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403776 (RPL)510IE0IIVG PtKMIT PERMIT NO. 03776 DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE FIELD DST] CONSTRUCTION ESTIMATE` ' NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. 2ND. FL. FOR. GAR. CAR P. WALL ESTIMATED CONSTRUCTION SO. FT. .@ $ Owner UNITS C m city -7 r SO. FT. @ YARD SPKLR SYSTEM SO. FT. @ MOBILEHOME SVC. BAR SINK SO. FT. @ POWER OUTLET ROOF DRAINS SO. FT. @ DRAINAGE PIPING SO. FT. @ DRINKING FOUNTAIN t, SO. FT. @ ' URINAL t VALUATION $ `N c„z WATER PIPING 47 NOTE: Not to be used as property tax voluotion Ck. By SWIM POOL, PVT 1. FLOOR DRAIN r MECHANICAL FEES Lot Size SWIM POOL, COMM WATER SOFTENER f VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER Electrical Fee Dbl $ GARBAGE DISPOSAL 1 FURNACE UNIT WALL FLOOR SUSPENDED Type t s SMI Fee S LAUNDRY TRAY AIR HANDLING UNIT CFM Plan No. 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. Branch SO. FT. @ a BATH TUB Registr. Fee $ .Mileage Fee $ SO. FT. @ a WATER HEATER Reinsp. Fee If Owner/Agent r• S0. FT. RESID @ 1 t/<a SEWAGE DISPOSAL 47 Zip 0 S0. FT. GAR @ 3/4a HOUSE SEWER i1y •-� ..". Zip . GAS PIPING PERMIT FEE * PERMIT FEE PERMIT FEE 1 DBL. TOTAL FEES MOB. MM. FEE, -MICRO FEE MECH. FEE PL. CK. FEE CONST. fEECT. °~ Ej SMI, FEE FEE PL B. FEE PERMIT NO. I'4-r/�'. 40.3776 Job -Address Spore Zip Owner , C m city -7 r "' Is Vm1uo'R6n /- C1lze�, tett.) .r Xv 6•" • �,~• - `MDIs. c' Ott. F.C.C. , MH Permit Fee $ Micro Film Fee Cop $ se or P.hnif- .. — 6„I L�'G/v 4 r✓ �,a;.6• /� �(J� / P rcal'No'. �..✓''; , Use/C s No. .. Ck. By Mech. Fee Dbl S Pl. Ck. Fee $ Set cki Lot Size Construction Fee Dbl $ L egal Description .�-r/A p F S S R •' �r 11c�`�i' / -� Electrical Fee Dbl $ ZB Restrictions de Grou Type t s SMI Fee S Plumbing Fee Dbl $ �, Bond Amt. Plan No. Plan Checker D In ec r Unit 1 Sp. Insp. Fee $ $ ✓ /'�� / Dental. Fee $ Const. Lender Branch Supplimentol Permit Numbers fin• s iy 7 Registr. Fee $ .Mileage Fee $ Address City Zip Witness Fee $ Reinsp. Fee If Owner/Agent r• Tel. Zip 0 Total Fees S .1 Address` "-'": , • ` •' "" i1y •-� ..". Zip . M.OCash Q Check y. - Received b Contractor - Tela '� •" L1e�nH A`•- r✓ t Trees n ' e ` \ %��,( Se oge System r Address .. City - Zip T -[7!•�•` P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN,120 DAYS. CESSATION OF WO rilied by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID; Sewer District ,?. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS. PERMIT WILL, -BE DONE IN ACCORDANCE WIT �- % s THE LAWS OF RIVERSIDE COUNTY AND' THE4TATE OF CALIFORN41. I H REBY CERTIFY. 'THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAStDONE50 IN Form 284208 (Res•. 1/80) E WITH SECTION 55A OF THE BUSINESS AND PROFESSIONS CODE OF THE -STATE OF CALIFORNIA. NO. OPERATION DATE INSPECTOR s NO. OPERATION DATE ' INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS I Set Back 33 Ventilation System 2 Ftgs 8 Frms 34 Plenums 8 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 10A Fireplace T. 0. [] °o 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 _ _ - _ -. _ _ _ .PLUMBIMG -APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 2 • Z ,. (/ 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test Z- Ll 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 — rl— i, 161 el Jre7 1Y LIZr z,-2 e ell, FOnce with self -latching gate required before plastering of pooll 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 sof_Californi.a 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 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 or more for the entire project, and such•.persons are not licensed as cot.ractors or subcontractors, then you may be an employer. If you are an emp'l,oye_r; you must register with the state and federal government as an employer and you are subject 6 •se:v'eral obligations including state and federal income tax -withholding, federal social security taw's, workers' compensation insurance, disability insurance costs, and unemploy- ment compensation contributions. There may be-financ.,a`], risks for you if you do not carry out these obligations, and these risks are especially seriou:srespect to workers' compensation insurance. _ For more specific.informition about your obligations under federal' law, contact the Internal -Revenue Service (and, if'you-wi'sh 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 ,commun.ity or. at _1020 N Street, Sacramento, Ca1ifornia:958.14._.,. - Please complete and return the enclosed owner -builder ve'rification'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, DEPARTMENT OF BUILDING AND SAFETY Leopoldo Rojo, Jr. Director 284-2001 7/80 DEPARTMENT1}F BUILDING AND SAFETY COUNTY,OF � 0F 8lVERSIDE . OWNER -BUILDER VERIFICATION _2 ° , Add res s - .-An "owner -builder" building permit has been applied for in your name and bearing .,.' . your -.signature. L ` ' Please complete and return this information in 'the 'nvel`pe provided at your ^' earliest.opportuni -blavoid unnecessary delay -in pracesg and issuing your ' building penmit.' No bui|ding permit will be issued unti]� this. verifjcatinn .is received, . l. l personally plan to provide the major labor and.ffaterialsfor con-" struction of the proposed property improvement.,(y.ps ',or n 2. I (have/have not) signed an application for building permit for the proposed work. (firm) '` � . ' . 3. l have contracted with the following person (firm) to provide the p.rn- ' posed construction: `�'' Name Phone' Address Ci ty Contractors License No. 4. I plan to provide portions of the work,'but � ' ve hired th ' 'flowing' person to coordinate, supervise, and provide the major krk: Name Ph6n ' Address Ci Contractors License No. 5' I will provide some of the work but l have contracted /hired\ the fol�' , lowing persons to provide the work indicated: ­ Name Name Address phone�` ^'Type of,work � . . ' L L~ �7gn��une��roperty�Uwn8r Date Social Security Number 284-2002 7/80 ,c�,�u��'�/� ,` �.' �i' � x..' NOTICE: THIS IS NOT A BUILDING PERMIT APPLICATION TO CONSTRUCT 1 DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE DISTRICT Permit 284 199A 9/74 CANARY—FILE, PINK—APPLICANT Q 3/ Architect —. —_—_ Contractor---.. — Owner 7 0033/7— Address P. 01 r3O 6 2_7__—_ Address___ Address—_ ---- City V_P'-C4"06-�L-cuA G U70 City--- City---------- Phone 5-33 a 6 Phone _ Phone— ._---_—.-- - W I (we) the undersigned, hereby certify and acknowledge that 1 (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 0 without an encroachment permit. NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause s i property to be occupied until I (we) have complied with all laws of the County of Riverside and the State of California governing said pr ty. DATE 1V — t"4 _�--- SIGNATURE OF OWNER AND/OR AGEN Approval by Signature from the Following Departments Listed Below Must Be Obtained Prior to the Issuing of a Construction Permit. I SPACE NO. .J USE OF STRUCTURE %} JOB ADDRESS _^v — �� ' FAMILY DUPLEX F LEG L DESCRI TION OF PROPERTYL� � ~��� pARTMENTS AGRIC. El � O LL � Q — COMMERCIAL E] INDUSTRIAL n '^ C COMMUNITY ALTERATIONS n Z NO. OF SUBMITTED PLANS -- USE OF PERMIT Q CASE N0. � l7 G Z NO. OF PARKING SPACES REQUIRED _ NO. OF BUILDINGS NOW EXISTING --_ Q -j ZONE SETBACKS: FRONT ��SIDE REAR J Co GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE ��• SETBACK ORDINANCE #— OF FEET REQUIRED ON STIR T SIGNATURE OF LAND USE OFFICIAL DATE��,��, --F DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET - t- z CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET H oe a CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ W HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET Q IMPROVEMENT? YES ❑ NO ❑ 0 °C DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL Z SWIMMING POOLS PUBLIC QW DISPOSAL SEWAGE _ FOOD ESTABLISHMENT WATER POLLUTION REMARKS in FLOOD CONTROL t— W AIR POLLUTION } `u :1DIV OF HWY YOUR PROPERTY MAY BE SUBJECT TO c cc — c FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199A 9/74 CANARY—FILE, PINK—APPLICANT DEPARTMENT OF BUILDING AND SAFETY Z APPLICATION CERTIFICATE COUNTY OF RIVERSIDE -PERMIT N Effective July1, 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 M OWNER -BUILDER DECLARATION I hereby affirm that I am.exempt from the Contractor's License Law for the following reasons: s YQ. 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: rw Date 10 &-<d 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 71 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,,, 10 N — 5-0 Applicant �d ,, 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 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.) 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 for which I have applied for this permit for the purpose of making inspections. lgnature of pp scant gent Date Print Applicant/Agent Name 284-2000 7/80 PERMIT NO. • 403776 PERMIT NO, 4 0 3776 DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE FIELD .OFFICE Osr CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES MH Permit Fee $ 1ST FL. 2ND. FL. POR. GAR. CAR P. WALL ESTIMATED'CONSTRUCTION SO. FT. .@ $ UNITS Use/C -No.f srcel Ck. By SO. FT. @ YARD SPKLR SYSTEM PI. Ck•. Foe $ SO. FT. @ MOBILEHOME SVC. BAR SINK Lot Size z '+ SO. FT. @ POWER OUTLET ROOF DRAINS Legal Desc/ripption / / 7 3 -GG -7. 17 / SO. FT. @ DRAINAGE PIPING S S SO. FT. @ DRINKING FOUNTAIN Electrical Fee Dbl S SO. FT. @ URINAL Group VALUATION $ >r.G WATER PIPING SMI Fee $ NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN Plan Checker MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER Sp. In¢p. Fee S VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) Registr. Fee S APPLIANCE DRYER Address City Zip GARBAGE DISPOSAL Reinsp. Fee $ FURNACE • UNIT WALL FLOOR SUSPENDED Tel. Zip LAUNDRY TRAY Total Fees $ M.O. [IN.C. Cosh Q Check AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK Contractor ABSORPTION SYSTEM M.U. TEMP USE PERMIT SVC WATER CLOSET Sewage System s 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 @lt/4a SEWAGE DISPOSAL S0. FT, GAR @ 3/4a HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE r DBI. TOTAL FEESMOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE T. SMI FEE FEE PL 87 FEE I �:O PERMIT NO. • 403776 Job Address Space Zip A Owner , amm y at, n $ Dthe /� ist. Off. F.C.C. MH Permit Fee $ Micro Film Fee Cop S se or PJr La G.��i I�r /(/ �vo-» G I . + 4o. _ 2? „ `• Use/C -No.f srcel Ck. By Mech. Fee Doi $ PI. Ck•. Foe $ --1, Se cks Lot Size z '+ Construction Fee Dbl S Legal Desc/ripption / / 7 3 -GG -7. 17 / F S S R Electrical Fee Dbl S Zo Restrictions Group Type . SMI Fee $ Plumbing Fee Dbl $ Bond Amt, Plan No. Plan Checker Final Doe Inspe�lX Unit Sp. In¢p. Fee S Demal. Fee $ Const. lender Branch Supplimentol Permit Numbers ' Registr. Fee S Mileage Fee $ Address City Zip Witness Fee $ Reinsp. Fee $ Owner/Agent Tel. Zip Total Fees $ M.O. [IN.C. Cosh Q Check Address - City Zip 2r4 Received b Contractor Tel. Trees r /r'c--✓ Sewage System s Address City Zip T `[�� 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. .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 ,FREBY RTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284.208 (Rev. 1/80) ” NCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.