BLCK (404337)52960 Avenida Martinez
404337
BUILDING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD DSr
40 4 3 3 7 COUNTY OF RIVERSIDE 1/ //1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST Fl.
2ND. FL.
FOR.
GAR.
CAR P.
WALL 1
ESTIMATED CONSTRUCTION
SO. FT. @ $
Valuation
/ /
S / •
i
UNITS
Dist.
SO. FT. @--'-
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC. -
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
n
SO. FT. @ (l./
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
R
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
Type
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
PIon No.
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Unit
Sp. Insp. Fee S
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Supplimentol Permit Numbers
I V r
Registr. Fee S
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Witness Fee $
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
M.O. E]N.C. 0 Cosh Q Check
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
License#
6) o i
AMPERES SERV ENT
SHOWER
801LER B.T.U.
City( /^ Zip
T r l " f t / f .. . .
SO. FT. @ a
BATH TUB
Sewer District
Q
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Form 284-208 (Rev. 1/801 /
SO. FT. @ a
WATER HEATER
SO. FT. RESID @ 1144
SEWAGE DISPOSAL
/
SO. FT. GAR @ 1/aa
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEEtpj
MOB. HM. FEE
MICRO FEE
MECH. FEE
PL. CK. FEE
CO ST. FEE J ' ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
4043 3 7
Job Address Space
Zip
10...'
Com niity
1 N IV.s
Valuation
/ /
S / •
i
Date
Dot{e ,1
Dist.
Off.F.C.C.
YY
MH Permit Fee $
Micro Film Fee Cop S
Use of Permit
t
C ,, D-02 ,L"sw
Parcel No./,.,rf
712- - //
Use//Case No.
,3
I1
Ck. By
45
Mech. Fee Del $R
Pl. Ck. Fee S
Set Backs
Lot Sise
Construction Fee Dbl $ a i
e9 , Description
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L/ \ q..: , L V - W
F s.
5 S
R
Electrical Fee Dbl S
Zone
ne Rest ct ns
Group
Type
SMI Fee S
Plumbing Fee Dbl $
Bond Amt.
S
PIon No.
Pan Checker
Final Dote Q
I Z -16- U
Inspector
Unit
Sp. Insp. Fee S
Demol. Fee $
Const. Lender Branch
Supplimentol Permit Numbers
I V r
Registr. Fee S
Mileage Fee S
Address City Zip
Witness Fee $
Reinsp. Fee S
Owner/Agent
Tel. Zip
Tocol Fees $ ! At;r
,Address 1, %
s
City Zip
M.O. E]N.C. 0 Cosh Q Check
Received by '
Contractor ,, ..
f- % f .', ✓ f .
.... I F .. C%' i'
License#
6) o i
Trees required
Sewoge System /
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T LL i P
Address }t '
fi ✓yam / / tPti
City( /^ Zip
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THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAY9. 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. ///
tr,4; ; I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN / A/
$aI<FJCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. V1I _
Sewer District
Q
/ )
Form 284-208 (Rev. 1/801 /
s-
NO.
Framing
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
Smoke Detection Device
9
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
Fireplace P. L.
33
Ventilation System
2
Ftgs 8 Frms
, Z _
34
Plenums 8 Ducts
2A
Slab Grade
12 Internal Lath
35
Fu-noce Comport.
3
Steel
7A Wolfs (Batts)
36
Inlets i3 Outlets
4
Grout Blocks
''Z l v —O v
37
Combustion Air
5
Bond Beoms
+ Z— I 0
38
Compressor
6
Roof Deck
22 Water Softener
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.
❑
°o
ADDITIONAL INFORMATION
,
.
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION
Thick R
Value
7A Wolfs (Batts)
128 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
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
.01
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
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DISTRICT r
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner/ Architect- -. --_ Contractor
f /ate
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Address -17'7 T- -_ Address___ Address-
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City-z,rz-c l -u r n City-- City----
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Phone - a TT- Phone
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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 laws of the County of Riverside and the State of California governing said property.
/all
DATE = SIGNATURE 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.
I SPACE NO.
✓ ,( /% l USE OF STRUCTURE
JOB ADDRESS ` !" j "r 'e'J!e-z_ A9Q -
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ANGLE FAMILY DUPLEX El
LEGAL E CRIPTION OF PROPERTY
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---'- - f7 COMMERCIAL INDUSTRIAL
COMMUNITY . ERATION LJ
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OF SUBMITTED PLANS - USE OF
jCASE
2MIT-
_
NO.00
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NO. OF PARKING SPACES REQUIRED .- -- NO. OF BUILDINGS OW EXISTING ted' 9
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ZONE SETBAIfKS: FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE -- OF FEET REQUIRED ON STREET
DATE :;2 - SIGNATURE OF LAND USE OFFICIALz-,
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET ---
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
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CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
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IMPROVEMENT? YES ❑ NO ❑
O'
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DATE _ SIGNATURE OF ROAD DEPT. OFFICIAI
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SWIMMING POOLS PUBLIC
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SEWAGE DISPOSALLu
-
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
vt FLOOD CONTROL
t-
W AIR POLLUTION
_ DIV OF HWY
cc
c a — YOUR PROPERTY MAY BE SUBJECT TO
a
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF `FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July *l, 1980, Chapter 1301, Section 19825•of the Nealth 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
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 '00 License No. _5,_5_a,6_3 7
Date -50' — 5 5r' Contractor /`•l%,a 41, a ,a 49 ,xr=. r r SV,, 4" "
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.).
[ I am exempt under Section B.&P.C. for this reason:
Date Owner
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. ( li-d7. Insurance
Q Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
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 // .2 — tro 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 i6 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.)
Q 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 -
pert for whioh'I have ap lied for this permit for the purpose of making inspections.
&ignature of Applicant/Agent Date
Print Applicant/Agent Name
284-2000 7/80