BLCK (413809)BUILUINU YtKMI I
PERMIT NO, DEPARTMENT OF BUILDING '& SAFETY FIELD DST
1413809 l COUNTY OF RIVERSIDE'" 1
e CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL ' �%ct4'T'i
ESTIMATED CONSTRUCTION
SO. FT. @ $
Community
sr ' •!1'. 1.
L._
UNITS
Valuation,/
$
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @ AJ7� r,yy� �� a '
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $ r, :;i 'a �
WATER PIPING
NOTE: Not to be used as property tax valuation
PI. Ck. Fee S
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
Construction Fee Dbl S s P t7
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
R
SIGN
WASHER (AUTO)(DISH) '
APPLIANCE DRYER
Group
,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Plumbing Fee
Dbl S
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Bond Amt.
S
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
Unit
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR_ HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
Supplimentol Permit Numbers
-
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Address City Zip
r• SO. FT. @ a
BATH TUB .
$
SO. FT. @ a
WATER HEATER
Tel.
/
Zip
S0. FT. RESID @ 1 t/<a
SEWAGE DISPOSAL
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PERMIT FEE
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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.
41389
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PI. Ck. Fee S
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Legal Description i tr•
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Electrical Fee Dbl E
Zone Restrictions
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Group
,
Type
SMI Fee S
Plumbing Fee
Dbl S
Bond Amt.
S
Plan No.Plan
Checker
Fin Date�i� ; Inspe for
.�.' V7�j_ 8
Unit
Sp. Insp. Fee $
Dental. Fee
$
Const. Lender
Branch
Supplimentol Permit Numbers
-
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee
Reinsp. Fee
$
Owner/Agentpgm«;. c('x•-•.`
Tel.
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Zip
Total Fees
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Sewage System
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T LL P 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. '4
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. - -
t I EREBYCER I IFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ///►��`i'%
Form 284.208 (Rev. 1/80) "���-- "'\ ^ ITH SECTION 5541 OF THE BUSINESS' AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. ///
NO.
OPERATION DATE
BUILDING APPROVALS
INSPECTOR
NO.
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS '
1
Set Bock
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 Deice
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O.
[]
°o
ADDITIONAL INFORMATION
„
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
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
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
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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 bui
of the property improvements specified.., , r.
For your protection you should be aware that as owner -builder you are the responsible party of r
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 F
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
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 subcontra
you should be aware 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-o'r more for the entire project, and`such persons a
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 z
you are subject to several obligations including state and federal income tax withholding, feder
social security taxes, workers' compensation insurance, disability insurance costs, and unemplo3
ment compensation contributions. ,
There may be financial risks for you if you do not carry out these obligations,'and.ihese'ri'sks
especially serious with respect to workers' compensation insurance. _
For more specific information about your obligations_ under federal law, contact the Internal Re)
Service (and, if. you wish, the U.S. Small Business Administration). For more specific informat•
about your obligations under state law, contact the Department of Benefit Payments and the Divi!
of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are all(
to perform their work personally or through their own employees, without a licensed contractor
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
labor and material personally. Building permits are not required to be:signed by'property owner
unless they are performing their own work personally.
Information 4aboUt.licensed.contractors may be obtained by contacting the Contractors', State Lic(
Board •in.you.r,communityior at 1020 N Street, Sacramento, California:'95814.
Please complete and return the enclosed owner -builder verification'form so that"we'can`confirm
you are aware of.these matters. The building permit will not be issued until the verification
returned.
Sincerely,
DEPARTMENT OF BUILDING AND SAFETY
- ._. _.
Leopoldo Rojo, Jr.
Director
284-2001 7/80
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATION
Owner '
Address r
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 (yes or no)
2. I (have/have not) signed an application for building 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 following
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
gnature Property Owner
cial Security Number
284-2002 7/80
Date
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199 - 9/74 CANARY—FILE, PINK—APPLI(
OwnerIyCL9 Me, O Architect Contractor
`
Addre--!is �s—�A+�� E I p Address_ Address -
City City 0. W'v v b Z -1_�.2%City_ City—
--
Phone ` 4 Phone Phone —
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
O
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.
n �y e�
/�
DATE SIGNATURE OF OWNER AND/OR AGENT��af
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior, to the Issuing of a Construction Permit.
1SPACE NO.
G�•� r r/ 1
USE OF STRUCTURE
F/ Y
JOB ADDRESS �Q /
�INGLE
}
�, - -
LE A DESCRIPTION OF PROPERTY
FAMILY � DUPLEX
APARTMENTS AGRIC.
0
Q
COMMERCIAL INDUSTRIAL
'^
CG
COMMUNITY
A TERATIONS
Z
NO. OF SUBMITTED PLANS -____
USE OF PERMITus . -'
u+ Q
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING ---
Q -1
ZONE SETBACKS- FRONT SIDE REAR
J M
ff
GRADING PERMIT REQUIRED? YES 0 NO _0 LOT SIZE
SETBACK ORDINANCE # — OF FEET REQUIRED ON _ STREET
DATE -. —6 ' SIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__—.
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
H
d
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT'FOR DRIVEWAY .AND STREET
OIMPROVEMENT?
YES C3NO C1
°C
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
W
SEWAGE DISPOSAL _
FOOD ESTABLISHMENT _
_
WATER POLLUTION REMARKS
�n FLOOD CONTROL—
z AIR POLLUTION
_ DIV OF HWY
c YOUR PROPERTY MAY BE SUBJECT TO
.4 —
d
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FL00[
284 199 - 9/74 CANARY—FILE, PINK—APPLI(
BUILDING PERMIT
PERMIT NO,
1413809
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE�o�
COUNTY OF RIVERSIDE t
CONSTRUCTION ESTIMATE
NO. - ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL P7±
r
ESTIMATED CONSTRUCTION
SO. FT. @ It
Voluotion
g
UNITS
"
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
50, FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
50. FT. @
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $ .�"�l ���
WATER PIPING
NOTE: Not to be used os property tax valuation
S ` S R
SWIM POOL, PVT
FLOOR DRAIN
" MECHANICAL FEES
Type
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
No.
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Unit
Sp. Insp. Fee $
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Supplimental Permit Numbers
-
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Witness Fee g
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
M.O. �] N.C. Q, Cash Check
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
License#
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
City Zip
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
SO. FT. RESID @ 1 t/aa
SEWAGE DISPOSAL
S0. FT. GAR @ t/<a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES,
MOB. HM. FEE
MICRO FEE
MECH. FEE
PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
413809
lob Address Space
Zip
Owner
-
Community y
It
vR ��{� 1 �% y /T
Voluotion
g
Data
Dist.
Off.
_
F.C.C.
MH Permit Fee $
Micro Film Fee Cop S
Use of Permit ` (/
/ ' ^•i [` I ,t ►/�//..f`.{,s,�
Parcell No.
f 3
Use/Case No. -
Ck. By
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Mach. Fee Dbl S
PI. Ck. Fee S
Set' Bucks
to Size
Construction Fee Dbl S ��
Legall/Description JJ J �` j%( �
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F
S ` S R
Electrical Fee Dbl $
Zone Restrictions
( � A
111 s
Group
Type
SMI Fee S
Plumbing Fee Del $
fond Amt.Plan
$
No.
Plan Checker
Final Date /= y�
/ _ 7
Inspector
Unit
Sp. Insp. Fee $
Demol. Fee $
Const. Lender Branch
Supplimental Permit Numbers
Registr. Fee $
Mileage Fee g
Address City Zip
Witness Fee g
Reinsp. Fee g
Owner/Agent
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rc,
Tel. /�/•� /y/ / 7Zip
Total Fees S (ril
Address
y 71, �� lam{ / 1 %_G
City Zip
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M.O. �] N.C. Q, Cash Check
Received by fi/s�✓'�ZYQ``�
Contractor
Tel.
License#
Trees required
Sewage System ` /lA t�
1f
Address
City Zip
T LL P THIS PERMIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 120 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
_ THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
1 EREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284208 (Rev. 1/80) p4MCE �NITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE 0F THE STATE OF CALIFORNIA.