384552 (BLCK)PERMIT;NO• • .. '' DEPARTMENT OF BUILDING & SAFETY
3 8 r5 5 2 COUNTY OF RIVERSIDE FIELD �'/
CONSTRUCTION
ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
POR
GAR.
CARR
WALL •
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
Date i
75'
f / '•` ` /
SQ. FT. @
YARD SPKLR SYSTEM
SQ FT @ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ - POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ FT @ -
DRINKING FOUNTAIN
SQ. FT. @�
URINAL
VALUATION $ FU%
WATER PIPING
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
No.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Unit
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
Received by
SQ. FT. @ c
WATER HEATER
LicenseX
i
SQ. FT. RESID @ 1114 c
SEWAGE DISPOSAL
'
S0. FT. GAR @ 3/4 c
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 ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
3 8 4 5 5
Job Address ,�^ t. Space
J-2- .. f-�,D
Zip
3
Ow
Community
Valuation_ .�-.l
E-�`',+yam`-
/ / �eParcel
Date i
75'
f / '•` ` /
Dist.
/
_ Off.
F.C.C.
MH.Permit Fee E'�
Micro Film Fee Cop E
Use of Perm)t)
G -> ->_. �
No.
-7 s - � /,j ` ,o %
Use/Case No.Y
Ck. By
J%�
Mech. Fee Dbl E
PI. Ck. Fee E
Set Backs
Lot Size
Construction Fee Dbl E
Lega escri tion
� eµp j� �{j,.� � ^� /
�b/�'4r(� ///!
C, Y L /,, ) -7
F S
S R
Electrical Fee Dbl E
Zone Re trictionsf
... /
Group
Type
SMI Fee E
Plumbing Fee Dbl E
Bond Amt.Plan
E
No.
Plan Checker
Final a 1VInsp r
3 —IS
Unit
Sp. Insp. Fee E
Demol. Fee E
Const. Lender Branch -
Supplimental Permit Numbers
Registr. Fee E
Mileage Fee E
Address City Zip
Witness Fee E
Reinsp. Fee E
Owner/Agent;'� //
Tel.
FeesE Ile .�
Address -•r
V� c'` el""a'^ �i...4 �!s•..f+.
Ciry r/ Zi
,I" `., %�,•4..+-.++e'^ tw...s• '�.- �r,.3 +
M.O. N.C. Cash - Check
Received by
Contractor
'
Tel.
LicenseX
i
Trees required
Sewage System
Address
City Zip
T U. P THIS PERMIT SHALL BECOME VOID IF WORK ISNOT COMMENCED WITHIN-120'DAYS'."CESSATION OF WORK—V
Sewer District FOR 120 DAYS SHALL ALSO CA_USE-PER_MIT TO BECOME VOID.
F:HEREEIYvAGREE THiiY ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
"THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
� q0 (' I HEREBY CERTIFY THAT, THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
s
ACCORDANCE WITH SECTION 5501 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
Form 28d-208 (Rev.B/78)
Itr, _. _. a. .. ..
-O. -. — -
,verified by:...
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab 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
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.
OP'
ADDITIONAL INFORMATION
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
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
Final
Tank Pit L.Line
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
i .i' STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMITDISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
V84 199-A 9/74
CANARY -FILE, PINK -APPLICANT
Owner QA Architect _ Contractor-.. -
Addres �ft0 ���" ---- Address___ Address_--_—' --
City � City_- _ City___ -
_---_—.--.._
Phone ` 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
W
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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'`
County R/W
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 `
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 a 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 �1
Approval by Signature from the Following Departments L' ed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
f I SPACE N0.
USE OF STRUCTURE
JOB ADDRESSv SINGLE FAMILY DUPLEX ❑
2
OF PR PER Y �_� J �Q
LEGAL -DESCRIPTION - APARTMENTS AGRIC.
70
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COMMERCIAL COMMERCIAL ❑ INDUSTRIAL []
COMMUNITY f -t
ALTERATIONS
C G
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NO. OF SUBMITTED PLANS -_ USS OF PERMIT �7 G
J
jCASE
NO.
,
� OF
O Z
NO. OF PA KING SPACES REQUIRED .- 0. BUILDINGS NOW EXISTING
Q o
ZONE SETBACKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATE -7'7 SIGNATURE OF LAND USE OFFIC
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET-
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
IP -
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
°C
DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
S
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
vt FLOOD CONTROL
t-
W AIR POLLUTION
DIV OF HWY
YOUR PROPERTY MAY BE SUBJECT TO
O Q _
. FLOOD. RIVERSIDE COUNTY ASSUMES
o
NO RESPONSIBILITY IN EVENT OF FLOOD.
V84 199-A 9/74
CANARY -FILE, PINK -APPLICANT