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ELEC (403716)BUILDING PERMIT PERMIT N0. DEPARTMENT OF BUILDING & SAFETY FIELD 7ST03716 COUNTY OF RIVERSIDE� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES t 1ST FL. 2ND. FL. POR. GAR. CAR P. WALL ESTIMATED CONSTRUCTION SO. FT. .@ $ UNITS f 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 SO. FT. @ URINAL VALUATION $ 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 Bond Amt $ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Fi 1 Dote r 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 e i SHOWER BOILER B.T.U. SO. FT. @ 4 BATH TUB City " Zip /. r r T 3 r , SO. FT. @ 4 WATER HEATER Can rac or "� ` " - S0. FT. RESID @ 1144 SEWAGE DISPOSAL Trees S0. FT. GAR @ V4c HOUSE SEWER Ciry Zip ,z 1 GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. TOTAL FEES i MOB. HM. FEE MICRO•FEE MECH. FEE PL. CK. FEE I CONST. FEE EL CT. FEE SMI FEE FEE PLUMB. FEE PERMIT NO. 403716 lob Address Space Zip -- Owner �^ Co u y f . $ / r MH Permit Fee $ Micro Film Fee Cop $ Use of'PPermis '/999 ,-/J / st�G� �C/ /T� r ��!iL we •/.' a, r ' Parcel No. "� i i _ -.-e .. i� r UUssse/ ase No. ,�,.' f f '�'•.' Ck. By �• " Mech. Fee Del $ PI. Ck. Fee $ Set Bac s Construction Fee Dbl $ Legal D•eschptil— - �• " /� / �/ r') ,b•( - /� Y F S S R Electrical Fee Obl $ s • Zone Restrictions Group Type - SMI Fee Plumbing Fee Dbl $ Bond Amt $ Lon o. Plan Checker Fi 1 Dote r In actor Unit Sp. Insp. Fee $ Demo]. Fee $ Const. Lender Branch Supplimentol P r umbers ' Cy Registr. Fee $ Mileage Fee $ Address �.��'"• City Zip �✓� �`•t tl�,.t, Witness Fee $ Reinsp. Fee $ Owner/Age nt.�•""""r"�f�^1 L» .- N CO Tel. Zip- Total Fees $ f Address •„Ej r✓ City " Zip /. r r T 3 r , M.O. ❑ N.C. ❑ Cosh C eck Received bye,,- Can rac or "� ` " - lel"' - License# Trees $�woga 5y ''�'r'=`•-^'^��•'' •�' V i i A47. r Address a� Ciry Zip ,z 1 T LL • r -'"p THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK 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 s• THE LAWS' OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARE5 THE PLANS'. AND SPECIFICATIONS HAS DONE SO IN Form 284-208 (Rev. 1/80( -- r _gj DANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. verified by: NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS I Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums 8 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. ❑ 43 Final 10A Fireplace T.O. No ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall , 13 Finish Grade INSULATION Thick R Value 7A Walls (Botts) 12B Ceiling (Botts) 12C Ceiling (Blown) 14 Final _ .. _ _P_LUMBIN.G. 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 PSL P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME ,r 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 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reasons: Qs -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.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). .r I am exempt under Section B.&P.C. for this reason: � //// ,,�+ r , Date /J- -®a Owner �hYf�n PWA.,A, C..� 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 r (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 /O'� *' 4 � ' 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 (Se c�. 309,7; Civ. Code). Lender's Name ti 11��1 Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION �A - 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 s 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. tt Q Division of Industrial Safety Permit No. Date m -c -Ab Applicant iii, W,6, rlli�_ CERTIFICATE OF COMPL'I•ANCE AND AUTHORIZATION OF ENTRY I certify I have read this application and state that the information given is correct. I agree to comply�w.jth all stat�e�l•aws aand county ordinances rel`at-ing to building construction, and authorize a ' representative of the County.b f Riverside, Department of,Building and Safety to enter upon the pro- perty f�o�r��whic��h I•havee appilied for this permit for the purpose of making inspections. Signaturehof AAp icant Aggdn�t(� % r� Dat/e tejZ t.J Print Applicant/Agent Name 284-2000 7/80 - �• DST ' - PERMIT NO.. 'A -.40.3716.• PERMIT NO.. 037,16 - Job Address - ? y J - Co mu ny Valuation • 0 T �• •8` • DEPARTMENT 'OF ByILDING & SAFETY" '" COUNTY OF :RIVERSIDE t F.C.C. FIELD OFFICE Mc o film Fee ' ESTIMATE ' .' 'CONSTRUCTION' '' NO. ELECTRICAL FEES Parcel No.. •' _�• NO. PLUMBING FEES 1ST FL. 2ND. FL;' POR.' GAR. CAR P. . • WALL. . ESTIMATED CONSTRUCTION SQ. FT..@ UNITS'. Backs LofSize SQ. FTS @ YARD SPKLR SYSTEM, SO:.FT.^ @ •• ' MOBILEHOME SVC. BAR SINK SO.t FT. @ POWER OUTLET ROOF DRAINS SO. FT': @`DRAINAGE PIPING " SQ. FT. @ - DRINKING FOUNTAIN SQ. FT. @ .... . '. URINAL -. VALUATION - $ .. . WATER PIPING NOTE: Not to be used as property tox valuation 'SWIM POOL, PVT Inspec- r FLOOR. DRAIN MECHANICAL FEES SWIM POOL, COMM t .' ' ' Sp. Insp` Fee S WATER SOFTENER "VENT SYSTEM _ r F'AN EVAP. COOL HOOD , • Y _ - - SIGN Suplpl�imen/tal Permit Numbers IJ.� WASHER (AUTO(DISH) ,APPLIANCE DRYER Registr. Fee g�7 Mileage Fee 5 ` GARBAGE' DISPOSAL FURNACEK UNIT WALL FLOOR SUSPENDED - S c LAUNORY'TRAY AIR HANDLING UNIT CFM - • • .IDLE METER ",' Zip KITCHEN SINK ABSORPTION SYSTEM B.T.U..: TEMP USE PERMIT SVC Address ,. - / WATER CLOSET COMPRESSOR. ,• HP ' POLE, TEMP/PERM O N.C. Q Cash. C'eck LAVATORY ' HEATING -SYSTEM ' .FORCED GRAVITY AMPERES SERV ENT p!I SHOWER' BOILER - B.T".U.' SQ. FT. @ c- Trees red BATH TUB ,. - • S.O. FT.@• a'. ' WATER HEATER - u + +, SO.' FT. RESID @ 1 t/<a SEWAGE DISPOSAL 4"+ ' S0. FT. GAR @ 3/4a HOUSE SEWER i GAS PIPING PERMIT, FEE PERMIT -£EE PERMIT FEE DBL. TOTAL FEES MOB. HM. FEE MICRO"FEE ` .'MECH. FEE PC CK.. FEE' - CONST. FEE E CT.'FEE SMI FEET FEE PLUMB. FEE DST ' - PERMIT NO.. 'A -.40.3716.• .. . Job Address - ? y J - Co mu ny Valuation • 0 T �• •8` • Space Zip Owner Dote Dist. OFF. n �� / F.C.C. MH Permit Fee - S Mc o film Fee Cop 5 •s Use ooffPPer , - �. - �/ ,.�/� /GD /v '� �7 . ��'2 (j/G�' , �• ��l��Set /J r, Parcel No.. •' _�• Use/Cosa No. - Ck. By f r Mach Fee DbI 5 Pl. Ck. Fee S - Backs LofSize t !( r - Coh•struction Fee DbI S _ Legal Descnpbon /�� /��� D G' �' /� /'• Alit—it F S 5 -^ R ' Electrical .Feb. DbI 5 SMI Feb S• Zone Restrictions ,. Group Type - Plumbing Fee ' DbI S Bond Am. 5 Pion, No. ` PIon Checker' Final Dote - r Inspec- r Unit Sp. Insp` Fee S Demol.'Fee 5 - ` Const. Lender j 1 ' Branch • Suplpl�imen/tal Permit Numbers IJ.� ' , . Registr. Fee g�7 Mileage Fee 5 Address 'f(��'•Is4s� City - Zip WitnBss,Fee 'S'' Reinsp. Fee-, S c Owner/Agee"`^ o ""` _ Tela, Zip Total Fees `n1.0. $ Address ,. - / City Zip' O N.C. Q Cash. C'eck Received b Contractor' el. ` Ucensell Trees red Address :.. -.. . City, _ s Zip 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.' HEREBY AGREE THAT ALL' WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS 0 RIVERSIDE'COUNTV AND THE STATE OF CALIFORNIA: - ' r' - I EBY CERTIFY THAT -THE INDIVIDUAL WHO,RJREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN - Form 284.208 (Rev. 1/80) D E WI SECTION 5541 OF, THE BUSINESS,AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.