HomeMy WebLinkAbout1001 HEALD AVE_
I t CITY OF LAKE ELSINORE CONSTRUCTION PERMIT
Pro*.i_d•ess _ %Do/._>`tegfJ 4vC �. E/�e'►�.�
Assessr• s Parcel Mj` i -y App;icant to fill in all spaces except those within heavy llorder lines and sign all appropriate declarations
O•+nw • `tee^c ,jj�•t c_ w /fit e�bG!�/.-_Phone PE M!T NO_ �t 2� TRACT ACT NO. LOT NO. UNIT NO. l j
JJ I
E _ _ __.r --r---- _ License fvo. _.-_ TYPE OFCONSTR'WION �NEW c ADD r ALTERAt10N REPAIR
1 a .ress - -----Phone
- - -- - CONVERSION DEMOLISH OTHER v
{ DESCRIPTION OF YrORK'USF OF BLT G V�r r -_ A.P. # zone
l�.1 /` �x
r,r.,. r;ur+fsc._ -_. ---Phone_- - -c ct _ E Main Building; r —
hJ-�_ E Ar:cesso.y 6uildinq:
TYPEIF 9ERt8T GRADING FOUNDATION STRUCTUR.:L T Frant ---- --- ---�I
C•v _ r v 'L,, i 1f - TENANT EtrCTRILAL PLUMBING ME HAWAL B - � ----- -- _I 0
LMENSED f,r}N7RACrOt7-DECLARATION OTI{ER ___ - 4 Rear --_-- ------ -
r n. fII.>t I am I"e'lied under pr.•v,sl' r:w C,Qrter i (c,nn enC,ng PROTECT DESCRIPTION Sq Ft -_ _O cupancy _- C Right I - N
h:•, r' �r 1000) of rilrrslpn 3 of the F.tuttru::and pro:FSS,Cns Code,and C n r rhen type __ _ 10ne •_�---" I -_
3 sr u - - - -- - - ark --- --
m> tom• r.,n full force and effect. �D^ `- Acres g Left I C+
L•CC-Y_ :_ a'i5 ---- _ .Llcr.nsC No. --.__- VDILa''Jn;----)-- PCd FL- - - - - -- --- -- -` Ping. Ref. # P inq Req./ProvidedE
oa:e _ slnnawre .- PemarksQ
Planning Notes
WORKERS'Cf7�N5ATION DECLARATIO J I�
`•t.e7�aft'm Ih I havC a cerrlllca tr.-if consent t.,sell-insure or a certificate -�-- - � I T
• -'-efs' Comp w\at,on Insurance, :❑ a cerLned copy thereof (Section - -- --`-- —. --- —— - -- JI S
350= un. C.)
P :�> `�. ---\� - Comp.,ny .. - - - - 1; 1` -E I t,;E
I t Cc,:',te copy Is hE,Cbq furnitned. -- ---—- ----- '(�� J� TdrT P ?T.ICU--- —
Cer;"ea Copy Is flied Witt,,the City nl,nd,n,:n•vrsrnl,.
'JJ•e Appllcarll .0 -v^^'Z`'�•�-`t:-*Or•(�'-__- ___
---- -- ----- •- CTf�:]OD-s�70-OL•2CI��(1QQ4QOQOQa?EX EIMPTION K ROM WORKE R�(GOMpENSAT ION DECLARATION T —_'---`•— _ �- - - �TL 1�'� �.�TPL:r= P. THEOSPI-0
�'.e:••"n neca n•,l Ile conlpfelt. If Iha'I''-,'r 111•' <I. r -.r1C•hundred S100 it
'Y.f" '.di ir1 !Ill' p,:r l.;r l,I,,II�,•, '1 :� 'I�r ',I. ;Ills:!rn:" •s St I:CC,I
.f1 ,. , ,m( s,:pr,: 1 Ire PLUMBING FEES ELECTRICAL FEES MECHANICAL ' FEES
.: '--•s• r.cmpensatlon L I a If Gait^n1>.y. - -- ------ f __ _
C Inatwe , Alter, Re air I ACCI a GRADING FEES
- \ P_--__ Generator! 0.5KW 5-15K1'V1-_ Boiler
YOTsC£ .I,! , ;.,.71 mil Iry1 <I.rlar.lt,un, �',� •,,1 7 t Cr•;,-'�C s I F': •., tr C Auto Wash
_-f ____.__ - _ - --__— f__ --�— _.
_ Construction Pole Sub- I Cut - ---- _cl ya:es
.. .•:t+t' -.,,prnsttinn nrn ins or the t 1 T, , �,I, ills. ••h:.,r, •.__ to W . _ _!-_----. ; Duct-Under ground -
:UCI, prnvl Sln.s ur this (7C1nu' isltil t e deC nco �.. '-CO. �Backflow Preventer I _ _1.-_ Fr'1
CONSTRUCTION LENDING AGENCY - -- -1-__ COOkI�Unit_ -__-, Ouct•Structural ---- - _--cu.yards
' ...•.Ina, t:wc s n a ns••ur.Il n, I,1 r :,,r •^e Ba kfIOW Irrigatltl� -` —`1--- 3360 337d PI fh
a cefr _ _ j___— - Pale Light �_ -t Fan -Ventil3tin an, ecbfeeS _- ---
v,.I- 1rr wtw,, tn.s permit I• 55urv, Sc_i nn 30n7 CIv, (� ---- - -- ---- g-----
I Clarifiers _ Dryers L,Gas Electric -- 33003312 P•irrrll irl; S
- - - - - - - { - - y - -- - _ Exhaust System I -
L5 Dishwasher ! - ------ -- -
I GJEA BL'1LUErt DEC LAPATI6N - Fan Evaporative Cooler _-- Tmal fie, S -
( Fixture Traps ea. ii
e•c r , .1,.,1 1 an, I vrnip! •rr, chi - _ F.A.U.F - ---- ---
Ir. s , ;� 5. L,.: r� :,•� Heating System&Ducting
r ^ Floor Drams I Fixtures- C10-100000 BTU
G100000 BTU
1 •e.l inl et.1"Cl rn,I ' C ; Ili,( ,1. I: d(' -II •, I p,l•r i--- -i--- -
:I.ah._ t1s en, e s :r; ,r Floor Sinks -.j Outle. ------ --- -- Hood or Canopy + -_ 1100- .es -
d S. u , urin• tI. Its p „ t '? 3312 Summary ofPerm,tlo
.f: tl.l•r Inrn' :r „ h,• 11 s II:.( sC 1't 1 , 1 f .�r n5 Of _
( (L, r.1 I Sir i •o^ Gas Senace Outlets - - - - - - - - - Yp-----3'�-I C
d.:ur's!I hie. C.I Ch,p•I r •r , t.I , ;C , t :Switches _ _- T E 1 1-f T P,II t_.
4 If the nnslne Ss and f'rut_•t ,I;S Cat•:) tLa hr r cv.r•,pI - - _�-----._ yI,114in(( $
t I c-,c•r .1-1 IhC bads for the alley••:fur,.• , p- ., Interceptors ---- ---- Meter i . I: le 200 amps ��t Refrigeration n• ', v � rill I• S�r,I.r, j _.._- _I _ p p / L Refri eratim
7'3:.= cy any applicant fn, a prr oils :uh(rc•s 1.1r- .1ppl,.a'•t a CIA P-Trap f - - Plumb.ni'. j
-r- Ity n1 r,It :nnrC uI r1 flvr nln,dren t,•,n.1r,(s', •o;. ___ _ -I Meer over 200 amps T_ F10.100,000 BTU L 100�060 BTU ! xj
tl Pr:,T,trtry .r rile .•,„�rvc•t r •..,wC: as :I o1• :N 1,• Roof Drains I S lb panel- -_ __ _ _- _x .i _--_- f C!1n!aI S
�j N,II r1:, tit,• rrurL, soft (h,• 5t a nn•%j
_ _ -_ ____- Firepl/Fact. Blt. ICBO rr
.p,'1 pr• r al C yr t nC ct n;rdr:,,,., 1 Trailer newer r, 15 50KW _Systa_m Repan,Alte1 'ion- j �+ecaamca! S
Sewer Cap - Transformer - f rh
Cr- n (1uCt nuI dp{I� L- uI „ ' I l npert t. t,.n' r.r ;nlprnvN. ! _ f, 50*KW I Fire Dampers -
1 _ _ dn. w,•„ ., �; ,u�h .r.:r I I I1,1 'rs,. ' I ,,, I,r, rIr -�C, n..n _ - •.V.:_
t tin lvnL 1, ;hat such nnp r •nu•n:'.ar. n: :r:.: ,r I•rr ren b r �Sewer Connection- Bldl, t - - v - --- ----- - - __. __-_ r
is r I ,evrt. thr bu11du1y to n,I'I n•n•,t;,c rb1, ,r C ve.L coot- .6
1•�• Registers 1 tU 231 1 kP RPt ;
I ors F l 0• HP' f
=r �:nl•1 �r,n n.Irr :h(.hnrnel.I,f p yn 11 r,rf I,• nl:Iv; Ir Ins• Solar Collect M 15 I - -
move 1 p,rr1„;r'.0•,1,•). -. - -
"-_ __ - - _F Inc. Solar I --- •---_ -` Incinerator i10232 .yu'L�m $
ors I HP i 116 15+
wn(.r h1 the w•'pr, s, an ,:<r1, rI� hpin SinglFam. Res. - _ -- - - ---- - -__ __ _ _. ----- _ .
f•,.r-tI u.t I IIv prI ,,: tS, ua,Y! r 11 •IC1c<J.q p Cor,C olal - - - ---- - - -—--- --- 3F0 3370
S 0 j - Misc.
: S(11af Tank-•, r•,r'IJ4I rf•', LII:CIISY. l.lY. C'•1'; III.1 anul> t J .'.rc• r.r :,,rlprlyd 5.•h„ _ _ Multi•Fam Res. Summary fPbnCheckFecs
--• 3 S a o
n •,rltrans r.,. n n „p::,, rlt,. a con- Swimming Pool/Spz t`Swimming PoDI/S p v - - - -`h •!sf hee,•SC our 5'tant t1, tf•C r,naraC:rn', (irensr ay.). I ,r^ a;.are :hat -i. - -_ _ __!_L _ �______._ _ _ ,-_ BU Id�ng j
p•n',' ,.' t',C❑ l'Jnrirr•t C:umpCnsd l:nn msur�rl,cc S o,p1 :•r p,•r.tdC•7 to nle. Watef.Heate( Issue
- t Pq mping S
an vPn,:. ur,tl r•r SC,:11 ', Ca. t P.rJ tint rp:t t:,n Water SLfvlfe c r)• --�--
r r f^ _1
SBpUr. SyStBm
re e3: cc fy !liat I n r Ian rills ap>hr:lnrrn am •,Lto Hilt t•,e ahr,ve _r.MISC DEVEL9PMENTSERVICESREQUIREMENTS:
n •Ta. n r :r..rrrt, I n,Cf unply witl, an r :y .Ir•.: tm>llly unman CCS .- _-.-`_... _-- .. _-
to e laws 1•.latrr.q it hwlnn,y :.IW11, n;,ant _luny aun,rnrvr rep•q- I _ Zoning A FMJBy --
S SCn:J:I.tS r 1 ibis c1tY 10 rotor .-} ._--_.._.--.._-._.-_�_. -__ _ --"DIIO u1A
DD
rip I. the )11Gve• cu'r,ned n•npCrty for _ buildingADDre►edBt _ •. �2�/ �") 3360.337$ PFdnm^g j
nlp3 pw,t• s. ��_ -- - _. --- -
r„rill 4. �iCv i 6un /�•.$• y { Issue .... - Application Tuned By ._ _ - -- - - ---- ._..Date
tow(m DY& j _ •,_0.
White B.'7.nj Green Tenrwlary F&!C',q Canary Astewo Pink Aliplqrant.Guldr.naxl Acs^unurg
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CITY OF LMNE EiSINORE
B:iILDING DIVISION
O N EP, - BI! T L D E R V E R 1 F 1 CAT- ION
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 pe t wil be issued until this
verification Jis received.
1. I personally plan to provide the major labor and materials
for construction of the proposed property improvement.
lYes No
2. I (have/have not) k av r_ 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 ( ) Contraccors 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 Lie.
S. will provide some of the work but I have contracted
(hired) the following persons to provide the work indicated:
Jame Address Phone Type of 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 Heal.:.h and Safety Code
and have complete the above information to the best of my personal
knowledge, in compliance with this , tate yaw.
Sianed: _ Date: (e
Name: -L1_s� A -7 A_Y L--�0
(Printed :sr typed)
Drivers Lie. t or So!;. Sec. #
A I E- Y
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JULY 22►1989
KEVIW SHEAR
CHIEF P`JILDING OFFICIAL
CITY OF LAKE ELSINORE
130 S. MAIN STREET
LAKE ELSINORE, CA. 92330
' 1001 W. HEALD STREET
LX,E ELSINORE, CA. 92330
DE.z1R. SIR:
THANKYOU FOR MEETING WITH ME ON MONDAY; DULY 17., 1989 CONCERNING STRUCTURAL
ISSUES BROUGHT TO LIGHT DURING THE SPECIAL INSPECTION CONDUCTED BY MR. SMITH
ON JC]NE 8,1989- YOUR SUGGESTIONS FOR CORRECTIONS ARE WELL TAKEN AND I AM
O THE
PREPAREDY UPON YOUR
BWOULD HOP--� 0 COMPLETE THE WORK WITHIN RU
AND WITH NE45�DAYSAOFLYOUR APPROVAL
APPROVAL AN
OF THE PLANS.
SPECIFICALLY, I PLAN TO MAKE THE FOLLOWING MODIFICATIONS TO THE STRUCTURE:
A. RECONSTRUCT THE EXISTING ARCHWAY IN THE THE MAIN LIVING AREA FROM A FLOOR
CLEARANCE OF 6 FOOT 3 INCHES, TO A NEW HEIGHT OF 7 FOOT 2 INCHES.
B. REMOVE THE SOLID DOOR AND 43 INCHES OF WALL IN THE ROOM NCW BEING CTTILIZED
AS A BEDRJOM AND REPLACE WITH A 72 INCH FOLDING DOOR.
C. INCLOSE THE EXISTING WA ER NtATERRHEATERPROVIDE
THROUGHLTHE EOD DOOR XTERIOR WLL THE
OFITHE
CLOSURE AND VENT THE INCLOSED
STRUCTURE ACCORDING TO CODE.
ND ELECTRIC DETER IN ORDER TO PROVIDE A SECOND
D. SECURE, A PERMIT FOR A SECO
LOAD CENTER TO THE STRUCTURE.
THANKYOU FOR YOUR TIME,
BRUCE THE^.BAM
/ CITY OF LAKE ELSINORE CONSTRUCTION PERMIT
Project Address .Z,2 d L
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations �jl� '��•
Asse>►aI s Parcel No. __ _ PERMIT N . 1 TRACTT 7O 7 LOT NO. UNIT NO.
Ownri's Name /l2L�_ JL�i�C/ -Phon es O i F
Address ------
-5 � __- a
ArchlEny._-_ - -License No. _._ TYPE OF CONSTRUCTION' ! ' NEW ADD ALTERATION REPAIR
CONVERSION DEMOLISH OTHER 7 . ��L� A.P. # Lone
Address _- --------- -- DESCRIPTION OFWCRK/USE OF BLUG._ �- - g f
Contractor's Name_— _--_-Phone_- - ( _ E Main Building: Accessory Building: - Z
Address Imailing) --_ TYPE OF PERMIT GRADING i:i FOUNDATION : STRUCTURAL Tl Front _ _ 0
TE44NT a ELECTRICAL PLUMBING 1 MECHANICA'_ B Rear N
City ucense No. --_-_-- - --- -
LICENSED CONTRACTOR DECLARATION OTHER _ __• _- -- t-- -�— —' —�N
I hereby affirm Ili-it I an,l,Cef+sed under PrOwiSipns of Charter ? (c,mmencing PROTECT DESCRIPTION Sa.Ft __-__-_Occupanry -. - .- K Right --- G
V, n se
er„o 7000) of niv,sitio 3 of the Business and Professions Code,and Construction tyoe _ _--_ Zone Acres -_- _-. g Left I
m Iicenle is,n full force and effect, R
Lice se Class _._-_._ -----License No.- 1ab_atro:S .Qt��--.PCa __ --._ - - Ping. Ref. # ; r eci.lProvided E
Date __ S+gnatUle _ ____-_--_-- Remarks �,,�- Planning Notes �� 2[ i t]
WORK S'COMPENSATION DECLARATION -
1 llefeby fu,n That I hived certificate of consent to sett-insure r. a certtr,cate L)�T�C (/ � / (% __ --------- y` -�T
of Worker ' Compensation lasurance, or a certified Copy thereof (Section
T '
3800, Lab.
Policy No- ---,-- Company
CCrGficd co is hereby furnished. -------- - _ ML
Certified cop is filed with the city Building Division
Date._-_.- - Applicant-------- - -- - - --
EXEMPTION FRO 'PORKERS'COMPENSATION DECLARATION
(This section need not a completed if the per lot ,s for one Inunared ISI00)or ---- `--'--- -
iess). _
I cCrnfy that in the nerlc niance of the work for wn,ch this permit is issued,1
Irian not employ any Pers •, ,n any manner so as to become sub:ec: to the PLUMBING FEES ELECTRICAL FEES _ MECHANICALWN7 FEES ACCT.0 GRADING FEES
Wort•.ers' Compensation Law of California. '_Alter, Repair Generator f IO.51(W❑ 5.15KW Boiler!
Date ._ _ _ _._-.__ _S,gn. lue - _ ..__. _-_-.___-__-__-__._-_ -_ C�—. -- _ --_- c- - ___ - -_------_ ..—.-
NOTICE:II,altcl maF Ing Ili,;de �,rat..,n, vn" showa become s:.b,ecl :, ire Auto Wash _ _ Construction Pole Sub. ^_� Duct-Under Ground -----t- Cut., cI: yarns
Workers' Cnmpensation Provisions t the Latter Cade, you rnasT fortr.tdn ----- --}------ - - -- -- - - --- - -- FJI yards
comply w„ut su•.h ProviSlnns n, t p (mil shall be decried .e.r.we.^.. -�ackIIow Pfeventer Cooking Unit Duet•Stnc�ttr al - _-
CONSTRUCTION LENDIN: ZENCI� - —'- -- "- --�-- �i - 1 —
p�rt Backflowlrrration _ __ Pole Li lit _ _____ _Fan -Ventilating3360.3..10 Plan Check
lrereby affirm.hat there is a cuv,struchon Len n agency for ire ze rr 2-ce - -� g----------{" - -----
of the work for wn,u, this permit is +sstt (Section 309� C C..) Cl2fifiefS - _I -- _ EfS❑GAS LiEICCtrIC i - - ExhaustSYstem _-_ -- 23003312 Perm!tFre
Lender's NamC __-________.______.—_- -_._--------- -"- , Fan Evapotive Cooler ) IOtaI FCCS 1
Lenders Address - --- - -- - --- ---- Oisliwasher---- -. _. -_---- -- — ra - -_ ---- -- -
OWNER BUILDER DECLARATION I Fixture Trap sea. '_F._A.U._____ _ _ I Heating System& Ducting
hereby'ff'rrr that 1 am exempt front file Contractor's L,ce-,1C Ls,. f :nC �- ri
c` Floor Drains _�-J Fixtures V ! 0.10t)000 BTU 1�100,000 BT U _
fnnnv„nn reason /$Cct,un 7031.5 Businr.Ss and Profess rove C em is• T e or --_.-__ ----_------------ ..-_._-- -_1_ "r___ ---- 3300.3312 Summaryof Permit Fees
cot.nty v,nlch requires a pernnt to consl,uct,alter,improve..em- •ts^ •eea,1Floor Sinks _ I ��"
any structure,Pr,or to its issuance. Its,,requires the apphc,n- fc, suCn cerm+f -__ �---- � Outlets - -__ -_- Hood or Canopy
to hie a S,gnCrl Statement that fie'She ,s I,cenSCd Purf.uarlt :o ire pf r ,nrl5 of I -�--- *
tne Contractor's Ltccnsc l�lw lChaptei 9(cnmmCncing wiR'� 5•:c:inn 7000) ::' Gas Servicp OULef_s -�Switches --__ _ i_ T C 1 _ri 1 e I{ U g _
-- .tee_ -- _ yp - eaadl�a s
O,.Sion 3 of the Business and Prufessions Code or inat he s e s e>er„pt 1 Refrl eratinn S stem, Interne tors � i Maser�, up to 200 amps � g y
therefrom and the basis for the alleged exel"Ptlnn. Any v .la or of SiQct,.n •_-._�-.--_ _-_--_- -^----- -- um
7o31.b by any a-pl,cant 1„r a oerm,l snhit:cts rfle appl„a a civil P•Trap _, Meter i_* over 200 anfps I _ _-i C70.100 000 BTU r 100 000 BTU rcrr.ca
031.5 or not more than five htnldred nnllafs($50G). ..- -� __--
I} P' b+ng
alty
as owner of file property „r my employees vn+r, :.ages as :Heir st fe ) Roof OfalnS ----- -+ ---- Sub panel _-__ -- - -- Fir C-PI/Fact.Bit. ICBO }r t ---- --
—j' -P.-- ct- - - --L-- Mechanical $
Co 1Pensation, will bo file worw,and the Iluctilre ,s n"1 mtitn C, or olfcred Trailer Sewer � �`-] 15.50KW �_ _ p,
for s'IIr. (5ecfiun 70•14 Business and ProfCsstonel Code: Tnc r_cn:ractrr4 _ -_ System
Re air/Alteration
forLic sale
Law does not a, clr to an n rid r :,prnpr11 v,hu pu,lds d• --- _-�--- I Transformer - - -.- --- - - )ro�3? Other $
n,+Pro ves N Sewer Cap __n 504.1 Fare Dampers
I nerCon, and wllo dl C5 such w,f•r4. h..,,Clf,llrfsel! nr lnrnugn ^,s Lr C' "I _..-__.-. ______ ___ _...-._._-___ _ ___.-_ ____...__ _ _.-.- _- -.- ---__ _- -
employees, Prna,mid T hat sucrl :mprnvc menu are not micndccl ',^c co f,,1 Sewer Connection- Bldg 1~ - ' Motors LI 0.1 HP FJ 1 i,-B __RC91Sie[S - _--__- _- _ T- T_ 110 231 SMIP Res $ r! v-
sale. It, howevef, the b,:..d,ny or,n,pr„vrn,•:n; Is s„Ia w thin >-.e year •.t cum. - #--- 1 110?32 SMIPCom
S
PIC;�in, the owner I, i have t,-e burden of waving hers'":d,! b+ •t r-• :m• . Solar Collectors - I_---- _ ; lac. Solar t 19.15 HP t_11E 15+ Incineratorprove tnr IhC Pill Pose.of salt•). - .. --- -- I
I,as owns ll ti,e prr,pclty,a,•:cxclniwrly �.oltlacting :. t^_n y:^.con- _ Solaf_Plpl ng - ' .._._ _~,SI n(J;FBm. RCS. -_ ; _. __ It�115e A. -___ _____-__.__.__. __ _
i„tit u,s l„ric,o„tr uw nit„tyecj AS.von iSlve1 �.,ut,ner. and P,..•e Ss� ender �Solar'lank '�-�_ `, - ---} 3360.3310 Summary of P17n Check Fees
The Conti a,lor'S to,
t.d••, dries not apply t" in uwrnct of Pr-':"rly whrJ Multi-Fain. RCS_ _ _..-..___
n. _
bui!e1s w rmpl.+vrs the ,,,,and v,h", ritractl, for SUCK pr�.xVs I.!, a c1„1. Swimming Puol/-pa .. 'SWirr nlnQ-P001/Spa __-- l :.—.-- - - --• 6c,idmy S
tract nr ,, _ pursuant lrl the r,,lnt:actr"'s l,o• .se I.ay.l. I a-,• a+.afe tha: -•- -- --- '---- - ..t -i--- -- _- '". --- I(s) cenS� r.
ro-.,f of thr•. Wnr�rr'S Cmm�c"satmn Insurance. Should be P, .nJCd to nit;, _ wafCr HCr1tCr --.-_ IssuC __._ _ _.*. -_.-_ Plnc UInQ
DateI am cxrrnpt undrr Sect u,n .. -_ - B.r. 1' :.', In,t rya tr.n Welef JCrviCP. _— - -lCulp Pop-- --_-.-__.-_. - --- Elett vat $
I
�1, 79' 1w,I,cr .� �,�/ _)Se-ptic_System_.,---_ - Mern,tmr.ai $
set us 1 fir-atu,n ant• •fate Ina: Ire above .,_ DEVELOPMENT SERVICES REQUIREMENTS: - - -I nc,nh, t.c,I,ry IIla1 1 na•ir. rr pp -;_Mist,_-__--.�.. .__- lithe! $
ml umah"n IS c rr,ec:. ! dg,UC :,, (,imp:y with all city and r"urt, -r,I,nanres lwtialApprotedBy.___._ ._.. ... _Date
'Intl tta:e Id's ntLtt,ng to bu,lamq coos uri,mi,altd lieraby JJ!r,Jll.•C (sore- -:-------__.._- _.__.�___._._ T_ f - - - - - -///-LLL- 3360.33T5 Planning -,-
Ser•'atives r,! In's City In enhir up tl+C above•n,entinnrd nrI pCr; fir I Bvaillmg AWoKd B2
7 y - --- --- I�Appticxtion Issued BT _"--
Total Fes Out $ 0'R,
tit .ers' i.,tente
While Budda,g G(een Temporary file Copy.Canary AStP.tsw, Pink Appil(ant Ga'dtefol Arrr,unpng
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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
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 Gwner:
An "owner-builder" building permit has been applied for in your name'
and bearing your signature. No buildi permit )Ze issued until thisi,
verification is received.
-<I. 1 personally plan to provide the major labor and materials
for construction of the proposed property improvement.
Yes No
(have/have not) v•e_ 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 L.
#
5. I will provide some of the work but I have contracted
(hired) the following per to provide the work 'ica-ed:
Name Address Phone Ty of ,9ork
(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 Sta Law.
Signed: ,4Date: _JZz�pf �a
(Prin ed or Typed)
Drivers Lic. # or Soc. Sec.