402761 (RPL)DVILVIP4{7 rCKMII
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
4 0 2 7 61 COUNTY OF RIVERSIDE FIELD osT
PERMIT NO.
" 4027 61
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO. ' PLUMBING6'FEES
_
Cswner -��-
1 ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
4 ESTIMATED CONST UCTION
SO. FT. @ $
_
Dote 7
jr/
UNITS
l� j
F.C.C.
MM Permit Fee $
SO. FT. @ ^ YARD SPKLR SYSTEM '
Cop $
SO. FT. @ MOBILEHOME SVC. BAR SINK
SO. FT. @ POWER OUTLET ROOF DRAINS
Use/Case
SO. FT. @ DRAINAGE PIPING
Ck. By
SO. FT. @ DRINKING FOUNTAIN
P1. Ck. Fee 8 � (�/
A§ CET?"@ URINAL
VALUATION $ i ,w WATER PIPING
j
• NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
S'. -I, 11 �.IS - %/f
FLOOR DRAIN _
iJ
Electrical Fee Dbl $ vA s
MECHANICAL FEES
Group
SWIM POOL, COMM
Type
'
WATER SOFTENER
Plumbing Fee
VENT SYSTEM
FAN EVAP. COOL HOOD
Plan No.
SIGN
WASHER (AUTO)(DISH)
Inspector
APPLIANCE
DRYER
Sp. Insp.'Fee $
Demol. Fee
S
GARBAGE DISPOSAL
FURNACE UNIT
WALL FLOOR SUSPENDED
Regior. Fee $
Mileage Fee $
Address City Zip
LAUNDRY TRAY
Reimp. Fee
AIR HANDLING UNIT
CFM
IDLE METER
Zip V.
�.
KITCHEN SINK
Total Fees
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
r�. Zip
WATER CLOSET
/
Receyved by `
u'e jy
COMPRESSOR
HP G
POLE, TEMP/PERM
LAVATORY
t
HEATING SYSTEM
FORCED GRAVITY
AMPERES SERV ENT
Zip
SHOWER
e
BOILER
B.T.U.
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
50. FT. RESID @ 11/4c
SEWAGE DISPOSAL
S0. FT. GAR @ s/4a
HOUSE SEWER
-GAS PIPING
PERMIT FEE
PERMIT FEE✓
r%
PERMIT FEE
DBL
TOTAL FEESMO8.
HM. FEE
MICRO' FEE MECH. FEE
PL. CK.
ii` /
EEE
, CCjO/NNSST. F.EEt.
EtECT. FEE ,
SgrMI�FEE
,
FEE P MB u -
PERMIT NO.
" 4027 61
- _.___.__,.
lob Address - - - - - _ - --��— -
- - - - Space
_ v
Zip
_
Cswner -��-
Communily ^
A/''/,J�1,�iI�
�jJc. %i!`i •vy
Valued
/,/yJgs/gyp //J1� 4
$ V c'?o ! '
_
Dote 7
jr/
Dist.
Off.
F.C.C.
MM Permit Fee $
Micro Film Fee
Cop $
Use of, Permit
/Sl
Parcel No.
..r
Use/Case
No.
Ck. By
Mach. Fee Dbl S
P1. Ck. Fee 8 � (�/
SeT Backs
Lot Size
Construction Fee Dbl EJ �'? �.
Lego( Description n
��'�'••'' v�." /�
(�. - ,/ .,� ,2'y
F !."
S'. -I, 11 �.IS - %/f
R
3 I
Electrical Fee Dbl $ vA s
Zone Restrictions
..,/
Group
Type
'
SMI Fee $ •S•,f
Plumbing Fee
Dbl $ /• /•>,
Bond Amt.
$
Plan No.
Plan Checker
Final. Dote SS
Inspector
Unit
Sp. Insp.'Fee $
Demol. Fee
S
Const. Lender Branch
Supplimentol-PermitNumbers
Regior. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reimp. Fee
$
Owner/Agent
Tel.
Zip V.
�.
Total Fees
$ 9
Address F,.p
%�
City 0
r�. Zip
M.f�y ❑ N.C. Cosh Check
/
Receyved by `
u'e jy
�
� l r�r�
, �l e ,r
r
Contractor
_/'tq / ,s
.fi /4 /�'.,^40-z �.J! 1=�.;�.1
Tet
J�Tres;r
✓� ,1�_ X' '/•
License#
:.
Sevlag ysi
y
06,
Address ... si
City -
Zip
'
+'")`' T LI, ✓_.1� P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
Sewer DistrictFOR 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..', •4
!!! /I EBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS,AND SPECIFICATIONS HAS DONE SO I Rv-�cpyg
Form 284208 (Rev. 1/80) ORDANCE WITH SECTION 5541 OF THE BUSINESS AND. PROFESSIONS CODE OF TH€NATE OF CALIFORNIA: /
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
•,INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set"ga�i •��'
_ l -� - Q
33
Ventilation System
2
Ftgs 8 Frms
�. �.+ b
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
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.
No
ADDITIONAL INFORMATION
q
SEWAGE SYSTEM SIZE & LOCATION
11 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 8W
PLUMBING APPROVALS
15 Ground Plumb _
16 Water Piping
17 Rough Plumb ,• Z Q
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
h
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final -•�
STREET NAME
V ` NOTICE: THIS IS NOT A BUILDING PERMIT
_ APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
!� DISTRICT ..#
Permit No
Owner TO 11 m ��� S1r �' Architect Contractor
Address 4-
Address «y t� I Address_ Address -
G� yt
City uICity City--)
Phone Phone Phone �7/
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
W
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 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.
I SPACE NO.
USE OF STRUCTURE
U!�J
JOB ADDRESS ICG r��_. t' ; SINGLE FAMILY DUPLEX
LEGAL DESCRIPTION OF PROPERTY ? �"� 1 < ��/
[] AGRIC.
Z
f .APARTMENTS ❑
N Q
17 COMMERCIAL E] INDUSTRIAL ❑
'^
i .
COMMUNITY ? t
ALTERATIONS Ej-
Z
NO. OF SUBMITTED PLANS — _ USE OF PERMIT /.Si 1 /V it �f l J� #
'
W Q
4+
CASE N0.
z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW E IX STING ---
jZONES!
SETBACKS: FRONT SIDE '` F REAR
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE T't-71 'A
SETBACK ORDINANCE N -- OF FEET REQUIRED ON — ,- STREET'
� SIGNATURE OF LAND USE OFFICIAL -� ✓ �
DATE " f / ;� - ---
--
_
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -- —
F
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
i
.
t-
oe
i
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
°L
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
t-
s
SEWAGE DISPOSAL
4 W
4
n=om
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
ONTROL
Pn FLOOD CONTROL-
W AIR POLLUTION
3
to
DIV OF HWY
o YOUR PROPERTY MAY BE SUBJECT T'0
a _
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
V l 1
O
C
30
---
'off
I'�r
m
ELECTRICAL:' CLOCK:
C7
EXCAVATION
/77
'Y7O
M
4-
U
41
�
1"
C
WALL T 0<6,41 i
N
7'a
---
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I'�r
PLUMBING FOR SPA:
ELECTRICAL:' CLOCK:
EXCAVATION
aN
M
4-
U
41
4
1"
¢900
¢
tI
4.
M f r
Zl000�
SO FT. POOL SO, FT. PANEL
PANEL TYPE PANEL SIZE
,
NUMBER PANELS PLUMB RUN
AUTOMATIC MANUAL-
ANUAL
13 000
75
75
253vo
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TO 'NATr
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SEE EJF_rAIL O 1
•3X� FOR REIr.; F2+R�l -PLAN,-rt - ^
2580 T- _ r 1
25"Bo �jC>110 3E AM n 30UD SEAM .7'P. TRAP DETAIL-
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---
Y
AIR BLOWER:
---
— ---
PLUMBING FOR SPA:
ELECTRICAL:' CLOCK:
EXCAVATION
DECKING
t
I MISCELLANEOUS:
SOLAR GENERAL
¢900
¢
09
.5
7So0
Zl000�
SO FT. POOL SO, FT. PANEL
PANEL TYPE PANEL SIZE
,
NUMBER PANELS PLUMB RUN
AUTOMATIC MANUAL-
ANUAL
13 000
75
75
253vo
l-9
Sfc/ �/1117' tet/ �
C -GK 10
c*z GAP .�-Y'L! e
PULL
2-+� CARS ��' Y+- R.: .`-Tl 17-, O.G.
_ _ I
' *71,
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VERT STL E 3
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—
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it
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or` /ow r.70inf RAISE Pa�iNT�r2
E-XPAI.!S!'✓C SOIL n�.tLY E_\/ F i� S10hJ J011JT
--- -- - -- - -- -- -- t� ------ ------ - - ------------------
---- ----- --- - --
" POOL GENERAL � SPA GENERAL
SPECIFICATIONS
SIZE tS X 32 AREA DEPTH it TO,5 I
SHAPE
LINER
POOL CAPACITY GALS.
PUMP
MOTOR H.P. 17'/2 H. P.
i FILTER 100 CA'r SO. FT.
VACUUM LINE & SKIMMER
iRETURN LINE ' "
MAIN DRAIN
SKIMMER MODEL U3
BACKWASH LINE
OF 1/2" FILL LINE
ANTI SIPHON VALVE 'v`
t HEATER �1 b SIZE BTU
GASLINE BY: VENTED BY:
I
LIGHT q/
CLOCK V
ELECTRIC BY:
I ELECTRICAL BONDING BY.
W61*1qL"wZm1 nZ
CHLORINATOR
BOARD — SIZE
I BOARD SUPPORTS
LADDER— MODEL
Water
SLIDE # __ _ --- Color _ -_ Hookup
GRADING
STUB PLUMB i-1 YES `1 NO
DECK BY'.
SPECIFICATIONS
SPA TYPE: MDL #
r DIMENSION
DEPTH
COLOR TOTAI GALLONS #
I
SPA JETS TILE
P HEATER
f
PUMP & MOTOR j
THERMOMETERS
Y
AIR BLOWER:
GAS LINE:
PLUMBING FOR SPA:
ELECTRICAL:' CLOCK:
EXCAVATION
DECKING
t
I MISCELLANEOUS:
SOLAR GENERAL
SPECIFICATIONS
SO FT. POOL SO, FT. PANEL
PANEL TYPE PANEL SIZE
,
NUMBER PANELS PLUMB RUN
AUTOMATIC MANUAL-
ANUAL
THERMOMETERS BOOSTER PUMP
a SINGLE O DOUBLE ❑ ELECTRIC BY:
JOB NO.
MAP BOOK NO.
LEGAL DESCRIPTION
- SCALE is} LOT NO.
seml a�-�, labn-s c
y i�V-Jo
# TRACT NO.
Gini e no e eas1007
/vn 4f%z, ZBday BOOK
PAGE BLOCK
51ee _T17,011/! -1967'11`7/
1;
Aro/6 G2 ¢01 /q�!`De�/ 40 l7/q• + ESCROW CLOSE
51'2a C 177!/ -5-0"
E y
from 6uilu�ii��s, frees or 1i } TENTATIVE DIG DATE IF
Soi 3hglp✓e earrfry /Dol> w F{. I
t PERMIT OFFICE
un. e 74o t
e}y 7/✓n>noucv�l/rnr,rofnue��yhraueyrca�/ neQPn�oeroE1-. ei arc�Ce7yes eiueCipn�oeCfo J.yo iin/its>Ja
401
/o eur�ar�i SALESMAN _
• ,�ee� mon C --7'G e Gon3 q7'! .
r el4�r7,o ,mor /4 t/ays./1! `�f.//
l'J2 /'/7C artifice e ween E or # V' i i H E R.
I and sy'ee/ •% 6e 2"'
.. TO DETERMINE
DwN15Y. Joyv //.vDATE: APPROXIMATE ELEVATION OF
CK'DBY. DATE ti POOL ON DAY OF EXCAVATION
I
POOL AREA TO BE FENCED, }
' BY OWNER PER COUNTY OR CITY
'
'ORDINANCE. GATES TO BE SELF
NOT TO SCALE CLOSING AND SELF LATCHING.
F DO,NOT TURN ON POOL LIGHT
DEEP WHEN POOL IS.EMPTY ,
END
SHALLOW
END POOL OR SPA
� t
i
UNLESS OTHERWISE SPECIFIED: ryAME/e5
POOL IS —SHALLOW TO -_-- DEEP ADDRESS
1 HAVE RECEIVED A COPY OF
THIS PLAN AND HEREBY
APPROVE POOL AND r ---u i to
EQUIPMENT LOCATION �0 1-- —
CROSS STREETS
RES, PHOI'JE----'-- -- ----
----� BUS. PHONE
CUSTOMER'S SIGNATURE DATE
, .. 111,1 . ... ... .. ... .... .. ... .. �'�-.-S
JOHN H. HA CKER & ASSO C/A TES :{
7/4 EUGENE RD., PALM SPR/NGS, CA. 92262...
(7/4) 323-7720
SWi , II G POOL.
.- - ..J-�-�� �,•� - G'/�i ;3�� /2i3 TE
Lit
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i; :2Ct� /�i• /¢
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• DEPARTMENT OF BUILDING AND SAFETY, APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE t. PERMIT N )
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 G S 3 License No. 3 y8 %fig
Date 17 1 1 f'd Contractor ,4
Q 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.).
[] 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. S-/ '% S -V --.t — 90. Insurance CtA TF. comp
Q Certified copy is hereby furnished.
Certified copy is filed with the County of�� side, Depar�ilding and Safety.
'
Date A 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).
-
1
Lender's Name 8A /V/(
Lender's Address /A/16/00 G'if #"AIA.' 19*Y.4Ve !V
' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
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),Jeet;high. .(Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.)
0 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. -
Q Division of, Industrial Safety Permit No. -
� Date � ,� •Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY t
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, of Riverside;•Depa'rtment of Building and 'Safety to enter, upon the pro-
inspections.
perty f� I have applied for this"permit for the purpose of making
Signature of Applicant/Agent r ., s, Date
tool Coasr� .
-
.. 4 ty� Print-Applicant/AgentnName
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