402722 (RPL)BUILDING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
02722 COUNTY OF RIVERSIDE FIELD FDS!TkI
CONSTRUCTION ESTIMATE
NO,
ELECTRICAL FEES
NO. PLUMBING FEES `
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. .@ $
6j
UNITS
Valuation
$ 1
P
SO. FT. @ YARD SPKLR SYSTEM
bt1.
SO. FT. @ MOBILEHOME SVC. BAR SINK
MH Permit Fee $
POWER OUTLET ROOF DRAINS '
SO. FT. @
Cop $
SO. FT. @. DRAINAGE PIPING
Use aY Pe e� ;e
/� 7 i, �y //
v
SO. FT. @ DRINKING FOUNTAIN
'Use/C s No.
ti• URINAL
Mach. Fee - Dbl $
VALUATIO� WATER PIPING
%"r •SeT'Bocl1 �'._i
NOTE: Not to be used as property tax valuation «
SWIM POOL, PVTFLOOR
Legal Description
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DRAIN
Cy
MECHANICAL FEES
SWIM POOL, COMM
TYPeGroLF' •
WATER SOFTENER
Plumbing Fee
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Plan No.
WASHER (AUTO)(DISH)
o Db �
APPLIANCE DRYER
Unit
,
Sp. Insp. Fee $
GARBAGE DISPOSAL
$
FURNACE UNIT WALL FLOOR SUSPENDED
Const. Lender Branch
S`u%p/pCliimm,).Jtttolll PPerm�it Numbers
n/
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-
LAUNDRY TRAY
Mileage Fee
AIR HANDLING UNIT CFM
Witness Fee $
IDLE METER
$
KITCHEN SINK
Owner/Agent
ABSORPTION SYSTEM B.T.U.
Zip
TEMP USE PERMIT SVC
Total Fees$/rte
WATER CLOSET
�S
COMPRESSOR HP
City
POLE, TEMP/PERM
M.O. ❑ N.C.❑ Cazh ❑'s_heck •�
LAVATORY
HEATING SYSTEM FORCED GRAVITY
Contra _
/ Y i �_ : /-
`xrt
AMPERES SERV ENT
.
SHOWER
Trees. regLi k... s- .y' ..� • e r w►�•
BOILER B.T.U.
SO. FT. @ a
tAdd' ss '✓%�..r/•7/;�T• - '., r �Y
BATH TUB
•
SO. FT. @ a
WATER HEATER
-
SO. FT. RESID @ 1 t/4a
SEWAGE DISPOSAL
S0. FT. GAR @ 1/44
HOUSE SEWER
•
GAS PIPING
PERMIT FEE
PERMIT FEE -
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO FEE .MECH. FEE
Pl. CK. FEE
CONST. FEE
CL<
SMI FEE
�.
FEE
PL B. CFE'E•
PERMIT NO.
402722
------Space
�
Zip
Owner
mmGni / i
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Valuation
$ 1
bt1.
F.C.C.
MH Permit Fee $
Micro Film Fee
Cop $
Use aY Pe e� ;e
/� 7 i, �y //
v
reel No. v t✓�
r• /
'Use/C s No.
Ck. By
/ {�''
Mach. Fee - Dbl $
PI. Ck. Fee $ � /,.
%"r •SeT'Bocl1 �'._i
Lot Size
•a C
4..✓
!t '
•
Construction Fee Db $ "
Legal Description
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.� 5 5
R
'�T
Electrical Fee Dbl $!�
TYPeGroLF' •
SMI Fee $
Plumbing Fee
Dbl $
Bond Amt.
$
Plan No.
Plan Checker
o Db �
Inspe<t� of �
Unit
,
Sp. Insp. Fee $
Demal. Fee
$
Const. Lender Branch
S`u%p/pCliimm,).Jtttolll PPerm�it Numbers
n/
�• .
"a1.
-
Regr. Fee $
Mileage Fee
Address City Zip
'
Witness Fee $
Reinsp. Fee
$
Owner/Agent
Tel.
Zip
Total Fees$/rte
�S
Address
;/'�jf'•� �"• �'/
City
Zip
-
M.O. ❑ N.C.❑ Cazh ❑'s_heck •�
b rf
`
Contra _
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Te
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.
iReceivd '
e L: c
Trees. regLi k... s- .y' ..� • e r w►�•
S�woQa'System
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City —'' .r' y Zip
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Sewer District
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,-Form 284.208 skev.•1/80)
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF/WORK .•erif..ied by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. t.
,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.
z •,
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.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
r"�
33
Ventilation System
2
Ftgs 8 Frms
�. /l.r o
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
—' �- (J
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. 0.
Ej
No ADDITIONAL INFORMATION
('
� V y '" "'•� '�"' Q" �-
-1-96
_-.-- - .._____.. _----- __-• -
- -
'
SEWAGE SYSTEM SIZE & LOCATION
I1 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
R '
Value
7A Walls (Batts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
------------ _.--..P.LUMBING-APPROVALS... - _ -...
15 Ground Plumb ! i' I
16 Water Piping
17 Rough Plumb - - bQk
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/
.t
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding /!
30 Fixtures
31 Service
32 Final e�I
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT //
Permit No
284 199 9/74
r' "' CANARY—FILE, PINK—APPLICANT
5 e 41/¢8% 5.
Owne / Architect &6A'JdA C.ntracto��%�
Address. y%tiAddress.i.?dd res6�?Q —a
City Ci47 __ �..✓l�aG C a ✓�
Phone— �� Pii�r3
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.
DATE l SIGNATURE OF OWNER AND/OR AGEN _
Approval by Signature from the Following Departments List Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
1/SPACE N0.
USE OF STRUCTURE
1� t/, I//�t�l
JOB ADDRESS.•
SINGLE FAMILY N-;-. DUPLEX
>_
Z t;
LEGAL DESCRIPTION OF PROPERTY e APARTMENTS AGRIC.
O
.fir - :�' JC t� _ r� �= /
H '^
� 4a COMMERCIAL � INDUSTRIAL
`� f
�
Z
COMMUNITY
ALT WATIONS ❑
NO. OF SUBMITTED'PLANS — USE OF PERMIT
CASE N0.
p Z
Q
NO. OF PARKING SPACES REQUIRED NO,/O'F' BUILDINGS NOW EXISTING --
ZONE Z SETBACKS: FRONT SIDE "� REAR „
'PERMIT
.r m
GRAKING REQUIRED? YES ❑ NO ❑' LOT SIZE -f—Al `
SETBACK ORDINANCE OF FEET REQUIRED ON STREET
/
DATE— SIGNATURE OF LAND USE OFFICIAL
F,
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET--
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
d
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR'., DRIVEWAY AND STREET
IMPROVEMENT? YES ❑ NO ❑
°C
DATE _ • SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC w
WSEWAGE
DISPOSAL
FOOD ESTABLISHMENT
_ IM
WATER POLLUTION REMARKS ,
fg ,
�n FLOOD CONTROL—
ONTROL
AIR
AIR POLLUTION
W x DIV OF HWY
c % ';YOUR PROPERTY MAY BE SUBJECT TO
—
s � z
c ;FLOOD. RIVERSIDE COUNTY ASSUMES
NO -RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74
r' "' CANARY—FILE, PINK—APPLICANT
n
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT q
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.
[7 LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of �th7e Business and Professions Code and my license is in full force and effect.
License ClassLicense No. 33%' 30 Z'
Date &,eZ4 /._ />✓FcJ Contractor % e,-7- !%�i���i/ �,t,�t �!y A irc_ fir, jc�li �iC•�
4
OWNER -BUILDER DECLARATION ` �
I hereby affirm that I am exempt 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.).
0 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
0 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
Q Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date dly4 ,/�e AppIicantd�',t( �_ _",- ,
[J r 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.
Date///G1% X//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
Q I hereby certify that no excavation five (5) or more feet in depth into which a person is re-
quired to descend, will be rtiade 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.)
[� 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.
M Division of Industrial Safety Permit No.
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION 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 for which I have applied for'this permit for the purpose of makkiin�g' inspections.
Signature of Applicant/Agent _ Date
i fl VAI UH A • T3 . /(,G 1)fA F14
Print^Applicant/Agent Name
284-2000 7/80
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1.
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,_DATE'.! RECORD D _ c;� HT t_UG
_FRONT,.I'ARD `_- /0 0� LC)T COV'D•.. z «.. 3
SIDE YAr.D �S�rsa'„I,: ORD. 1.r.w1�+u�sXr�..t
11
Prior to final inspection or a
i any us6,
_I . r the pool will be fenced as required
. by County Ordinance 421,1
.
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APPROVE®
O
DSDIVI'
LAND ��
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