426889 (ELEC)oulllvllnv rcRmn
PERMIT NO.
1426889
PERMIT NO.
426889
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD
DST
f
Fit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
SQ. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT, @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER'
r, _ ~ 19
�t I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
Sp. Insp. Fee $
SQ. FT. @ c
WATER HEATER
Const. Lender
SQ. FT. RESID @lncc
SEWAGE DISPOSAL
SupplimeMot Fermi Numbers
r f • ��
SQ. FT. GAR @ s/. c
HOUSE SEWER
Registr. Fee $
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE I
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
1426889
Job Address
Space
Zip
Owner
C
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Illif",
Community
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Valuation
$
Date
Dist.
Off.
I F.C.C.
MH.Permit Fee E
Micro Film Fee
Cop $
Use of Permit
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Parcel No.rr
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se/Case
AU
No.
Ck. By
f �.
Mach. Fee Dbl E
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbl E
Legal Description
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f I
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F S
S R
Electrical Fee Dbl E !
Zone Restrictions j
�. _
Group
.i
Type
✓
,SMI Fee $
Plumbing Fee
Dbl E
Bond Amt.
$
Plan No.
Plan Checker
Final Dole�
Unit
Sp. Insp. Fee $
Demol. Fee
$
Const. Lender
Branch
SupplimeMot Fermi Numbers
r f • ��
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee
$
Owner/Agent
Tel.
Zip
Total Fees
$ 7 t _
Address
r
City
II
Zip
M.O. N.C. Cash Check
Recei46 yContractor-
Tel.
License#
Tree re uijed
Sewage System
Addless
City
Zip
T LL p
Sewer District jam/
Form 284-208 (Rev.8/78) V
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.
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 SO4N
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs B Frms
34
Plenums 6 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
IDA
Fireplace T.O.
oo
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Valve
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
.r
Tank Pit L.Line
REAR OF PROPERTY LINE
PSL P/
ELECTRICAL APPROVALS
26 Power Pole -�
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final i
r
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE
OFFICE DATE TIME / _ _ PERMIT NUMBER
INSPECTION
ADDRESS
OWNER COMMI
t�
BUILDING PLUMBING ELECTRICAL
REMARKS:
SPACE N0. REQUESTED
FOR:
MECNANICAt
OWNER/CONTRACTOR TEL.NO,
A.M.
P.M.
TUES
WED
allUR
FRI
28146 11/75.
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE' PERMIT N
Effective July 1, 1980, Chapter 1301 Section 19825'of the Ninth 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 sigrrbelow:•
M 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 License No.�Z 3
Datej
y;e Contractor ��, pC,(1sj�iJ_�i�
Q
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.).
M 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'(S�ec. 3800, Lab.—Code).
ZY
Policy No. Za 05 / - � > y Insurance
0 Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date 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. 3097, 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 iri 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-
pIN
erty fov�havd for this permit for the purpose of making inspection
;2 e / s
ignature-of pp scant gent Date
PrintApplicant/Agent Name