SPIN (374669)BUILUING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY MDS374669COUNTYOF RIVERSIDE FIELD
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
FOR.
GAR.
SQ. FT. @ $
UNITS
SQ. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
_ WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
MH.Permit Fee $
Micro Film Fee
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
Use of Permit t
: A-9
4 z 0 +j """ 7- ,? , . :
SWIM POOL, PVT
FLOOR DRAIN J
MECHANICAL FEES
Mech. Fee Dbl E
SWIM POOL, COMM
WATER SOFTENER '
VENT SYSTEM FAN EVAP. COOL HOOD
Lot Size
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Legal Description _
J� j
ate'" 0
2
4
Electrical Fee Dbl $
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Type
LAUNDRY TRAY
AIR HANDLING UNIT CFM -
Dbl $
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
Plan Cjkecker
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
Unit
POLE,TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
$
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
Fee g
Mileage Fee $
Mileage
e
SQ. FT. @ c
WATER HEATER
Reinsp. Fee
$
SQ. FT. RESID @1'/4c
SEWAGE DISPOSAL
Tel.
y'
SQ. FT. GAR @ 3/. c
HOUSE SEWER
Total Fees
M.O.
Is
-C. n Cash n Chec s
Address
_
GAS PIPING
PERMIT FEE
Zip
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO FEE
MECH. FEE
PL. CK. FEE f
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.Job
374666
Address
Space
Zip
Owne
Community
Z A 1
Valuation
$
Dote
r
Dist.
!✓
Off.
--
F.C.C.
MH.Permit Fee $
Micro Film Fee
Cop $
Use of Permit t
: A-9
4 z 0 +j """ 7- ,? , . :
Parcel No. ,tIf
Use/Case No.
Ck. By
Mech. Fee Dbl E
PI. Ck. Fee $
�-
Set Backs
F S 5
R
Lot Size
Construction Fee Dbl E
Legal Description _
J� j
ate'" 0
2
4
Electrical Fee Dbl $
Zone Restrictions Group
Type
SMI Fee $
Plumbing Fee
Dbl $
Bond Amt,
$
Plan No.
yGJ lr
Plan Cjkecker
Final Datea/q�
g / 7
Inspector
Unit
Sp..Insp. Fee $
Demdl. Fee
$
Const. Lender Branch
Supplimental Permit Numbers
,
'
Fee g
Mileage Fee $
Mileage
e
Address City Zip
Witness Fee $
Reinsp. Fee
$
Owner/Agent
Tel.
Zip
Total Fees
M.O.
Is
-C. n Cash n Chec s
Address
_
City
Zip
Received by
_ /
Contractor,f" r
v
Tel.
rr�,
LicenseM
Trees required
Sewage System
Address
17( "A re3,1'N F (Air h, X=
City t
Zip
T LL P
Sewer District
gForm 284-208 (Rev.8/78) Ds
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
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.
4
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
21
verified by:
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & 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. C]
43
Final
IDA
Fireplace T. 0.
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
7 -
NOTICE: THIS IS NOTgA BUILDING PERMIT --
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY t
COUNTY OF RIVERSIDE
DISTRICT
Permit No °
284 li0' 9/74
CANARY—FILE, PINK—APPLICANT
TV ti * Ir'
A r") f
Owner rL Architect Contractor_ 'fir
f
Address _ Address_ Address_
City S C /i u : ! .t i . !) ; J City City_
1
Phone ` ' ; `r f r 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.
g r ��
DATE ! SIGNATURE OF OWNER AND/OR N&EN-T `
ti
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
iSPACE NO.
USE OF STRUCTURE
JOB ADDRESS 1 IV es t� v . f+V I
SINGLE FAMILY DUPLEX
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Z W
LEGAL DESCRIPTION OF PROPERTY —CJ.
APARTMENTS AGRIC.
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i
� lo.� / / � /% COMMERCIAL INDUSTRIAL LJ
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COMMUNITY .� l� iX I N 7 r1
1. ALTERATIONS ❑
Z
NO. OF SUBMITTED PLANS _—___ USE OF PERMIT_—
N Q
CASE N0.
p Z
NO. OF. -PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING --
Q
ZONE SETBAC'KS: FRONT SIDE ~REAR
J
m
/
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE _— OF FEET REQUIRED ON—,—/�_L— STREET
'�
'
DATE _ - SIGNATURE OF LAND USE OFFICIAL
F
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET-_
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ i STREET
H
oc
-
W
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES ❑ NO ❑ S
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DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
i
S
I
SWIMMING POOLS PUBLIC i
WSEWAGE
DISPOSAL 3
FOOD ESTABLISHMENT j
1
_
WATER POLLUTION REMARKS
�n FLOOD CONTROL—
ONTROL
i
AIR
AIR POLLUTION
W
DIV OF HWY
o a — YOUR PROPERTY MAY BE SUBJECT TO
d
o FLOOD. RIVERSIDE- COUNTY ASSUMES
f
NO RESPONSIBILITY, IN EVENT OF FLOOD.
284 li0' 9/74
CANARY—FILE, PINK—APPLICANT
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.
[] 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
TX7 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons:
0 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 Owner1—arc.,
Q 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
0 Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
Q 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. Q Q
Date T S 8U 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
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.
Q Division of Industrial Safety Permit No.
Date ��� U Applicant %41.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY
r
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.
14
Signature of Applicant/Agent Date
14 IJ L, 1<11LA)v E�
Print Applicant/Agent Name t
284-2000 7/80
DEPARTMENT OF BUILD D SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER INFORMATION
Dear Property Owner:_ --J_
An application for a building permit has been submitted in your name listing yourself as the builder
of the property improvements - speci,.fi ed 'r; .
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 be-i.ng--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-.,of_ California._ and.,_ where
required, to have a -business license from the_city.or county.._. They_are also_ reguired_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."I _ °'-*
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, en tire,(prajectj,Iand, such= -persons are
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 and
you are subject to several obligations including state and federalU'income tax withholding, federal
social security taxes, workers' compensation insurance, disability•insurance costs, and unemploy-
ment compensation-contribut,ions... -
There may be'financial risks for you if you do not carry out thesetobli0i'i ons;"and`these-risks are
especially serious with respect to workers' compensation insurance..
For more specific information about your obligations under fede"rW law, contact the Internal Revenue"
Service (and, if'you wish, the U.S. Small Business Administration);:'etFor 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 condi-tions.
( t0' r. 0 _ i ;• Lief . t
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`lto be'signedcby property owners
unless they are performing their own work personally.
Information ,about licensed:contractors may.be obtained by contacting the; Contractors,,,',, State License
Board iinf.your communi,ty;GorFat,•1:02.O;,N. Street,.Sacramento; ,,Cal•,iforni'a;,9581.4. 1,.
0u"",i";.6 t7tlS4 r:.14: a0UAC 000,A4�- �,C1o4}..
Please complete and return the enclosed owner -builder verification -form so that we can confirm that
you areo;a are,off,,these matters. The building permit will not be issued until the verification is
♦I. returned. ~- ., r }q p 1 "r Di.. !>1 n.U!t 07tilG 4L16 Poi` k,qa
t;F'l;F ii t 7" j i'7 ) ,_� 1 C y 6; t:( l F
Sincerely,
DEPARTMENT OF BUILDING AND SAFETY -�
Leopoldo Rojo, Jr.
Director
C
2001 7/80
ffbvv�i!Eoi OE 1, tJit', Vf ,D Cf",_ to
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATION
Owner
Address
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 I`.! t Address Phone Type of work
Signature Property Owner Date
Social Security Number
284-2002 7/80