403573 (RPL)6UIWING YtKMII �
PERMIT No. DEPARTMENT OF BUILDING & SAFETY
403573 COUNTY OF RIVERSIDE FIELD oST
I W-1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES LL
NO. PLUMBING FEES
1ST FL.
2ND. Fl.
POR.50.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
s
��
Owner
t \."'�•� �
+•d
SO. FT. @ YARD SPKLR SYSTEM
;
FT. @ MOBILEHOME SVC. BAR SINK
SO. FT. @ POWER OUTLET ROOF DRAINS
SO. FT. @ - DRAINAGE PIPING
F.C.C.
SO. FT. @ DRINKING FOUNTAIN
SO. FT. @ URINAL
Use o ermit
Legal Description
VALUATION $ WATER PIPING
r1
S a - a% i.✓
Parcel No. f U,./Col.'Nof
�J 'y
/ —7 4/ ! .,
d' Set Backs lot Size
F 5 V.+ S R
Zone R ictions Group Type
'
NOTE: Not to be used as property tax voluotion
SWIM POOL, PVT
Micro Film Fee Cop $
FLOOR DRAIN
PI. Ck. Fee $y Lr+
MECHANICAL FEES
SWIM POOL, COMM
SMI Fee
WATER SOFTENER
;�s 4,
Y•
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Plan Checker
WASHER (AUTO)(DISH)
Final to Try(
I -' —
APPLIANCE DRYER
Inspector
Unit
GARBAGE DISPOSAL
Sp. Insp. Fee S
FURNACE UNIT WALL FLOOR SUSPENDED
S
LAUNDRY TRAY
1
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
Branch
COMPRESSOR HP
POLE, TEMP/PERM
Numbers
LAVATORY
Fee $
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
Witness Fee $
SHOWER
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Zip
SO. FT. @ a
Total Fees S
WATER HEATER
Address �
r' r
50. FT. RESID @11/44
City �.,
SEWAGE DISPOSAL
t'
M.O. N. Cash ❑ Check
50. FT. GAR @ 1/4a
HOUSE SEWER
Receive .�
Trees
GAS PIPING
Con
PERMIT FEE
PERMIT FEE
QJ
PERMIT FEE
DBL.
�rTAL FEfSMOB.
HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
WTE
T. FEE
$MI FEE
FEE
PLUMB. FEE
�
PERMIT NO.
403573
Job Address
�"
- .�
Space
Zip
��
Owner
t \."'�•� �
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`!-^•�+(
u ,
Community
Valuation Dote - Dist. Off.
F.C.C.
Use o ermit
Legal Description
-
\,,,`L 1'�'` � IL—
r1
S a - a% i.✓
Parcel No. f U,./Col.'Nof
�J 'y
/ —7 4/ ! .,
d' Set Backs lot Size
F 5 V.+ S R
Zone R ictions Group Type
'
_`
Ck. By
s
MH Permit Fee S
Micro Film Fee Cop $
Mach. Fee Dbl $
PI. Ck. Fee $y Lr+
Construction Fee Dbl $
Electrical Fee Dbl E
SMI Fee
Plumbing Fee Dbl $ ,
;�s 4,
Y•
Bond Amts
Plan No.
Plan Checker
Final to Try(
I -' —
Inspector
Unit
'
Sp. Insp. Fee S
S
V6
Demol. Fee $ ,
Const. Lender
Branch
Supplimental Permit
Numbers
Fee $
Mileage
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel.
Zip
Total Fees S
Address �
r' r
A
City �.,
Zip
M.O. N. Cash ❑ Check
Receive .�
Trees
Con
Tel. \
Ucensell
required
` v
GT
Sewage System
Address
City
Zip
T LL P CHIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK [
Sewer District j FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
j..-/ THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
I tjEREBY CERTIFY THAT THE INDIVIDUAL WHV PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 (Rev. 1/80) ORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by: 'j l
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECIOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
�V
/
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
t' �id
Zo
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
'0
sN
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Deice
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
43
Final
IDA
Fireplace T. 0.
NO
ADDITIONAL INFORMATION
, -- -- - - _..------------ ---------_--
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)
'7�
ld Final Z -I1- u
PLUMBLNG.APPROVALS _ ..
15 Ground Plumb
16 Water Piping
17 Rough Plumb i
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final l2^ Z—
Tank Pit L. Line 1
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L P/
{
26 Power Pole
27 Conduit 0,vaj
28 Service Entrance
29 Wiring 2 D
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
• STREET NAME
jZ F s/ A cti�c�" ��' 2•• : I •
' MR`• y 1 �,�� . G— £c=2C C' STI `✓E=`Ns ..� .. ..
{
/7'X30
/Cao Qs�r
i y.S
(r a AKA � ���
-_.
�"F RECORDED PARKING
FRONS- YAPD _ - OADING
( SIDE
B
rd DAT ARD �-tEfCF(7' BLDG.
E � OF LOT COWL).
APPROVED R) SETBACK ORD.
--- ---- - 3_. D USE DI Z-7 FE` �� --- -
wlor to Etna! tnspEct�on or an�p"'
-bY the C untY Ordinance 421 1 qu�rc�d G. H.. POOL ON�STR TC'PIO I
P. O. BOX, 399
UR IN
�CATHEDRAL CITY, CALIF. 924
r `
AD PHONE 328-2681
i
POC L. - . �/•/ G S`Q'. FT � �
7-1
foo CA2:T2i0eo z. F,1
Ee-i 44 P �vrb ry
( 0
N0 I%,e yu/ELL
COUNTY OF vtovFP5e®1
DEPART GE& SAFE
OF
BU �
AP 0 ED •
aTZ"�
BY plans shall not 'ba construed to
val of these P royal of, any" laws oThis y s»
or ant„e state or county
a permo 1 cons of the lob until comoletln^ `
he ut be kept on
I
i Atm
1
jZ F s/ A cti�c�" ��' 2•• : I •
' MR`• y 1 �,�� . G— £c=2C C' STI `✓E=`Ns ..� .. ..
{
/7'X30
/Cao Qs�r
i y.S
(r a AKA � ���
-_.
�"F RECORDED PARKING
FRONS- YAPD _ - OADING
( SIDE
B
rd DAT ARD �-tEfCF(7' BLDG.
E � OF LOT COWL).
APPROVED R) SETBACK ORD.
--- ---- - 3_. D USE DI Z-7 FE` �� --- -
wlor to Etna! tnspEct�on or an�p"'
-bY the C untY Ordinance 421 1 qu�rc�d G. H.. POOL ON�STR TC'PIO I
P. O. BOX, 399
UR IN
�CATHEDRAL CITY, CALIF. 924
r `
AD PHONE 328-2681
i
POC L. - . �/•/ G S`Q'. FT � �
7-1
foo CA2:T2i0eo z. F,1
Ee-i 44 P �vrb ry
( 0
N0 I%,e yu/ELL
COUNTY OF vtovFP5e®1
DEPART GE& SAFE
OF
BU �
AP 0 ED •
aTZ"�
BY plans shall not 'ba construed to
val of these P royal of, any" laws oThis y s»
or ant„e state or county
a permo 1 cons of the lob until comoletln^ `
he ut be kept on
I
NOTICE: THIS IS NOT A BUILDING PERMIT 1
DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
199 9/74 CANARY—FILE, PINK—APPLICANT
1
N
I
I
0 ner Contractor f r
p
AddressiG+ciBrre' Address ^ t 'fir "-/'
City Nri r ?/G City
;e—
Phone PhPhone f
W
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
Z
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
0
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
compliedwith all laws of the County of Riverside and the State of California governing said property.
J
DAT SIGNATURE OF OWNER AND/OR AGENT
ll
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
aj I SPACE NO.
�� f �� J✓ ��,� / USE OF STRUCTURE
>.Y
JOB ADDRESS / _ /V _
-7��� � ��� O(] � SINGLE FAMILY � DUPLEX
C
LEGAL DESCRIPTION OF PROPER
c �� (� — APARTMENTS AGRIC.
�, ,� rJ c rc, Lig. _
h
C C —f COMMERCIAL E] INDUSTRIAL L,
v
COMMUNITY. (
ALTERATIONS n
G C
Z
t¢�
NO. OF SUBMITTED PLANS USE OF PERMIT
CASE NO.
Z
NO. OF PARKING SPACES REQUIRED NO. OF B YLDINGS NOW EXISTING
Zo
ZONE < SETBACKS: FRONT _ fT SIDE > REAR
J
m
GRADING PERMIT REQUIRED? YES [] NO ❑ LOT SIZE
SETBACK ORDINANCE ___ OF FEET REQUIRED ON �""" �'� STREET
DATE SIGNATURE OF LAND USE OFFICIAL't
t
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET --
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
19t—
dL
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
G
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
O
C
IMPROVEMENT? YES [INO ❑
°L
DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
SWIMMING POOLS PUBLIC
H
WSEWAGE
DISPOSAL
FOOD ESTABLISHMENT
S
WATER POLLUTION REMARKS
�n FLOOD CONTROL—
zAIR POLLUTION
_ I— DIV OF HWY
0 a — YOUR PROPERTY MAY BE SUBJECT TO
o FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
199 9/74 CANARY—FILE, PINK—APPLICANT
1
N
I
I
-- �v�.i•• � `+��„� ,Y.�'."`' 4r�.`.�.�^'w..+--/'^.....'•�R�r;r-.,.,,.r,r..r" , .�.r�_l^��r•;s�..+d'.+a♦ �: � „w'•.. ,,.,�.. x .,, •• F.u� .. .�. "• - w _ ._ ,. ��_
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
APPLICATION CERTIFICATE
PERMIT # yD 573
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.
Q 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 C 5-3 ,License o. e��r;M
Date /O 0 Contractor / /V--
0 OWNER -BUILDER DECLARATION
I hereby affirm that I 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.).
Q 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, or a Certificate of Workers'
Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Code)
Policy No. _ / D R?7" o3 Insurance
MP�ertitied copy rs hereby furnished.
0 Certified copy is filed with the County;of Riversrdee,,Department of-80-1.6trig—and—Safety.
Date /(0 ?O Applicant
Q CERTIFICATE OF EXEMPTION FROM 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. 3091; Civ. Code).
Lender's Name
Lender's Address
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
Q 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.)
[� 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 River3ade, �epar Pent—ofBuildingand Safety to enter upon the pro-
pertyy for which I have applied'for�0is pe, a for—the—pure of making inspections.
Signature of Applicant/Agent Date
Print Applicant/Agent Name
284-2000 7/80
fBUILUING YtKMII
PERMIT No. DEPARTMENT OF BUILDING '& SAFETY FIELD OFFICE
4035.7 3 DST
' COUNTY OF RIVERSIDE '
CONSTRUCTION 'ESTIMATE
NO. ELECTRICAL ,FEES
- ..-..�----._ - - - _.
-�M
--
NO. PLUMBING FEES
Zip'
IST FL.
:2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
' - UNITS '
Community
Valuation
SO. FT. @ - YARD SPKLR SYSTEM
Dist.
SO. FT. @ MOBILEHOME SVC.- BAR SINK '
F.C.C.
ol
SO. FT. .@ POWER OUTLET ROOF DRAINS
Micro Film Fee Cop S
SO. FT. @ - DRAINAGE PIPING
-
- /i..
1•w/ L ( . J k_
• - DRINKING FOUNTAIN
SO. FT. @
Use/Case
SO. FT. @ URINAL -
Ck. By `
VALUATION $ WATER PIPING
'0
NOTE:Not to be'used as property tax valuation
SWIM POOL, PVT79- _FLOOR
_
DRAIN
.O
.. MECHANICAL FEES
Swim POOL, COMM
S S,•�'
WATER SOFTENER
VENT SYSTEM FAN EVAP..000I. HOOD
SIGN
-
WASHER (AUTO)(DISH)
SMI Fee - S
'APPLIANCE DRYER
Bo d mt.
S '
Plan o.
GARBAGE DISPOSAL y
final ata
Or ��0
FURNACE UNIT WALL FLOOR SUSPENDED
Unit
LAUNDRY TRAY
Sp. Insp. Fee ..8
AIR HANDLING UNIT CFM
IDLE METER
Branch
-
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
'Mileage Fee $
WATER CLOSET.
Witnesr Fee g
COMPRESSOR HIP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM, FORCED GRAVITY
AMPERES SERV ENT
:Total Fees 5
M.O. Q N. Cash Check
SHOWER
/"�
n ' / Y'%y\ ,r%r/ /
BOILER B.T.U.
SO. FT. @ a
Zip
BATH TUB
Con or •
'
SO. FT. @ a
WATER HEATER
Sewage System • s
"
S0. FT. RESID @ 1'/4a
CityNN,
SEWAGE DISPOSAL '
.
S0: FT. GAR @ s/4a
HOUSE SEWER '
GAS PIPING
(�
PERMIT FEE
+
PERMIT FEE
09
PERMIT FEE
DBL.
IPTAL FE&S .
�-
MOB: HM. FEE
MICRO FEE
MECH. FEEPL. CK. FEE
,�.
CO T. E�E� T' FEF
SMI FEE
FEE PL M8. FEE
PERMIT NO.f
403573
Job Address-`
- ..-..�----._ - - - _.
-�M
--
:- Space
Zip'
Community
Valuation
Dote
Dist.
Off.
F.C.C.
ol
MH Permit Fee
Micro Film Fee Cop S
Use o ermt -
•
-
- /i..
1•w/ L ( . J k_
Parcel No.
7-7 "K
Use/Case
No.
Ck. By `
Mech. Fee DbI S
PI. Ck,. Fee S
Set cks
Lot Si-'
_
Construction Fee Dbl S
Electrical Fee Dbl S
Legol Description
°�
-
F
S S,•�'
R
Zone R ictlons
i I
GroupType
'
'
SMI Fee - S
Plumbing Fee Dbl $
Bo d mt.
S '
Plan o.
.Pan Checker
final ata
Or ��0
Inspector -
. D
Unit
Sp. Insp. Fee ..8
Demol. Fee S
Const. Lender
Branch
-
Supplimentol Permit'Numbers.
Regisir. .Fee S
'Mileage Fee $
Address City. Zip
Witnesr Fee g
Reinsp. Fee S
Owner/Agent
Tel.
Zip ,
:Total Fees 5
M.O. Q N. Cash Check
Address' /
,�•�
/"�
n ' / Y'%y\ ,r%r/ /
City ,.
"_ . _ _
Zip
Receive _
Trees required
Con or •
�0�
Tel.
Licenset+ 'vr
Sewage System • s
Address
..
CityNN,
Zip
.
T _ LL. p THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION'OF WORK F yerified by:
Sewer District
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
� -
+ I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
. THE LAWS OF.RIVERSIDE COUNTY' AND THE STATE OF CALIFORNIA. '
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 28x208 (Rev. 1/80) �Ji ORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.