PLBG (403179)54490 Avenida Madero
403179
BU1LU11VG rtKMlt
PERMIT NO.
4 0 317 9
PERMIT NO.
1403179
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
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ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Parcel No.
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Use/Case No.
Ck. By
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SO. FT. @ YARD SPKLR SYSTEM
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SO. FT. @ MOBILEHOME SVC. BAR SINK
Lot Size
SO. FT. @ POWER OUTLET ROOF DRAINS
Legal Description
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SO. FT. @ DRAINAGE PIPING
S S
SO. FT. @ DRINKING FOUNTAIN
Electrical Fee Dbl S •> '
SO. FT. @ URINAL
Group
VALUATION $ WATER PIPING
SMI Fee $
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Plan No.
FLOOR DRAIN
Final Dote
i - ` O
MECHANICAL FEES
SWIM POOL, COMM
Sp. Insp. Fee S
WATER SOFTENER
1
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Mileoge Fee S
WASHER (AUTO)(DISH)
y (Jitness Fee S
APPLIANCE DRYER
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GARBAGE DISPOSAL
:Totol Fees $ rj,
FURNACE UNIT WALL FLOOR SUSPENDED
City Zip
M.O. [] N.C. Cosh Checks
_
LAUNDRY TRAY
Contractor
AIR HANDLING UNIT CFM
IDLE METER
Trees req 4!e •-^"-
KITCHEN SINK
Address
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.
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
{^;
S0. FT. RESID @ 1 114 4,
SEWAGE DISPOSAL
S0. FT. GAR @ t/.a
HOUSE SEWER
GAS PIPING
a.
PERMIT FEE
PERMIT FEE
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PERMIT FEE
DBL.TOTAL
FEES,
MOB. HM. FEE
MICRO -FEE
MECH. FEE PL. CK. FEE
I CONST. FEE J)ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
PERMIT NO.
4 0 317 9
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Construction fee Dbl $
Legal Description
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Electrical Fee Dbl S •> '
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SMI Fee $
Plumbing Fee Dbl S / y
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Plan No.
Pton Checker
Final Dote
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Inspector
Unit
Sp. Insp. Fee S
Demol. Fee S
Const. Lender Branch
Supplimentol Permit N m
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Registr. Fee $
Mileoge Fee S
Address ^ l City Zip
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:Totol Fees $ rj,
Address
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Trees req 4!e •-^"-
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Address
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T LL THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
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I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
sTTHE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
y°J'Hf,REBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN, ,
Form 28d-208 (Rev. 1/80) 6' ' v/jFjCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.:.; ,.
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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 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.
Ej
43
Final
10A
Fireplace T.O.
No
ADDITIONAL INFORMATION :
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION
Thick
R
Value
7A Walls (Batts)
128 Ceiling (Botts)
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 1
25 Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L P/
1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
c
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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0
y DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder
of the property improvements specified.
For your protection you should be aware that as owner -builder you are the responsible party of re-
cord on such a permit. Building permits are not required to be signed by property owners unless
they are personally performing their own work. If your work is being performed by someone other
than yourself, you may protect yourself from possible liability if that person applies for the pro-
per permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and, where
required, to have a business license from the city or county. They are also required_by law to put
their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract,
you should be awa're'of the following information for your benefit and protection. '
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and -other costs) is $200 or more for the entire project, and such persons are
not licensed as contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal
social security taxes, workers' compensation insurance, disability insurance costs, and unemploy-
ment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious,with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information
about your obligations under state law, contact the Department of Benefit Payments and the Division
of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed
to perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -
builder" building permit, erroneously implying that the property owner is providing his or her own
labor and material personally. Building permits are not required to'be signed by property owners
unless they are performing their own work personally.
Information'about licensed contractors may be obtained by contacting the Contractors' State License
Board in-your.•community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is
returned.
Sincerely,r
DEPARTMENT'OF BUILDING,AND SAFETY
,
Leopoldo Rojo, Jr. '
Director "
284-2001 7/80
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATIONF
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1 t53
,
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Address
An "owner -builder" building permit has been applied for in your name and bearing
your.signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your
building permit. No building permit will be issued until this verification is
received.
1. I personally plan to provide the major labor and'materials for con-
struction of the proposed property improvement (yeses or no) zJ
2. I (ave/have not) {1 signed an application for buildingg permit
for the proposed work:
3. I have contracted with the following person (firm) to provide the pro-
posed construction:
Name Phone
Address City
Contractors License No.
4. I plan to provide portions of the work, but I have hired the fol -lowing
person to coordinate, supervise, and provide the major work:
Name Phone
Address City ,
Contractors License No.
5. I will provide some of the work but I have contracted (hired),the fol-
lowing persons to provide the work indicated:
Name Address Phone Type of work
Signature Pr6perty Owner Date
F
` Social Security Number
284-2002 7/80
i
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
n
DISTRICT
Permit No
@ 199 9/74
r CANARY—FILE, PINK—APPLICANT
Own e ct Contractor CAE
Addres Address Address_
City City City_
Phone ` Phone Phone
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
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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 all laws of the County of Riverside and the State of California governing said property
DATE SIGNATURE OF OWNER AND/OR AGENT !
_4vli 4k
►!
Approval by Signature from the Following Departments Liste Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
ISPACE NO.
I USE OF STRUCTURE
JOB ADDRESS - /9n 4/0-A95064e I
_
SINGLE FAMILY DUPLEX El
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LEGAL DESCRIP ION OF PROPERTY (/
APARTMENTS AGRIC. ❑
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, INDUSTRIAL
COMMERCIAL CJ
N
COMMUNITY
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ALTERATIONS n
NO. OF SUBMITTED PLANS --_—_ USE OF PERMIT w- T
CASE NO.
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NO. OF PARKING SPACES REQUIRED N0. OF BUILDINGS NOY EXISTING
R
ZONEA ETBAC'KS: FRONT - —SIDE REAR of
m
GRADING PERMIT REQUIRED? YES `J NO ❑ LOT SIZE
SETBACK OR INA CE _— OF FEET REQUIRED ON STREET
DATE SIGNATURE OF LAND USE OFFICIA ___
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___
iCURB
AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
H
o
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
IMPROVEMENT? YES ❑ NO ❑
°L
DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
SWIMMING POOLS PUBLIC.'
WSEWAGE
DISPOSAL
FOOD ESTABLISHMENT
WATER POLLUTION
REMARKS
n FLOOD CONTROL
AIR POLLUTION
°Y z
DIV OF HWY
oa — YOUR PROPERTY MAY BE SUBJECT TO
o FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
@ 199 9/74
r CANARY—FILE, PINK—APPLICANT
C
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT # _
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.
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 Class License No.
Date Contractor
Q OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt 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.).
Q I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B.&P.C.).
[:J 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. Insurance
0 Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
a 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 permi t 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 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.
] 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, f -6r which I have applied for this permit for the purpose of making inspections
Signature of Applicant/Agent Date
Print Applicant/Agent Name
284-2000 7/80
BUILDING PERMIT
PERMIT NO.
403179
PERMIT NO.
403179
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
Micro Film Fee Cop E
FIELD OFFICE
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
Mech. Fee Dbl $/
NO. PLUMBING FEES
Set Back,
+1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
j
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
f
S S
R
SQ. FT. @ YARD SPKLR SYSTEM
ZoneorRestrictions
A67
50. FT. @ MOBILEHOME SVC. BAR SINK
Type
SQ. FT. @ POWER OUTLET ROOF DRAINS
Bond Amt.
S
SQ. FT. @ DRAINAGE PIPING
Plon Checker
SO. FT. @ DRINKING FOUNTAIN
Inspe
URINAL
SQ. FT. @
Demol. Fee S
_`
VALUATION is WATER PIPING
Supplimentol Permit Numbers
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Cf
FLOOR DRAIN
°Reinsp. Fee S
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
Address
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Contractor
WASHER (AUTO)(DISH) ;
License#
APPLIANCE DRYER
Sewage System
Address
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. @ a
BATH TUB
SQ. FT. @ a
WATER HEATER
S0. FT. RESID @I%c
t SEWAGE DISPOSAL
S0. FT. GAR @ 3/<a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.TOTAL(FFEES
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. F EyE
SMI FEE
_51_.
FEE PLUMB. FEE
PERMIT NO.
403179
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se/Case No.
Ck. By
Mech. Fee Dbl $/
PI. Ck. Fee S
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Lot Size
Construction Fee Dbl S
Legal Description /
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Electrical Fee Dial S
SMI Fee S
ZoneorRestrictions
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Group
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Plumbing Fee Dist S
Sp. Imp. Fee S
Bond Amt.
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Plan o.
Plon Checker
Final Dote
Inspe
Unit
Demol. Fee S
Const. Lender Branch
Supplimentol Permit Numbers
Regist, Fee E
Mileage Fee $
Address City Zip
tr
Witness Fee g
°Reinsp. Fee S
Oser/Age . ,/r 7 . /s
12,
Te, Zip
Total Fees E
I M.O. N.C. Cash Q Checksill
Address
City Zip
Received by
Contractor
Tel. r
License#
Trees re
Sewage System
Address
City r Zip
T LL THIS PERMIT SHALL BECOME VOID IF WORK^Ws t401"QMMECLGED.-YOT!i$` VO DAYS. CESSATION OF WORK verified 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 r 4
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
REB CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE 50 IN
Form 284.208 (Rev. 1/80) JCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.