BLCK (403134)BUILOING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD
0 3134 COUNTY OF' RIVERSIDE
[_j_DST
/
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. .@ $
2ND. FL. SQ. FT. @
FOR. SO. FT. r@
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL / SQ. FT. @J
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
r Li j
r
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL - f
WATER PIPING ,
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN +
MECHANICAL FEES
SWIM POOL, COMM,
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Ck. By
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
i •.l
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.
SO. FT. @ a
BATH TUB
Sp. Insp. Fee E
SQ. FT. @ a
WATER HEATER S
Supplimentol Permit Numbers
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50. FT. RESID @ 1 t%4
SEWAGE DISPOSAL
Address City Zip
SO. FT.'GAR @ z/aa
HOUSE SEWER
Owner/Agent
Tal. Zip
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBI.
TOTAL FE,FS
s
MOB. HM. FEE
MICROFEE
MECH. FEE Pl. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
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PERMIT NO.
403134.
Job Address s Space
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Zip
Owner
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Com nify /^
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Valuation !
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Mech. Fee Dbl S
PI. Ck. Fee S
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Lot Size
-
Construction Fee Dbl $
Legal Description
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Electrical Fee Dbl $
Zone Restrictions
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Group
Type
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SMI Fee $
Plumbing Fee Dbl E
Bond Amt.Plan
E
No.
Plan Checker
If.nN D.Gili 41,
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Inspector
Unit
Sp. Insp. Fee E
Demol. Fee S
Const. Lender Branch
Supplimentol Permit Numbers
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e. r- Fee $
Mil
Mileage Fee g
Address City Zip
Witness Fee S
Reinsp. Fee S
Owner/Agent
Tal. Zip
Total Fees S •�
Address
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City Zip
M.O. N.C. ❑ Cosh Q Chec
Received /t•'
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T LL `J P1�. .TF&WRI iX SkALL''�EC M6 f6t&tf- WORK IS NOT COMMEN61ED WITHIN 120'CAYS.`''Cd ATION OF WORK—,,verified by:
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. f
;o •1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH r _-
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. >
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00IJ5; CERTIFY THAT THE INDIVIDUAL WHO�PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 (Rev. 1/80) f31(�CE WITH SECTION 5541 0F THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. `
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs 8 Frms
z v
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
q-? ..
36
Inlets 8 Outlets
4
Grout Blocks
--ffLyp
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
loA
Fireplace T. 0.
No
ADDITIONAL INFORMATION
—
ti
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
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/
1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
• tir NOT:CE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner '` 1% A h e -_ _ Contractor�C�"--g
.yam—�—s
Address 4"Y Address_.__ Address--n!V
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Ad
City QU_L� City—_— City----/.
Phone Phone _ Phone-74--k—�
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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
0
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
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
� 3 1 SPACE NO.
7-2USE OF STRUCTURE
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ADDRESS �—/ J /_S _QI_i�� %� I _
5— SINGLE FAMILY yQl DUPLEX
LEPA'L DESCRIPTION OF PROPERTY Q ' 0-0 /�—
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.172 APARTMENTS AGRIC. C1
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COMMUNITY TE ATI NS ❑
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NO. OF SUBMITTED PLANS — USE OF PERMIT dae,6nz/�
jCASE
NO.
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NO. OF PAR KI G SP CES .— NO. OF BUILDINGS NOW EXISTING
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�RE�Q--U�I�RED
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ZONE E FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBAC RDINANCE # OF FEET REQUIRED ON STREET
DATE CJ SIGNATURE OF LAND USE OFFICIAL
DEDICATION REQUIRED: YES O NO ❑ 'NO. OF FEET__
F
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
t—
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CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
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HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
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IMPROVEMENT? YES ❑ NO ❑
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DATE SIGNATURE OF ROAD DEPT. OFFICIAL
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SWIMMING POOLS PUBLIC
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SEWAGE DISPOSAL
—
= G
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
H FLOOD CONTROL
F-
W AIR POLLUTION
S DIV OF HWY
c 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
COUNTY OF RIVERSIDE
APPLICATION CERTIFICATE
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, ContractorX `i/,,,,,
Q OWNER Bs UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons:
�Q.
Date
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
imp"rove 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.).
am exempt under Section
Owner
B.&P.C. for this reason:
Q I 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
t0 Certified copy is hereby furnished.
Qi Certified copy is filed with the County of Riverside, Department of Building and Safety.
Da�te- Applicant\! �,. /�.a.,..-•-�
[J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
i
fes. (This section need not be completed(if permit valuation is for $100.00 or less.)
I�cert�fy that in the performance of the work for which this permit is issued, I shall not employ
anywper--son in any manner so as to become subject to the Workers' Compensation laws of California.
I% Aher understand that if after making this Certificate of Exemption, I should become subject to
the QWorkers'.Compensation provisions of the labor code, I must forthwith comply with such provisions
or Ah,is permit shall be deemed revoked.
Datte4 � Applicant
CONSTRUCTION LENDING AGENCY
\,IF ereby 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
[7 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 for which I have applied for this permit for the purpose of making inspections.
�__57ig%nature of Applicant/Agent Date
-Print Applicant/Agent Name
284-2000 7/80
BUILDING PERMIT
"
PERMIT NO.
40 313.4
a PERMIT NO.
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Job Address, - ! _ Space
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DEPARTMENT OF. BUILDING &' SAFETY'
- 'COUNTY OF RIVERSIDE
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FIELD OFFICE;
t
DST.
CONSTRUCTION ESTIMATE
Date
NO. ELECTRICAL FEES
OIL
`NO. .PLUMBING FEES. T
1ST FL.
2146. FL.
FOR. ••
GAR.
C AR P.
WALLSO.
ESTIMATED CONSTRUCTION
SO. FT. .@ - •� $
r UNITS' .
-
(
SO. FT. @'
YARD SPKLR SYSTEM
SO. FT. @ _ - MOBILE HOME. SVC. 7
BAR SINK
SO.,FT: @ - POWER OUTLET `y
ROOF -DRAINS- l
•
SO. FT. @
'DRAINAGE PIPING
FT. @ -
DRINKING FOUNTAIN
_ - -
SO. FT. @ '
URINAL Y _
�•••.�+'
,VALUATION ' $' �,c - .�
WATER PIPING S
NOTE: Not to be used as property tan valuation, .
Electrical Fee", �Dbl 5 -
SWIM POOL, 'PVT. -
FLOOR DRAIN')
• MECHANICAL:` FEES . y.
`
SWIM -POOL, COMM '
WATER SOFTENER
VENT SYSTEM . FAN , EVAP. COOL' HOOD.•
Checker -
{+
1
SIGN
_
WASHER (AUTO)(DISH).
APPLIANCE - `- DRYER'
•
t - _
Demol. Fee S
GARBAGE DISPOSAL
FURNACE UNIT - WALL '" FLOOR '. SUSPENDED
Supplimenlol Permit Numbersy
-
LAUNDRY TRAY
AIR .HANDLING UNIT, v CFM
Address- City Zip
s
IDLE METER
Reinsp. Fee 5
•KITCHEN SINK
ABSORPTION SYSTEM � B.T.U.
TEMP USE PERMIT SVC
�
WATER CLOSET -
COMPRESSOR HP
c J
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM • • FORCED GRAVITYAMPERES
M.O.s' Q N.C.Cosh Check',i�-;,,.
SERV ENT
1
SHOWER.
'BOILER B.T.U. ' '•i
Tel. -.
- SO. FT. ' @ - a
License# .
_
BATH TUB
Sew ys em
(j ''00
�
SO. FT. @ a
WATER HEATER
Zip
SO. FT. RESID @,1 /a¢
SEWAGE DISPOSAL'
• -
. S0. FT. GAR. @. t/a¢
HOUSE SEWER -
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r
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GAS PIPING
PERMIT FEE ~ .cs
PERMIT' FEE
PERMIT FEE
DBL.
.Ad,
TOTAL FbEy7
MOB.'HM. FEE.
MICRO*FEE
MECH., FEE
PL CK. FEE
_ CONST. FEE ELECT. FEE
.�^
SMI FEE
FEE PLUMB. FEE -
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PERMIT NO.
40 313.4
Job Address, - ! _ Space
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Zip
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Owner
a�T,•� -
Co unity 4
A y �� �..'
Valaotion
$
Date
'Dist.
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F.C.C.4
MH Permit Fee S -
Micro Film Fee Cop S
Use. of Permit. / 1 - ,1
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Parcel No. -
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Mech. Fee Obl 5
PI. 6. Fee S
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Lor Size
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Construction Fee Dbl S
Lego1 Description • ,. - -
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F. _
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Electrical Fee", �Dbl 5 -
Zone Restrictions ,Group.
Type
SMI Fee 5 -
Plumbing Fee Dbl- g
Bond Amt. .'
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Checker -
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Final Dore - /y�/..
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Sp: Insp. fee S
Demol. Fee S
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Supplimenlol Permit Numbersy
Regist, Fee, 5
Mileage Fee - $
Address- City Zip
s
Witness Fee, S.
Reinsp. Fee 5
Owner/Agent
Tel. .,
- •' Zip.
Total Fees S-
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Address - - -s s
City•,
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M.O.s' Q N.C.Cosh Check',i�-;,,.
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T LL '�H P "THKfER10QfT SHALL BECOME- VOID IF WORK IS NOT COMMENCED WITHIN 120" DAYS. CESSATION OF WORK 't . verified by:
FOR 120 DAYS SHALL ALSO. -CAUSE PERMIT TO BECOME VOID.
Sewer District
•1 HEREBY AGREE THAT ALL•WORK IN CONNECTIONtWITH THIS PERMIT WILL S& DONE W'ACCORDANC_E WITH
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
•RE ERTIFY THAT THE INDIVIDUAL.WHO PREPARED'THE.PLANS AND SPECIFICATIONS HAS DONE SO'IN -
Form 284.208 (Rev. 1/80). C ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA, '