RPL (399525)RI111 F111sir: DCDAAIT
PERMIT NO.
399525
PERMIT NO.
1399525
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
OT�/-7�''
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FIE!p
Voluoti
$/` :/� `�
J
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
F.C.C.
NO. PLUMBING FEES
Micro Film Fee Cop $
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P. .
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
ou
Mech. Fee Dbl $
v>
PI. Ck. Fee $
Set Backs
SQ. FT. @ YARD SPKLR SYSTEM
Construction Fee Dbl $ l'
SO. FT. @ MOBILEHOME SVC.. BAR SINK
F S//, 5/_3 R
s_ C/
SQ. FT. @ POWER OUTLET - ROOF DRAINS
Zone Restrictions
SQ. FT. @ DRAINAGE PIPING
YP
SQ. FT. DRINKING FOUNTAIN
Plumbing Fee Dbl $ z Sol
URINAL -
Pion No.
VALUATION $ / c�•:ir WATER PIPING
Final Date
1 Z
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Lr
FLOOR DRAIN
Const. Lender Bronch
_Zr
MECHANICAL FEES
SWIM POOL, COMM
Address City Zip
WATER SOFTENER
Reinsp. Fee $
Owner/Agent
i
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Total Fees $'
WASHER (AUTO)(DISH)
City - Zip
Tel.<% LicenseR
/// ^{Jni(s
�` •n " ✓G �
M.O' ❑ N.0 Q? Cash Check
Recewed r. .� .
APPLIANCE DRYER
swage System ji•� /(J•I s,��(s
Addreeiisf�J-, •,
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. @ c
BATH TUB
_
• SQ. FT. @ c
WATER HEATER
'•d=
SO. FT. RESID @ 1 t/a¢
SEWAGE DISPOSAL_
S0. FT. GAR @ s/44
HOUSE SEWER'
/ GAS PIPING
PERMIT FEE
•
PERMIT FEE
✓
PERMIT FEE,r
i
DBI.
TOTAL FEES
MOB. HM. FEE
MICROFEE
MECH. FEE
]ECK. F,EE
%CONSTy� E ECT F/
SM FEE
FEE
PLUMB. r'i
PERMIT NO.
399525
Job_' Space
J
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/
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Voluoti
$/` :/� `�
Dote
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Dist.
��
Olf.
F.C.C.
MH Permit Fee S
Micro Film Fee Cop $
Use ermit /
lL r
Parcel No.
_f Gtr
+�k
Use/Case No.
Ck.
'✓-„J .
Mech. Fee Dbl $
v>
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbl $ l'
Legal Description
,�ky;
Z,9 T �� — `�•Yv C/�
F S//, 5/_3 R
s_ C/
r
Electrical Fee Dbl $ iU
i
Zone Restrictions
GroupType
YP
SMI Fee $ ?
Plumbing Fee Dbl $ z Sol
Bond Amt.
$
Pion No.
Plan Checker
Final Date
1 Z
Inspector
Unit
Sp. Insp. Fee $
Demol. Fee $ -
Const. Lender Bronch
Supplimental Permit Numbers
C/r . t
1.
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
i
Tel. Zip
Total Fees $'
Address
�^'. ..�+�"` a.rt,�Y ry'!'�. f
Contractor 1�+y
'/��l�y-/:�.. / i(,
-' /v G ® C/ji li"
City - Zip
Tel.<% LicenseR
/// ^{Jni(s
�` •n " ✓G �
M.O' ❑ N.0 Q? Cash Check
Recewed r. .� .
/
Treer e W sCf'
swage System ji•� /(J•I s,��(s
Addreeiisf�J-, •,
Cit /) Zip
`
T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF F WORK verified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT .TO BECOME VOID. +
Sewer District T %•
+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. '
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ((Lj
Form 284-208 (Rev. 1/80) — ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
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CD COUNTY.Of RIVERSIDE
'.° DEPARTMENT OF
2 -:jBUILDIN & SAFETY
:j APPROVE
1t >
/DA
I permit for,
-sKall'P6t be con
of th,6,se plan's construed be
r,O approval
y of.
Va 1 0 , a violation
or r
LLI the provisions of the stateZntlaws. This Set
CA vf plans must be kept on the Job until completion
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W LL,< 0.
LU
0
LLI LLJ Uj z
7-
00
Fence with self -latching
gate required before ~
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�Plasterfhg 'of' pool
f
7
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COUNFTY 0
0
IVE4
AIPPROasl, "RIOT
r, 10 V� I N Ey VA OXI I MR
j to by P. 0 Ay— tans shall not any viol of 4 9
firs07
.:visions or. the state or C
PAI P kept On the
be
E S E R To Uj Q�
' NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT ' •' `
t
APPLICATION TO CONSTRUCT Permit No
t DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199 -9/74 eUAIA,
-y�•- CANARY — FILE, PINK — APPLICANT
Owner F -77F Architect Contractor Tj ^
Addressi LirFnn/k�tfdress_ Address -P K 2-7-0 S_
City_L00 14)'1-R City_ City --L �f ,Z,,E,E;ir
Phone Phone Phone 341, _1C151_9!
41
W
1 (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 withi 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 occu ie ntil I (we). have
complied with all. aws of the County of Riverside and the State of California governing said property.
V_
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.
AS -3I SPACE N0.
1 USE OF STRUCTURE
JOB ADDRESS syr C.gINGLE
FAMILY DUPLEX
_
LEGAL DESCRIPTION OF PROPERTY.. — /
Z t-
O t`
A T . -, - APARTMENTS AGRIC.
—� ,44
N a
COMMERCIAL E] INDUSTRIAL Ej
r
y
COMMUNITY9ALTERATIONS
C
- CJ
NO. OF SUBMITTED PLANS — _ USE OF PERMIT l5� 3 C
In
-CASE NO.
Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING _
.4
ZONE ,CL -SETBACKS: FRONT '�- SIDE'T�REAR
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # __ OF FEET REQUIRED ON _ - STREET
DATE SIGNATURE OF LAND USE OFFICIAL
DEDICATION REQUIRED: YES ❑. NO ❑ NO_ OF FEET__—'
iCURB
AND GUTTER REQUIRED: YES [I NO ❑- STREET
W
CAN CURB 'AN D GUTTER' FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES ❑ NO ❑
°L
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
WSEWAGE
DISPOSAL _
Z
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
�n FLOOD CONTROL
Z AIR POLLUTION
1 WIlia
DIV OF HWY
c YOUR MAY BE SUBJECT TO
a — Y PROPERTY
c ~` FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN. EVENT OF FLOOD.
284 199 -9/74 eUAIA,
-y�•- CANARY — FILE, PINK — APPLICANT
'l:
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.
Q 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 / /_ <' .55 License No.C'7
Date e_) Contractor�---
Q OWNER -BUILDER ECLARATION
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.).
I am exempt under Section B.&P.C. for this reason:
Date Owner
F] WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers'
Compensation Inssu�u.ra//nce, or a certified copy thereof (Sec. 3800, Lab. Code).
Policy No. C^,[_ 25 Insurance
0 Certified copy is hereby furnished.
[Z] --'Certified copy is filed with the County »ivers,ide`� Department of Building and Safety.
Date4711g,) Applicant
Q CERTIFICATE OF EXEMPTION FROM WORKERS'�COMPENSATILY/fNSURANCE
(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 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 fs re -
"red 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.)
® 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.
Q 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 Countp 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 inspeptions'
Signature.-of,''Appl i cant/Age "t' Date
Print Applicant/Agent Name - y
284-2000 7/80
BUILDING PERMIT
7
' PERMIT NO.
39-9 525
PERMIT No.
Job Add re `.' -' - - Space
DEPARTMENT
OF & .SAFETY
Community /%'�f yI� -
�.Jv�_.'�r7L �'^d - . t
Valuation
S/i DVj/ W • .Q
Dafe /�
C/?
V G/
Dist.
'
Off..
F.C.C.
�V
MH Permit Fee S
.BUILDING
FIELD' OFFICE
arceL No. ._
4./
Use/Coles✓Jsee No. 1,Ck.
•Lot
By
3 9.9 5 L 5
PI. Ck: Fee ' " S
COUNTY OF RIVERSIDE
•P
. <.
Construction Fee "Dbl $ -
Legal Description - -
,��Vj .i,'
G.l% � 7., •6/ r
CONSTRUCTION ESTIMATE.`
Electrical Fee Dbl S
NO. ELECTRICAL FEES
NO. PLUMBING FEE$f .
1 ST FL. SO. FT. @ $
SMI- Fee - g
UNITS 0
Bond Amt. ,
$
Pion No.
V
• - ,.
2ND. FL.'. SQ. FT. @'
Fm.f Dole�'l�
�f �:. 7r �. X v"Ik
Inspector
1.. .. s
- YARD SPKLR SYSTEM
Demol: Fee 1 S -
•Registr.
POR. SO. FT. @
,SO.
.'SuupplimVentol Permit Numbers ,� `• + -+• - -
,t .• '
MOBILEHOME SVC.
BAR SINK
Address city".
.• - _
GAR: FT. @
•Reinsp. Fee S
-POWER OUTLET
ROOF DRAINS
CAR P, SO. FT. @
j
+.
DRAINAGE .PIPING
Rec ' ed -
-WALL SO: FT. @.
Tel, v. • r ,
�/,4? •�Q' ��.� �1
Ucensell • ''ti
DRINKING FOUNTAIN '
swage System , j�J1. r1, /�� `f�/y�,'
Address �" y-///\///,j/(•/�'}� s _ < _
City�/1 Zip
9
URINAL ..,
@
ESTIMATED CONSTRUCTION VALUATION •_. $
WATER PIPING
rJ
NOTE: Not to be used as property tax. valuation
-
SWIM POOL, PVT
FLOOR DRAIN
'. MECHANICAL FEES
SWIM;: POOL,. COMM'. ' • t,
'WATER SOFTENER
-.
VENT SYSTEM -FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
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
...a
SHOWER, +-•
BOILER _ - 'B.T.U.-:,..SQ:c�FT.,
.@
BATH TUB,;• , _
• ' -
�' SO. FT:,' @ a!-
WATER HEATER
•
-
S0. FT.'RESID._ @ 1 1A a,
SEWAGE "DISPOSAL,:
.
S0. FT., GAR "@ 3/4a
HOUSE SEWER
. A
,. n
GAS PIPING% �
+.
PERMIT FEE' '
PERMIT FEE +
PERMIT FEE;
DBL..
TOTAL FEES
MOB. HM'. FEE
MICRO'FEE 'tr
MECH. FEE'PL
GK. FE
G
EE: EL
CONST. FECT F&6
SMI.FEE
FEE
,PLUMB. FEE
3,a
7
' PERMIT NO.
39-9 525
',
Job Add re `.' -' - - Space
I Zip
Owner r e ,
Community /%'�f yI� -
�.Jv�_.'�r7L �'^d - . t
Valuation
S/i DVj/ W • .Q
Dafe /�
C/?
V G/
Dist.
'
Off..
F.C.C.
�V
MH Permit Fee S
Micro,Film Fee ;Cop S`'.
Use of Permit^
�o� L /3'
�j .�.• s -
/�/./ Iii 1� s �% si Jk ` t
arceL No. ._
4./
Use/Coles✓Jsee No. 1,Ck.
•Lot
By
Mech. Fee. Dbl g -
PI. Ck: Fee ' " S
I Set Backs - - '•
Size
� .
'
Construction Fee "Dbl $ -
Legal Description - -
,��Vj .i,'
G.l% � 7., •6/ r
F. -. S ;/- S/ R • /'
� ��%,
Electrical Fee Dbl S
Zone Restrict ons s
Group
Type
SMI- Fee - g
Plumbing Fee + Dbl S•
Sp. Inspr Fee $
Bond Amt. ,
$
Pion No.
V
Plan Checker
•
Fm.f Dole�'l�
�f �:. 7r �. X v"Ik
Inspector
1.. .. s
Unit- -
Demol: Fee 1 S -
•Registr.
Const. Lender Branch -
.'SuupplimVentol Permit Numbers ,� `• + -+• - -
,t .• '
Fee S -
Mileage Fee- S `-
Address city".
.• - _
Witne—FeeS. ..
•Reinsp. Fee S
Owner/Agent -
'
^Tel. s„ . + - 'Zip
Total Fees S.
Address - �• `y -
/
0 /
City ., Zip
h
" M.O. Q'N.C. Cash -� Check
Rec ' ed -
Cont`roctor ,� ;.1
} fir. ,.
L d •
Tel, v. • r ,
�/,4? •�Q' ��.� �1
Ucensell • ''ti
swage System , j�J1. r1, /�� `f�/y�,'
Address �" y-///\///,j/(•/�'}� s _ < _
City�/1 Zip
.
T `' LL P THIS PERMIT SHALL'BECOME-VOID .IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORKT rverified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.' Y
Sewer District
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. r�
_ I HEREBY CERTIFY.THAT THE INDIVIDUAL V�HO PREPARED THE PLANS AND SPECIFICATIONS•H_AS'bONE SO IN
+ ( l�J� ACCORDANCE WITH SECTION 5541 OF THE BUSINESS,AND'PROFESSIONS CODE OF THE STATE OF CALIFORNIA.' -
',Form 284.208 Rev. 1/80) . • -