s Name .- --- F.A U. Hl sting System&Ductiny 1
--- ----- Fixture Traps ea. - GC. _ -------
„s. .,Address ___-- ---- - / i J6 G;1-100000BTU.0100,000STIJ+-_ Salama7ofPermitFees
O"s'Lri!11cR BUII_DER DECLARATIONLaw IxtureS —'�`
froro Floor Drains ,_j - Q�
�r �a`nyareason that(Sectl on 7031 5t Businesrs and vrntoz�)Iu License code: A ti•1 re h I "- I _ utletS ��. $O Hood Ut Canopy /I rj -
nlcFfool Sinks -- T T p TyLle 11 G 3220 Bwhi!nS $rist --
'�,s, y wtrich reub'res a14 issuen0 COa SO rrerl tl after,
the appliC�dcmOSuct�pCrerPr�i it --- Sygl CfleS ___--____- - --
;:r P Gas service Outlets �.— _ 3P21 Plumbing $ =�rw-
It• +..,. a s:g^ea s!a:¢ment tr.at he/She B licensed pursuant to the prnvisient of c' - Refrigeration eration System ,
g.F :�!rac!or's UCCnSC lJw(G!aPler 9(commencing with Section 7000)c 1 Intefce OI Mete!❑ U to 201 am s
pt s l --� ❑D•?rp 000 BTU UT00 000 BTU
3 of the Bus••.ess and Professions Code) Or foal he/she e>ter on _ Meter;J over 200 amps -- ---- 3222 E(ech�cdl f
n the ha,is for the allegeC exemption. Any vlolatiors 0' SCcl.o^ •-----j- ,--�- _ --
fr✓•e•'' and
apr.acant for a perm.t Subjects the applicant to a •. •�1 I r-Tr'p_- 1.----._ Fir fi Fari BIt.IC # 3223 Mechan:ral $ -_ y
Ruof Drains I Sub anal _
not a than five hundred donors(ssool. _ --p----'"--"-"-' System Repair/AI(era_tiU❑ _ f
yr C l Tb 5oK4v __ - 3224 Retent x!
T/„ s owner of the P'oPerlY or mi employee' with wags as thou tea Trailer Sewer - - _ j TransformP.- Fire Dallpers �- _-_ -
rontra;tors Q_ 50+K1h' _ _ - C '301 SMIPRes f
y e�(4CClinnll 044,leBworCSS i,do professional zCOAe intended
ed or of¢retl _ p ----- - - 4_ -_--- --
o Hullos or imurovra Selll'el C3 RP 15ters "�
t,avv does not apply to an owner of a Property w h his Or lire own Sourer Connertion Blag. Motors 0 0.1 HP t71'1z B 9 __-__ 2302 SMIP Com. $ _-_._--
:_t.��r• and who, does SuCh work h•msclf/nersclf or Inrbug _ -- Inc. Solar 09-15 HP Ci1E'1 Fit Incinerator ___ __ _
-.c cyets. j •wiGed that such improvements arc not ifIthin C or olio r:d fO• SUlar CollectsrS -- 3225
.� f however, the building or improvement vS Sold within on¢rear, tom• _. - -- Sing/Fain. Res. Misc. _ _ - -
e: the Owner will have the burden Of proving he/she did no' Ot!iI.Or im• Solar Piping ._ -` Sammary of Plan Check Fees
^,,eve fr-r the purpose of salt). �T---�---- _,_-�---- .-_.-
as owner or ute property,am exclusively cnntracung wi.n Ircer'sce con• MUltt•Fam. r�as�___. a 3401 Budding S
Soar Tank
;•a::ers to construct the pro!^.CI(Sectior.7044,pjy to ness and Pn owner f feS6i.;ns COtle: SYfImmlOg POOI/S�la Swimmin Pool/J�a _ -- - -- 5/ Plumbin( f -
6,t imprOV¢S -,hereon,lntl who cconnot tracts 10,such Pry eCtS with la COfO __ - - �_ Issue -_W._- ---.`
co,IS licenON
se PurSuanl to the rnntIactor'S License Law`- I am aware Inal Willer Heater -_ - -- v I Electrical
�• •7t tha+r Worker's C o the or n insurance ShoulA be pro�iCed !^ ^'¢• Water ServlCe -- ' -
-_ B.& P.C.for this reason _ -_ Mechanical S
r am e.eempl under Section------- - Sf! hC S Sie _-•
-- _ OEYEIAPAIERT SERYICEi REQUIREfAEfETS: _
pa'e ..✓ -►/ -/- Owner i_YL.-._. i - ---- i -- _Date 3412 °tannin[ i
-.treGY certify that I nave read this application and stale that the above 1Ade .- Zoning Approved lfT_--_---------y +Y
Builltin[Approead 91 - __ ihta .. '� ��.
.•ymatron is correct. I agree to comply with an city and county ordinances -lltla_� r2 (7n
ae c:a its laowst relalf jy rtp enter 9i poll f ileti above mentelnnedutPr,Pnrty pJAr - �- I{gfl0n IiflfeQ O1 -- -----" �. Teel Fe4S(IW S
�s �/ �l' /' -'r2'v -.----
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T
CITY OF LAKE ELSINORE
BUILDING DIVISION
0WNEI_ BTJI L D E R V E R I F I Cr. T1 ON
A city or court;, which is required to give not:.ce 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-builde•-" building permit has been applied for in your name
and Lhearing your signature. N2 building Re=i will hg Iss}e.d intil this
verification is yeceived.,
1. I personally plan to provide the major labor and materials
tuy__construction of the proposed property improvement.
Yes No
2. I (have/have not) i ` 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 pr:svide the
major work:
Name
Address
Phone (714) Contractor's Lic. #
5. I will provide some of the work but I have contracted
(hired) the following persons to provide the work indicated:
Name Address gbsmq T y Pg 2f Work
(If additional space is required attach subcontractors list. )
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. 0 or Soc. Sec.