GRD (A012521)77310 Calle Madrid
A012521
FIELD
°f.. DEPARTMENT OF BUILDING & SAFETY
PF MITNO. PER 111*
COUNTY OF RIVERSIDE C%
I -A012521 g,elv„
Additional Information:
t
;FACTORY BUILT HOUSING
Manufacturer
MOBILE HOME INSTALLATION
MH Monuf.
New ❑
Model Designation
Size
Relocated ❑
Unit Serial No.
Total Fees $
:Plan Approval No.
f
i,lnsig. Serial No.
Moving
;,Sewage System
f T 1 1
p
Permission is hereby granted to move the
structure, described below, in
Width Length
Height
,Total Fees $
t.
'.GRADING
!
t
#1
Number
of #2
Sections
#3
.
i Cut
:Fill G y
:Total Fees $
'
'Present Location
Community County
-RELOCATION INSPECTION
t
Destination
(:Present location
-Community
- County
Total Fees
$
tTotal Fees $
"-' -Permit No.
O
Job Address
7 %-,yam/ a' GLS- / A 1 %G
SP #
3
Zip
S3
Owner
ZS`7g r, 4” -o
Plan Checki4
Valuation
$
D
Q
istff
P.C.
FReinspection
Use of Permit
R19 41'
+`t
`,',
P%4eo.
Lot Size
,Factory-
[Built
Set bocks
Use Permit q
Lg gJ scyiptior C s
L / J SCJ
"Us. , j #2L/
rk
CGrading
li
C;2 e9
off/
Bond ane
$
Grp
Type
Unit
rMobile home
Engineer License
#
Final Date
Inspector
Env. Assmt.
Requirement
F.
,'Relocations
Escrow Company
Branch
ii
IotaI Fees
$
Address
City
Zip"
cash
Check
Mo
Nc
Owner/Agent
-
Tel.
I'
t:
Recei d by D to
/
Addresses'")
City
Zip
L'Related Permit(s)
I'
Caritr'actor/Mover ,
Tel
workers' comp.
11yes ( no ❑
A `
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Dv
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(Lij r I / C•i
Zip
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0.I certify that in the performance of the work for which this permit is
issued I sholl not employ any person in any manner so as to become sub-
ject to the workers' compensation lows of California.
Owner Signature
w Builder Signature
-
FORM 284-208A 5-77 (DM
This permit sholl become void if work is not commenced within 120 days. Cessation of work 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 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 & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beoms
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Froming
40
Fire Damper
8
Vents
41
Smoke Detention Device
9
Garage Fire Walt
42
Commercial Hood
10
Fireplace P.L. O
43
Final
10A
Fireplace T.O.
NON
ADDITIONAL INFORMATION
_ _ _ — _ — — ` _ — _ y — _ — — _—_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Bons) '
12B Ceiling (Botts)
12C Ceiling IBlownl
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
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 -
STREET
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT w`
APPLICATION TO CONSTRUCT Permit No t
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
1
Owne 74 ti Architec ! `a Contracto/
A
Addres 'S JES Address -y5 Address/_
{
City . . citY . JLA. I E .Jl. City_ E?✓ a, i . <: .
Phone - y - Phone 7
Phone
t
1.
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
W
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 t 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 propert o b occ ied ntil I (w have
complied with all laws of the County of Riverside and the State of California governing said property. '
vy k
DATESIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
SPACE N0.
/I USE OF STRUCTURE
[ D CA LI MA
JOB ADDRESS -C iii f f% I _
>
SINGLE FAMILYDUPLEX
7 '- t7 0/
C
LEGAL DESCRIPTION OF PR PERTY
- APARTMENTS AGRIC.
f
n
COMMERCIAL(( ❑ INDUSTRIAL ]
GCOMMUNITY
C
x-71 ALTERATIONS ❑
NO. OF SUBMITTED PLANS—_— USE OF PERMIT ---
H Q
CASE NO.
c9TF.0
p Z
NO. OF P KIN SPACES REQUIRED NO. OF BUILDINGS NOW EX;64ING
Q
ZONE —SETBACKS: FRONT SIDE REAR
Jm
GRADING PERMIT REQUIRED? YES ❑ .NO ❑ LOT SIZE
SETBACK OR IN CE # _ OF FEET REQUIRED ON STREET '
DATE '_ SIGNATURE OF LAND USE OFFICIAL
F
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
r
WI
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
p
.r
C
IMPROVEMENT? YES ❑ NO C3
°L
DATE SIGNATURE OF ROAD DEPT. OFFICIAL—
x
SWIMMING POOLS PUBLIC
WSEWAGE
DISPOSAL _
FOOD ESTABLISHMENT a
_
WATER POLLUTION REMARKS
F
n FLOOD CONTROL—
Z AIR POLLUTION
W DIV OF HWY
o < — YOUR PROPERTY MAY BE SUBJECT TO
s'
o ' FLOOD. RIVERSIDE COUNTY ASSUMES '
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74 Ay 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 Health and Safety Code requires the execu-
tion of the following applicable declarations prior to the issuance of a building permit. Please
print o'"pe.and sign below: -
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.
Date /— %.. 9Contractor
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 ractors to
construct the project (Sec. 7044, B.&P.C.). r
Q I am exempt under Section L2 't B C. for tis r on:
Date /— % — / Owner
kae WORKERS' COMPENSATION DECLARATION C
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. Insurance
Q Certified copy is hereby furnished.
ertified copy is filed with the Cou Ri rside De rtment of uild' g nd Safety.
Date l" 7_1443/ Applicant .J
_r 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
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.)
[7 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 certif I4hav
application and state that the information given is correct. I agree to
compl r and co ty ordinances relating to building construction, and authorize a
repr entaty of iverside, Department of Building and Safety to enter upon the pro-
per wl' for this permit for the purpose of making inspections.
io I/_7 /
ranature oo r ntl sent Da e
Print Applicant
284-2000 7/80