403919 (RPL)BUILDING PERMIT
PERMIT NO.
403919
DEPARTMENT OF BUILDING & SAFETY FIELD rf;�
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Ow/n(y'' q
\..+�/7 /�� ^•r �l�/
Community
(2 (_,k I
Voluatidyr
$
SO. FT. @ YARD SPKLR SYSTEM
Dote
SO. FT. @ MOBILEHOME SVC. BAR SINK
Off.
SO. FT. @ POWER OUTLET ROOF DRAINS
MH Permit Fee $-�
SO. FT. @ DRAINAGE PIPING
VW
SO. FT. @ DRINKING FOUNTAIN
Use of Permit t
/ `" c) Y ( It i 1 l / ,iJ ( �� //� 1T
SO. FT. @ URINAL
Use/Cosa No.
VALUATION $ WATER PIPING r
Mech. Fee Dbl S
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
pry
FLOOR DRAIN
f
j
`•" �
MECHANICAL FEES
SWIM POOL, COMM
R �^
WATER SOFTENER
Zone Restrictions
Grou P
VENT SYSTEM FAN EVAP. COOL HCOD
SIGN
Plumbing Fee
WASHER (AUTO)(DISH)
�"�.&and
Am.t.
$
APPLIANCE DRYER
Plan Checker
Final Dota
GARBAGE DISPOSAL
Unit
Sp. Insp. Fee $
FURNACE UNIT WALL FLOOR SUSPENDED
§
LAUNDRY TRAY
a
't
Supplimentol Permit Numbers
s
AIR HANDLING UNIT CFM
IDLE METER
Reinsp. Fee
KITCHEN SINK
Owner/Agent �% �� %
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
S �•, ^✓
i
COMPRESSOR HP
POLE, TEMP/PERM
City Zip
LAVATORY
Received by '
( {"
rte'
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
Licensest
/
Trees required
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Ci L Zip
SO. FT. @ a
WATER HEATER
r -
SO. FT. RESID @ 1 t/.a
SEWAGE DISPOSAL
S0. FT. GAR @ V/a
HOUSE SEWER
' GAS PIPING
PERMIT FEE
PERMIT FEE
y_,.�.�
PERMIT FEE
_
DBL.
TOTAL FEES
MOB. HM. FEEMICRO
FEE
MECH. FEE Pl. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
PERMIT NO.
403919y
Job Address
�' � � �
Space
�.it/ ��.r�t///L�
�Zip
( i l
Ow/n(y'' q
\..+�/7 /�� ^•r �l�/
Community
(2 (_,k I
Voluatidyr
$
Dote
Dist.
Off.
I F.C.0
MH Permit Fee $-�
Micro Film Fee
Cop $
Use of Permit t
/ `" c) Y ( It i 1 l / ,iJ ( �� //� 1T
Parcel No.
Use/Cosa No.
Ck. By
Mech. Fee Dbl S
PI. Ck. Fee S
Set Backs
Lot Size
Construction Fee Dist $
Legal Description
i
j
`•" �
F S/ �.� S
R �^
Electrical Fee Dbl S /�
Zone Restrictions
Grou P
T
Type
SMI Fee
Plumbing Fee
Dbl S
�"�.&and
Am.t.
$
Plan No.
Plan Checker
Final Dota
Inspector
Unit
Sp. Insp. Fee $
Dental. Fee
§
Const F N C r
Addr&
r,.
a
't
Supplimentol Permit Numbers
s
Registr. Fee $
Mileage Fee §
Witness Fee §
Reinsp. Fee
§
Owner/Agent �% �� %
Tel. Zip .,
Total Fees
S �•, ^✓
Address
City Zip
M.O. N.C.E] Cash ❑ Check
Received by '
( {"
rte'
Contractor
,
c../ ('i 7 �l f �_
All"
Tel.
•�
Licensest
/
Trees required
Sewage System
Address /
f
Ci L Zip
T LL p
Sewer District
Form 284208 (Rev. 1/80(
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verlfiesti by: -
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.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN k'
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
IM14PECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System 6
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slob Grade
35
Furnace Comport.
3
Steel
36
Inlets 6 Outlets
4
Grout Blocks
37
Combustion Air '
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearonce
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. 0.
Ej
°o
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 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
Finalf1�
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/l
P/
26 Power Pole
27 Conduit
28 Service Entrance
y�
(�V
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
- sJ
CFrnceeff-latching
�, before
t.
poo)
NOTICE: 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 E (�1>C%%fi/��-Z� Architect —. f,41 !vSZ%�CL�T!
Address_5Rog_ address___ Add ress�lny 3 En,?
City City--- City_1/�.�Q/vr(�/
Phone Phone
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, ana/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 o ed until I (we) have
complied with all lawns of the Countv of Riverside and the State of California governing said property..
6.-
DATE `� • — -- SIGNATURE OF OWNER AND/OR AGENT�y�-- --- -
Approval by Signature from the Following Departments Listed B ow
Must Be Obtained Prior to the Issuing of a Construction Permit.
4qi SPACE NO.
S -3 7;> � z� C*Ve4 _v.Z� USE OF STRUCTURE
J08 ADDRESS _— SINGLE FAMILY DUPLEX
%
O uj
LEGA OESCRIPTIOA OF PR ERTY �_/ f2� 0
�__ �PQ�` y21 y�O Q ��� - APARTMENTS AGRIC.
/oP�/ `�+
J- V _' �
H Q
`v-- COMMERCIAL INDUSTRIAL L,
C
COMMUNITY - rJl w�Y
ALTERATIONS n
NO. OF SUBMITTED PLANS _ USE OF PERMIT --
uj uj Q
CASE NO.
_
p Z
NO. OF AR ING SPACES REQUIRED .- NO. OF BUILDINGS NOW EXISTING -
/�
Q
ZONE ETBACKS: FRONT SIDE �- -'REAR
. J
m
GRADING FERMIT REQUIRED.' YES ❑ NO ❑ LOT SIZE
SETBACK ORD NANCE __— OF FEET REQUIRED ON - STREET
`#
DATE I Y - I-0 SIGNATURE OF LAND USE OFFICIAL--
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -- —
I
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
Cc
oe
a
CAN CUR3 AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
IMPROVEMENT? YES ❑ NO ❑
09
DATE SIGNATURE OF ROAD DEPT. OFFICIAL—
I
SWIMMING FOOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
S
WATER POLLUTION REMARKS
FLOOD CONTROL -
H
z AIR POLLUTION ;
_ 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 APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 'I, 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 z,
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 e " :53 License No.
Date li T i 19' irD Contractor 5//�/ SN R/�' T�� cr�li✓ ro , �✓ - .�/ ( fes`
0 OWNER -BUILDER DECLARATION
I hereby affirm that I amexempt 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.).
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
V1� 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. 139J• L?3- A?.3 C Insurance i�:�A/Y?F'P,'-ly-':� UPPAII •/= 4Pf9u k)
0Certified copy is hereby furnished. f If
12 Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date f"11f I/ 19F0 Applicant J�A'SN//V4_ �✓ySTJiG/�977r1 �
CERTIFICATE OF EXEMPTION•FROM WORKERS' COMPENSATION INSURANCE
(This section need notbe completed if permit valuation is for $100.00 or less.)
I certify that,in the performance of the work for which this permitfis 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 cod {I must forthwith comply with such provisions
A
or this permit shall be deemed revoked. //
Date (�j_ . i'/ / Zfi/ Appl icant
CONSTRUCTI�L'ENDIN6�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
i
DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION
0 I hereby certify that no excavation five (5) or more feet in depth into whicha person is re-
quired to descend, will be made id 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.)
Q 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. i �t
M Division of Industrial Safety Permit No
�/ _
k' Date -, 21 / Ci 9) Applicant "I-/-
CERTIFICATE
/l
CERTIFICATE OF COMPLIANCEPAND" AUTPORIZATION 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 fdr—whith/f have applied for this permit for the purpose of makingrispections.
02
ianature/of a scant/ oent Date
Print Applicant
284-2000 7/80
PERMIT NO,
03919
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
PERMIT NO.
403919
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
v
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
CiQ
/
+G//�ell
SQ. FT. @ YARD SPKLR SYSTEM
,
SO. FT. @ MOBILEHOME SVC. BAR SINK
Voluoti
S
SO. FT. @ POWER OUTLET ROOF DRAINS
Date
i ^ �
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
F. C.
SQ. FT. @ URINAL
Micro Film Fee Cop S -
VALUATION $ WATER PIPING
•�"'
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
oo
FLOOR DRAIN
Ck. Fee S
Construction Fee Dbl S
Set Backs
MECHANICAL FEES
SWIM POOL, COMM
•�
F S/ g R
WATER SOFTENER
Zone Restrictions
VENT SYSTEM
FAN EVAP. COOL HOOD
SIGN
SMI Fee S
WASHER (AUTO)(DISH)
APPLIANCE
DRYER
Plan Checker
GARBAGE DISPOSAL
Inspector
FURNACE UNIT
WALL FLOOR SUSPENDED
Sp. Insp. Fee S
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
Supplimentol Permit Numbers
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
Witness Fee $
-WATER CLOSET.
COMPRESSOR
HP
POLE, TEMP/PERM
Tel.
LAVATORY
Zip
HEATING SYSTEM
FORCED GRAVITY
AMPERES SERV ENT
Address
SHOWER
BOILER
B.T.U.
SQ. FT. @ a
M.O. [3 N.C. ❑ Cash Check
BATH TUB
Contractor
SO. FT. @ c
Tel,jj
`/ 3 - / o
WATER HEATER
License#
Sewage System
S0. FT. RESID @ 1 '/c
Address
SEWAGE DISPOSAL
Cit ) /nom l'] Zip
'
50. FT. GAR @ 3/4a
HOUSE SEWER
GAS PIPING
"PERMIT FEE
PERMIT FEE
O
PERMIT FEE
Q
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE PlU B. FE�E
PERMIT NO.
403919
- -
_�_ sdurria
l
v
- "
X�,
- - gpuce
Zip
Owne
/
+G//�ell
mu
,
Voluoti
S
Date
i ^ �
1Dist.
OII.
F. C.
MH Permit Fee g
Micro Film Fee Cop S -
Use of Permit I
!
i kur
i, ( �!t
- /7
legal Description S /y a+/�
u / 0 r ""' Gr^
Parcel No. Use/Cole
/ / 00
No.
Ck. By
Mech. Fee Dbl S
Ck. Fee S
Construction Fee Dbl S
Set Backs
Lot SizePI.
•�
F S/ g R
Electrical Fee Dbl g
Zone Restrictions
Group
Type
SMI Fee S
Plumbing Fee Del $
Bond Amt.
S
Plan No,
Plan Checker
Final Date /I
//J/3 (SO
Inspector
Unit
Sp. Insp. Fee S
Demol. Fee $ •
Const. Lender
Branch
Supplimentol Permit Numbers
Regisir. Fee S
Mileage Fee g
Address City Zip
Witness Fee $
Reinsp. Fee $
Ov,rw Agent
/
Tel.
-
Zip
Total Fees S
Address
City
Zip
M.O. [3 N.C. ❑ Cash Check
Received by
Trees require
Contractor
Tel,jj
`/ 3 - / o
License#
Sewage System
Address
'J`
Cit ) /nom l'] Zip
T LL P
Sewer District
Form 284208 (Rev. 1/80)
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
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 r
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
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA_