403191 (RPL)PERMIT NO
4 0 3191
PERMIT NO.
1403191
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD
Space
� � �� �.�
T.
CONSTRUCTION ESTIMATE
c.
NO. ELECTRICAL FEES
NO. PLUMBING FEES.
1STFL.
2ND. FL.
POR.
GAR.
CAR P.
WAIL
r �G
ESTIMAT CONSTRUCTION
SQ. FT. @ $
Valuation
$
UNITS.`
Dote
Lf ✓
c
SQ. FT. @ YARD SPKLR SYSTEM
I F.C.C.
SQ. FT. @ MOBILEHOMESVC. BAR SINK
t
SQ. FT. POWER OUTLET ROOF DRAINS
@
Use of Permit
SQ. FT. @ DRAINAGE PIPING
Parcel No.
J
SQ. FT. @ DRINKING FOUNTAIN
i
ll
SQ. FT. @ wl URINAL
Pl. Ck. Fee $7
VALUATION $ 0 61? WATER PIPING
lot Size
NOTE: Not to be used as property fox valuation
Y`
SWIM POOL, PVT
FLOOR DRAIN
92
MECHANICAL FEES
F S �' S R
SWIM POOL, COMM
WATER SOFTENER
Group
VENT SYSTEM FAN EVAP. COOL HOOD
,
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
on No.
Pon C ecker
GARBAGE DISPOSAL
Inspector
FURNACE UNIT WALL FLOOR SUSPENDED
Sp. Insp. Fee S r
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET '
Witness Fee $«`
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
-
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV.. ENT
SHOWER
Total Fees $
M O. E] N.C. E] Cosh n Check
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Zip "
Received
SQ. FT. @ a
WATER HEATER
' L
y
ILL -k.1,01111,-<
Tel.
SO. FT. RESID @ 1 t%ct
SEWAGE DISPOSAL
Trees required ^`
Sewage System
SO. FT. GAR @ 3/4a
HOUSE SEWER
City - Zip
"
_
-GAS PIPING
,� �•� '
PERMIT FEE
PERMIT FEE x
PERMIT FEE
DBL.
TOTAL FEES
?L�-
MOB. HM. FEE
MICRO'FEE
MECH. FEE
Pl. CK. FEE
CONST. FEE ECT. FEE
SM FE
FEE
'PLUMB. FEF
y
PERMIT NO
4 0 3191
_Job Adcss
)
.,,.`.r4031
Space
� � �� �.�
Zip
/
r Qc
1 ,..1
c.
S
Community
_
L4n- ,
Valuation
$
T
—�
Dote
Lf ✓
Dat.
Off.
/
I F.C.C.
MH Permit Fee $
Micro Film Fee Cop $
Use of Permit
l`
Parcel No.
J
Use/Casa No.
Ck. By x i
Mech. Fee Dbl $
Pl. Ck. Fee $7
Se Basks
lot Size
Y`
Construction Fee Obl $
legal Description �
�.�.
/
(
(
F S �' S R
Electrical Fee Dbl $all
Zone Restrictions
Group
Type
,
SMI Fee $
Plumbing Fee Dbl $
Bond Amt. -
S
on No.
Pon C ecker
Final, Dote%
Inspector
Unit
Sp. Insp. Fee S r
Demol. Fee $
Const. Lender
Branch
Supggpliimmantnjntta✓all�Permit Numbers
Mileage Fee $
Address CityM Zip
Witness Fee $«`
Reinsp. Fee $
Owner/Agent
!
-
Tel.
Zip
Total Fees $
M O. E] N.C. E] Cosh n Check
Address
, `•
✓ '
City
Zip "
Received
�,
troctor
�Address'
l
y
ILL -k.1,01111,-<
Tel.
licensap
'
'
Trees required ^`
Sewage System
j
:C
City - Zip
_
T LL p ✓ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESIATION OF W RK verified by
Sewer DistrictFOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. %.
I HEREBY AGREE THAT ALL WORK IN CONNI`CTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
E LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
,t•
I EREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
A CORD CE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CAt PORNIA.
Form 284208 (Rev. 1/80) r •It
VVV t`
_ _.. f:- .4•- a iV .+1 w .f4�'
NO.
OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums 8 Ducts
2A
Slab Grade
35 Furnace Comport.
3
Steel
36 Inlets 8 Outlets
4
Grout Blocks
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
10A
Fireplace T. 0.
NON ADDITIONAL INFORMATION
�V v 'tb7
_ -0111LO
SEWAGE SYSTEM SIZE & 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 y-
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final Z� Z..
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
c
1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final 112,—Z-10
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301, Section 19825 of the Health 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 below. t.
0 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 C
Date
f/
I hereby
0
0
0
Da to
OWNLR-BUILULR ULCLARAIlUN
affirm that 1 am exempt from the Contractor's License Law for the following reasons:
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
Owner
B.&P.C. for this reason:
0 WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers'
Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.'Code).
Policy No. J -103(4(o" go- Insurance s-%Pr�e ('nn-\npS-A4,'aiv SiUSlad`ANQC'
0 Certified copy is hereby furnished.
_G rti e s filed with the Count of Riverside, Depart en of Building and Safety.
Date Applican
0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATI NSURANCE
(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 isa 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 in 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.)
0 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.
0 'Division of Industrial Safety Permit No.
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY i
I certify I have read this
on and state that the information given is correct. I agree to
comply with all state lawy ordinances relating to building construction,.and authorize a
representative of.the urside, Department of Building and Safety o e e n the pro-
p�er _ for hich I hav ah• permit for the purpose of makin
Signature of Applicant/.Ag . Date
Print Applicant Agent Name
284-2000 7/80
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I'-�X32•
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LAJ
LOW
Lam
44 f
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6-
P14�D
fP.
�Y'f-`=5`
1
Pump H.P. Aa
Heater Type
0
Depth
Yl
voltage
3'
Booster pump ---�
9
O
Cont.
Slide Size _
Elev.
•
Ladder
J
m
~
V
Type
SPA size •�)( �}
C ✓/g L
Y•
Z�UU
Jets
Gas footage 75
a
no
Elect. footage
Sub panels yes
t o 1
Motor voitage _DQQ
Lilso *I. Pool 1 ie.gPA
F1
'J' -box's -
Deck a4 footage µj r— V
Typo Cant. Std.
J
Type finish
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Q
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til
Y
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a
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P14�D
fP.
�Y'f-`=5`
1
.S�ff+Q•L %`
�//' 7-0 46-. P r
/✓D ..ar -44.4-`
Pump H.P. Aa
Heater Type
Pool size
Depth
Yl
voltage
Access
Booster pump ---�
.S�ff+Q•L %`
�//' 7-0 46-. P r
/✓D ..ar -44.4-`
Filter Size 1tiC_1 T- Type �_ +� T
Pump H.P. Aa
Heater Type
Pool size
Depth
Air bower Amp. % J
voltage
Access
Booster pump ---�
Fence R&R Owner -
Cont.
Slide Size _
Elev.
•
Ladder
Rail -
Crane footage r7
Pool cleaner
Type
SPA size •�)( �}
C ✓/g L
Other
Jets
Gas footage 75
Gas T stub yes
no
Elect. footage
Sub panels yes
t o 1
Motor voitage _DQQ
Lilso *I. Pool 1 ie.gPA
F1
'J' -box's -
Deck a4 footage µj r— V
Typo Cant. Std.
Type finish
EQUIP
Filter Size 1tiC_1 T- Type �_ +� T
V I
Name LJV�7C v
Add. / ^ lu
City .� C?+a�r7 7-.-]
Tele
g �
Lot % .�, Trac; G?rel4]��n
Owner approval:](
SUN SAVER FIBERGLASS POOLS, INC.
732 Williams Road
Palm Springs, Ca. 92262
Telephone (714) 323-4293