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
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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
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•
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.