404246 (BLCK)BUILDING PERMIT t `—
PERMIT NO. DEPARTMENT OF BUILDING 8l SAFETY FIELD DST
0 42 4 6 COUNTY OF RIVERSIDE `
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 1ST FL.
r
I 2ND. Fl.
FOR.
GAR.
CAR P.
WALL `_,z
R
J
ESTIA;A�ED'f OIGStRUN'
CTI
SQ. FT. .@ $
UNITS
ouoton
SQ. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
1
SQ. FT. @ 'r•✓ �! ^1
DRINKING FOUNTAIN
SO. FT. @-
VAL(IGATION
URINAL
WATER PIPING {
NOTE: Not to be used os property tax voluotion
G6
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
Construction Fee Dist $ �.,
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH).
APPLIANCE DRYER
Type
'
i
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Bond Amt.
$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FiV61 t
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
Const. Lender Branch
POLE, TEMP/PERM
LAVATORY ,
HEATING SYSTEM FORCED GRAVITY
Registr. Fee $
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Reinsp. Fee $
SQ. FT. @ a
BATH TUB
Tel.
SQ. FT. @ a
WATER HEATER
v
�/
50. FT. RESID @ 1 V<a
SEWAGE DISPOSAL
Zip 1
SO. FT. GAR @ �/aa
HOUSE SEWER
'
Contractor
d .y.•-�''+
Tel.
SJ` •1 r �f
GAS PIPING '
PERMIT FEE
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PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
HM. FEE
MICRO*FEE
MECH. FEE
PL. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
Job Address
�4404246
Space Zip
Owner
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Off.
F.C.C.Commum t
MH Permit Fee 5$
Micro Film Fee Cop $
sa of Permit
ii ` r �7 C.� / �/ ,4
Parcel No. /
` - Use/Case
No.
Ck. By
Mach. Fee Dist 5�.
PI. Ck. Fee $
✓ '• Set Backs
lot Size
,
Construction Fee Dist $ �.,
legol scripii n I,� / yr r= r-- '-• �'
JLCt /. a O r� r M• / J / {¢" /
jyy C (/ '
F
S S R
Electrical Fee Dbl 5
Zone Restrictions
Group
Type
'
i
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
FiV61 t
Inspector
Unit
Sp. Insp. Fee s
Demol. Fee $
Const. Lender Branch
Supplimenta Permit Numbers
L
rs
s'.
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel.
Zip
Total Fees E
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as ,,.��' _,✓
City °
Y
Zip 1
M.O. E) N.C.4Cash ElC ec " �'
-
Received by '
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Contractor
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Tel.
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LicenseW
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Tres reldu'•i�'d,I'
A read ti. '
City
Zip
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T LL L1r P _ -THIS PERMIT SHALL BECOME -VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
FOR, 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
'.Sewer District ,f
�. 1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCO,
DANu vJITH � ?'
i! THE LAWSOFRIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. .!i`tj•ir
t�—HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
arm 48d-208 (Rev. 1/BO)
! Att01Z6
ANCE WITH SECTION 5541 OF. THE BUSINESS AND PROFESSIONS CODE OF.THE STATE OF CALIFORNIA. �•
F .
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAV APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
_ / _
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
/� 3—
36
Inlets & Outlets
4
Grout Blocks
'Z�/-8O
v
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
toA
Fireplace T. 0.
No ADDITIONAL INFORMATION
� � �n^nn i4Jrl �% � �, fyc�L/V" _ J2��f—OV�•�Jj
SEWAGE SYSTEM SIZE 8t 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
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 i Fixtures
31 Service
32 Final
STREET NAME
` NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
t'� L
284 199 9/74 CANARY—FILE, PINK—APPLICANT
Architect ` Contractor
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Addres r '0 ✓ Address_ Address. .1 3: -
6"_ - ~
City_.City--- - City- -
Phoneme JS - �/ L
r� Phone Phone -5
01W
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
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Paving, and/or Dedication of right of way is required by the -County of Riverside, the Riverside County Department of Building and Safety
3
shall not make a Final Inspection, until said requirements have been met. I am also aware that no work is to be done within the County R/W
O
without an encroachment permit.
' NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be occupied until I (we) have
complied with alllaws of the County. of Riverside and the State of California governing said property.
11—Z dJ vSIGNATURE
DATE OF OWNER AN&e'7,A
D/OR AGENT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
;2 ;;� _'�F J I SPACE NO.
1
/ USE OF STRUCTURE
�~ �✓ Q— r 4_1v
JOB ADDRESS SINGLE FAMILY E] DUPLEX El
>_
C W
LE L E. CRIPTION F PR P TY
i.' d5. �oc, l�
P, s r — APARTMENTS AGRIC.
,� H
r.. COMMERCIAL INDUSTRIAL
G CERATIONS
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COMMUNITY
[]
NO. OF SUBMITTED'PLANS --_— USE OF PERMIT k(- %
N Q
CASE NO.
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NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS OW EXISTING -
N
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ZONE /—SETBACKS: FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON — STREET
DATE SIGNATURE OF LAND USE OFFICIAL
.t
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_.
CURB AND GUTTER REQUIRED: YES ❑ NO ❑. STREET
H
d
CAN CURB AND GUTTERti�FEASIBLY BE INSTALLED? YES [INO ❑
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HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
CIMPROVEMENT?
YES ❑. NO ❑
°C
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
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SWIMMING POOLS PUBLIC
c
W
SEWAGE DISPOSAL _
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS.
�n FLOOD CONTROL
W AIR POLLUTION
W DIV OF HWY
I-
0 < — YOUR PROPERTY MAY BE SUBJECT TO
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY'OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301 Section 19825,of the 14"Ith and Safety Code requires the execu-
tion of the following applicable declarations prior to the issuance of a building permit. Please
print or type.and sign,belowr•
[� LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code and my license is in full force and effect.
License Class /3– / 4icense\No -%
Q OWNER -BUILDER DECLARATION
I hereby affirm that I amexempt from the Contractor's License Law for the following reasons:
Q I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. If I sell within one-
year of completion, I understand I will have the burden of proving I did not build or
improve for.the purpose of sale (Sec. 7031.5;'B.&P.C.).
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B.&P.C.).
[ ] I am exempt under Section B.&P.C. for this reason:
Date- Owner
[] WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, ora Certificate of Workers'
`Compi sation Insurance, or a certified copy thereof'(Sec. 3800, Lab. Code).
Policy No. Insurance
E], Certified copy is hereby furnished.
c2g Certified copy is filed with the County,,of Riverside, epartmentent c, f Building and Safety.
�Da.:tae /' / — �� Applicant -/�1�/in
CERTIFICATE OF EXEMPTIONFROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed if'permit valuation is for $100.00 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' Compensation laws of California.
I further understand that if after making this Certificate of Exemption, I should become subject to
the Workers' Compensation provisions of the labor code, I must forthwith comply with such provisions
or this permit shall be deemed revoked.
Date Applicant
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is Issued (Sec. 3097, Civ. Code).
Lender's Name
Lender's Address
DIVISION OF INDUSTRIAL•SAFETY PERMIT CERTIFICATION
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is re-
quired to descend, will be made i6 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 Industrial Safety, as noted above, unless such person has a permit to do such work
from that division.
�] Division of Industrial Safety Permit No.
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY
I certify I have read this application and state that the information 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 Safety to enter upon the pro-
perty for which9I have applied for this permit for the purpose of making inspections.
Signa ure�pplicant/Agent Date
PrintApplicant/Agent Name
•r'
284-2000 7/80 .� ,,