403712 (BLCK)BUILDING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
0 FIELD Dsr
3 712 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES_
1ST FL.
2ND. Fl.
POR.
GAR.
CAR P.
„-WALL
,1
ESTIMATED CONSTRUCTION
SO. FT. .@ $
Owner
F
UNITS
C uhfiy
SO. FT. @
YARD SPKLR SYSTEM a
SO. FT. @ MOBILEHOME SVC.
BAR SINK +
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @ r V
DRINKING FOUNTAIN
SO. FT. @ 1 L
URINAL
VALUATION $
WATER PIPING I
NOTE: Not to be used as property tax valuation
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SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
s.
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
R
Electrical Fee Dbl $ off,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SMI Fee $
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Bond Amt. .f'
S
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
Fi al 1b.1de
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
Dental. Fee
POLE, TEMP/PERM
LAVATORY ;c
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Mileage Fee $ }
SO. FT. @ a
BATH TUB
Reinsp. Fee
$
SO. FT. @ a
WATER HEATER
Tel.
S0. FT. RESID @I%a
SEWAGE DISPOSAL '
Total Fees
S s C.trt
SO. FT. GAR @ 3/4a
HOUSE SEWER
City
- Zip
M.O. ❑ N.C. 0 Cash C eck
GAS PIPING
PERMIT FEE
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PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
HM. FEE
-MICRO'FEE
MECH. FEE
PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEEPLUMB. FEE
PERMIT NO.
403712
lob Address
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Zip
Owner
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Valuation
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Micro Film Fee
Cop $
Use of Permit /�J �7 `rel
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Use/Cosa No.
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PI. Ck. Fee S
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Lot Size
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Construction Fee Dbl S
Legal Description
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Electrical Fee Dbl $ off,
Zone Restrictions
Group [TIVelef
SMI Fee $
Plumbing Fee
Del S
Bond Amt. .f'
S
PI o.
Plan Checker
Fi al 1b.1de
In,pecto
Unit
Sp. Insp. Fee $
Dental. Fee
S
Const. Lender
Branch
Supplimentol Permit Numbers
'
'
Regist, Fee S
Mileage Fee $ }
Address City Zip
Witness Fee S
Reinsp. Fee
$
Owner/Agent
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Tel.
Zip
Total Fees
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` T u Is THIS PERMIT SHALL IfE60WE VOID IF WORK IS NOT COMMENCED WITHIN 120 DAV97 CEsWroq-oF WORK
Sewer District
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. t, t
` t •, L L,. t, i
•1 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 H EBY CERTIFY THATTHE INDIVIDUAl.WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
sForm 284.208 (Rev. 1/80) RDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by:
NO.
OPERATION
DATE
INSPECTOR � •
NO.
OPERATION
DATE
IN$PECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
O 6 .-
34
Plenums B Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
\ v 6 -
36
Inlets 8 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.
[�
°o
__..____-___•_.
ADDITIONAL INFORMATION
_15
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final �. •g�
__, _ __ _.PLUMBING.APPROVALS__..._ __-------------------
15Ground 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
psi
1
P/
i
26 Power Pole
27 Conduit
28 Service Entrance
29• Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT 'A• BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY, OF RIVERSIDE
2r4 '199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner G L� Architect— — --_ Contractor�7_�—'
S—d' V Sa Address— 2lf-
Addres ---- Address---
City__00CA-61
City City-- _
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PhonePhone—_ Phone -3 O p v
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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
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- �� g_r--P6- 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.
ISPACE NO.
1 USE OF STRUCTURE
JOB ADDRESS S.? kZ ^y,_9 d_ �'-� I SINGLE FAMILY DUPLEX
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O LL
G S T10 F PROPERTY APARTMENTS AGRIC. El
N Q
�_�ERCIAL COMM
E] INDUSTRIAL [�
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COMMUNITY ALTERATIONS
C C
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NO. OF SUBMITTED PLANS USE OF PERMIT
VCASE
NO.
Z
NO. OF PARKING SPACES REQUIRED _— — NO. OF BUILDINGS NOW EXISTING
Q
ZONE—SETBACKS: FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE OF FEET REQUIRED ON STREET
DATE��—� t SIGNATURE OF LAND USE OFFICIAL
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET—
F
W
CURB AND GUTTER REQUIRED: YES ElNO ❑ —STREET
X
H
-
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ N0. ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT 'FOR DRIVEWAY AND STREET
CIMPROVEMENT?
YES C)' NO C1
o%
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
H
W
SEWAGE DISPOSAL-
Q us
C
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
H FLOOD CONTROL
H
W AIR POLLUTION
W DIV OF HWY
0 .4 YOUR PROPERTY MAY BE SUBJECT TO
—
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
2r4 '199A 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNT•Y'OF RIVERSIDE PERMIT q
Effective July1, 1980, Chapter 1301, Section 19825,of the Heilth 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 signbelow:•
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 licensee is in full force and effect.
License Class C_ --d / License No.
Date r_A-c-f,. c-�,, $�55 6 Contractor G�� r c^+a-+^-~•�
Q W 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.).
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. Insurance
0 Certified copy is hereby -furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
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' 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
t
DIVISION OF INDUSTRIAL•SAFETY PERMIT CERTIFICATION
0 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
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.
[� 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 ap. lied for this permit for the purpose of making inspctions.
Signature of Applicant/Agent Date
;rin'tZpplicant/Agent Name
284-2000 7/80