403723 (PAT)DUILlJILYV rCKmll
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD FBTT
1403723 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR. !
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
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UNITS
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SO. FT. @ -
YARD SPKLR SYSTEM
SO. FT. @ i T MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @'
DRAINAGE PIPING
SO. FT. @
DRINKING FOUNTAIN
SO. FT. @ L
URINAL
VALUATION $ L
WATER PIPING r
NOTE: Not to be used as property tax valuation
5
SWIM POOL,,. PVT. •
FLOOR DRAIN
MECHANICAL FEES
Group
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
Bond Amt.
$
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Insp
Unit
'
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Const. Lender Branchuppli
ntol rmit Numbers
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LAUNDRY TRAY f
AIR HANDLING UNIT CFM
Address City Zip
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
Tel. Zip
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
City Zip
POLE, TEMP/PERM
LAVATORY t
HEATING SYSTEM FORCED GRAVITY
Tel.
/
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Address
SO. FT. @ a
BATH TUB
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.
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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 C�LIFORP(iA.'
I HER BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE'? ANS AND SPECIFICATIONS HAS,DONE 50 IN i
_ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
Sewer District
Farm 264-208 (Re, 1/80) 4 �
SO. FT. @ a
WATER HEATER
S0. FT. RESID @1114c
SEWAGE DISPOSAL
S0. FT. GAR @ t/<a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.VTOIT
t'f
MOB. HM. FEE
MICRO'FEE
MECH. FEE
PL. CK. FEE
�C N T�.FEE ELECT. FEE
rG/
SMI FEE
.V -
FEE PLUMB. FEE
PERMIT NO.
4037 2 3
Job Address Space Zip
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Owner '
CommunityValuation
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F.C.C.
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MH Permit Fee $
Micro Film Fee Cop $
Use of Permit
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/ •^-i^�/,y
Parcel No.
f 1 ,./•�s'.s
Use/Coke No.
It. By
5
Mach. fee Dbl $
PI. Ck. Fee $��/,/(tJ-
Set Backs
Lot Size / /�
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Construction Fee Dbl $
Lego] Descriptio
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5
R /
Electrical Fee Dial S
Zone Restrictignit
Y
Group
Type '
.
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
F;'
Q 80
Insp
Unit
'
Sp. Insp. Fee . S
Demol. Fee $
Const. Lender Branchuppli
ntol rmit Numbers
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Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip
Total Fees b
Address t
City Zip
M.O. ❑ N.C. Q Cash Q Check _
Received by -�
Contracts � �/ I' j
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Tel.
/
License#
Trees 9Yd�� ��.[' ;-'/ ,d-°"=,- s r�r
Sewage System
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Address
City Zip
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.
f
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 C�LIFORP(iA.'
I HER BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE'? ANS AND SPECIFICATIONS HAS,DONE 50 IN i
_ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
Sewer District
Farm 264-208 (Re, 1/80) 4 �
e
NO.
OPERATION
DATE
INSPECTOR
NO. �. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Ser Back
/0 /J
33
Ventilation System
2
Ftgs & Frms
/OX�Jb
34
Plenums 8 Ducts
2A
Slob 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
P Q�
v
�
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.
°o
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 (Batts)
12C Ceiling (Blown)
14 1 Final Q ED 619�
PLUMBING A .P_R VALS
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
P/L
r
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT I
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner Architect _. _—_. Contractor__CLG�It�✓ w.-
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Addres 1P1411_Q__-_ Address___ Address__ •
City!_—_ City_-
Phone Phone _ Phone—
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I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if. Curb and Gutter, and
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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
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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 ocyWfi)e
complied with all laws the County of Riverside and the State of California governing said property.
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.
1 SPACE NO.
�0,/ 1 USE OF STRUCTURE
JOB �yPNDA� �LS �d/U I
ADDRESS J SINGLE FAMILY DUPLEX
LEG L DESCRIPTION OF PROPERTY ��� — APARTMENTS AGRIC. ❑
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COMMERCIAL INDUSTRIAL n
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COMMUNITY . ALTERATIONS C
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NO. OF SUBMITTED PLANS - USE OF PERMIT/42
CASE NO.
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NO. OF PARKING SPACES REQUIRED — NO. OF BUILDINGS NOW EXISTI G -
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ZONE/ SETBA(fKS: FRONT -go SIDE REAR
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GRADING PERMIT REQUIRED?
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATE O SIGNATURE OF LAND USE OFFICIAL --
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ -STREET
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CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
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IMPROVEMENT? YES ❑ NO ❑
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DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
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SWIMMING POOLS PUBLIC
Qa.
SEWAGE DISPOSAL
-
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
rn FLOOD CONTROL
H
W AIR POLLUTION
W F ., DIV OF HWY
c a — - YOUR PROPERTY MAY BE SUBJECT TO
d
UA 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 1, "I 1980, Chapter 1301, Section 19825,of the Hth and Safety Code requires the execu-
tion of the following applicable declarations prior to the issuance of a bui,l:ding 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 Classes „�^� License No. %Gal .3Z
Dante_ /13�q Contractor_ —e -4, /„�, rn-p�wv 41 /1^0 4rolc t
OWNER -BUILDER DECLARATION
I hereby affirm that I amexempt from the Contractor's License Law for the following reasons:
[� 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.).
M I am exempt under Section , B:&P.C. for this reason:
Date Owner
?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. 1,no-530-);13e31/y Insurance 07 -
Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
n 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, should become subject to
the Workers' Compensation provisions of the labo code, I must ort.w'W comply with such provisions
or this permit sh�ll be deemed revoked. /(�
Date' ) D P Applicant—
CONSTRUCTIONILENDING AGENCY
I hereby affirm that there is a construction lending agency for -the performance of the work for
f,(1whic"h this .permit is Issued (Sec. 3097, Civ. Code).
✓
Lender's Name
-7 �Ltdir's Address
DIVISION OF INDUSTRIAL'SAFETY PERMIT CERTIFICATION
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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 i6 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.
r-] Division of Industrial Safety Permit No.
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY 1
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'authorizela
representa.ive of the Countypof ',Rigg ide, Department of Building and Safety to enter upon the pro-
perty for which I hr'e�pplied fo his permit for the purpose of making insp ct'ons.
7 i�
SignatureoyAppTicant gent " ` Date
Print Applicant/Agent Name
284-2000 7/80
conk, lin, homes •
work of our hearts
P.O. BOX 912 LA QUINTA,'CALIFORNIA 92253 714-564-41017
DF)V
COUNTY OF RIVERS194.
DEPARTMENT OF
BUILDING* SAFO M
APPRO%
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By�'; V1. E
Approval of these plan'ds shall not con ed to bo
permit for, , an ppa[ of, any violation of any ag
theof the state or county laws. This @C9
=isions
must b(D kGPt job until conwWtkm
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work of our hearts
P.O. BOX 912 / LA OUINTA, CALIFORNIA 92253 / 714 -564 -
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14-564-,Lxis;i;Vq Jt;v�ie7
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BOUNTY OF
_ DEPART GE &T OF
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P,PPRCw
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ans t be ns mt to �
pproval of toeae app oval of, vola
e sor tlon of es s
pE'' r,v sons of thtate county laws. �I�fl
mutt be keot on the lob ulD°"