399278 (BLCK)BUILDING PERMIT
PERMIT NG. DEPARTMENT OF BUILDING & SAFETY
9927'8 COUNTY- OF RIVERSIDE FIELD osr
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO: PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR. / r
` CAR P.
WALL : �"1 ��fSQ.
ESTIMATED CONSTRUCTION
SO. FT. .@ $
UNITS
�r F.C.C.
MH Permit Fee E
SO. FT. @
YARD SPKLR SYSTEM
SOMOBILEHOME SVC.
BAR SINK
S/ml Fljr j° POWER OUTLET K
FT. @
ROOF DRAINS
DRAINAGE PIPING
. FT. @ {s?
DRINKING FOUNTAIN
FT. @
URINAL '
VALUATION $
.WATER PIPING ti
NOTE: Not to be used as property tax �oluotion
SWIM POOL, PVT
Construction Fee Dbl E
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
S R
WATER SOFTENER;
VENT SYSTEM FAN EVAP. COOL HOOD
' SIGN
type,"N
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Plumbing Fee Dbl E
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Plan Checker
'Fihol
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER'
Unit
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
Mileage Fee $
SHOWER
BOILER B.T.U. r .
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
Zip
S0. FT. RESID @ 11/44
Total Fees
SEWAGE DISPOSAL
•
S0. FT. GAR @ 3/aa
r:; �.
HOUSE SEWER
Zip
! �.� .';+
M.O. ❑ N.C. ❑ Cosh ❑ he ❑
Recei.ed by'—I,. T
GAS PIPING
PERMIT FEE
Tel.- "
PERMIT FEE
LicensaN
PERMIT FEE
DBL '
TOTAL FEEEESS
MOB. HM. FEE
MICRO'FEE
MECH. FEE Pk. CK. FEE
CONST.. FEE
ELECT. FEE
SMI FEE
FEE PLUMB. FEE
`
PERMIT NO.
399278
Job Address c. _
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ommuni L/ '
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Space Zip Owner
Valuotion. s to "' Fit.
ryg, �-�v, {'f•
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E ••^'ry' , / t.�� 1 \
-
O .or
�r F.C.C.
MH Permit Fee E
Micro Film Fee Cop S
Use�oofff Permii ��+ "//, -
/Z b: �-',G - f+-1 T• ""' A-''
, 0z A
Parcel No. - r
(�/ (sj f y •T
Use/Case
No.
Ck.'
Mech. Fee' Dbl E
PI. Ck. Fee $
Set Backs
Lot Size
-
t
Construction Fee Dbl E
i' Desa�-
Legal_
//
r ..'�/
F
E
S R
Electrical Fee Dbl $
Zone Restrictions
Group
type,"N
SMI Fee S
Plumbing Fee Dbl E
Bond Affil:
$
Plan No.
Plan Checker
'Fihol
to
7/
Unit
d
Sp. Insp. Fee $
Demol. Fee S
Const. Lender Branch
Oplimental Permit Numbers
/
Registr. Fee $
Mileage Fee $
Address City Zip
�/�
Witness Fee S
Reinsp. Fee . $
O /Ag'erii / r.;�' "�'•+C•"',G�'` '
Tel.
Zip
Total Fees
^°
/�'� `7" .. 'i..- ,,,
r:; �.
Zip
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M.O. ❑ N.C. ❑ Cosh ❑ he ❑
Recei.ed by'—I,. T
Contractor
Tel.- "
LicensaN
Trees re��e
Sewpgo-a�� ystem
vv
Address
J f
City ,. Zip
T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
SewerDistrict FOR 120 DAYS SHALL ALSO.CAUSE PERMIT TO BECOME VOID.
c �T 1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT'WILL BE DONE IN ACCORDANCE WITH
/, ��O'_� • °�:Y WS RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
OO I DIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Farm 284.208 (Rev. 1/90) ACCORDAN WITH SECTI N 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
s•erified by:
NO.
OPERATION
DATE s
INSPECTOR
140.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
_
MECHANICAL'APPROVALS .
1
Set Back
-7— �.
•:33
Ventilation
2
2A
Ftgs & Frms
Slab Grade
=1 Q�6`f-�
O �J
-„ n
34
Plenums & Ducts
35
Furnace Comport.,
3 -
4
Steel
Grout Blocks
-2 Q_�
U/p0
i
36
Inlets & Outlets ,
37. ..Combustion Air <
38 Compressor
5 Bond Beams C/ /)N
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.
D
43
Final
l0A
Fireplace- T.O.'
O
°oN ADDITIONAL INFORMATION
'
t '
r
'•
,
r
r -
I
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A 'Drywall
13 Finish Grade `
INSULATION Thick R
Value
7A Walls (Batts)
128 'Ceiling (Batts)
12C Ceiling (Blown) /n
14; -' _Final `.T Aa >16-10a '
PLUMBING Ai(PROVALS
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
C
J'
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29AGrounding Wire
29B Bonding
30 Fixtures
_
31 Service
32 . Final
STREET NAME
CERTIFICATE OF EXEMPTION'FROM 410RKE
COMPENSATION INSURANCE
(This section.need not be completed if permit .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 perso'n.in any manner'so as to become subject to the
Workers' Compensation laws of California. h further undersand 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.
Hato A_ -I :-,-4.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perform
ante 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.
I hereby certify that no excavation five (5) or more =eet in depth.
into.which a person is required 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.
As owner-builder,'I will not employ anyone to do work which would re-
quire_..a permit from the Division of Industrial Safety, as noted above,.
unless such person has a permit to do such work from ghat division.
Division of Industrial Safety Permit No.
Date App1 i a�
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.s.tate laws and county ordinances
relating to building construction, and authorize representative of the County
of Riverside, Department.of Building and Safety to enter upon the property
for which I have applied for this permit for the purpose of making inspections.:
ignature of AppI nt/.gent Dais
Print Applicant/Agent Name
9Qa_9nnn
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
APPLICATION CERTIFICATE
PERMIT #
Effective July 1, 1980, Chapter 1301, Section 19825 of the Health and Safety
Code requires the execution of the following applicable declarations prior to
the issuance of a building permit. Please print or type and sign below.
C 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 License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt 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 in-
tended or offered for sale. If I sell within one year of comple-
tion, I understand I will have the burden of proving I didnot
build or improve for the purpose of sale (Sec. 7031.5, B.&P.C.').
I, as owner of the property, am exclusively contracting.with li-
censed contractors to construct the project (Sec. 7044, B.&P.C.).
_AMI am exempt under Section B.&P.C. for this reason:
Date Owner
�Li% 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 Company
Certified copy is hereby furnished.
Certified copy.is filed with the County of Riverside, Department
of Building and Safety. ,
Date -7- Appl i cant �.r z--
� a
DEPARTMENT OF BUILDING AND SAFETY
COUNTY.OF RIVERSIDE
An 'owner builder'* building permit has been applied for in your name and bearing
your signature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processirg and -.issuing .your.
.- building permit. No buildingpermit will be issued until this verification
is ived.
1. -I personally plan to provide the major labor and.mEterials for con-
struction of the proposed property improvement (yep: or no) _171 S
I (have/have not.) < signed an application for building permit_.:
for the proposed work. ,.
I have contracted with the following person. (firm) to provide the pro-
posed construction:
-Name - - - Phone -�
Address City
Contractors License No.
---- � . tan
I t
Pv p o provide portions of the work, but I have hired the following
person -
to coordinate, supervise, and provide the major work:
Name Phon
Address City
Contractors License No.
5. I will provide some of the work but I have contracted (hired) the follow-
ing persons to provide the work indicated:
Name Address Phone Type of Work
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
0
Owner,az L F Architect —. _ Contractor _
AddresqTVy6 _�y�S.�O=-_ ' Address-__ Address—.— — ----
��-
.City City_---- -_ _ City_—_— -
Phone _ Phone—
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 Depatment 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 tc be occupied until 1 (we) have
complied with all laws of the Countv 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.
SPACE N0. -
_ 1 USE OF STRUCTURE
_��//
JOB ADDRESS `-may - ///' Q SINGLE FAMILY DUPLEX
>
LEG 1- OESCR1PT10N PROPERTY �� - �� _ APARTMENTS AGRIC.
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�'42--�"'�-t►`-�
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- COMMERCIAL INDUSTRIAL n
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COM NITY 99i� ' ❑
ALTERATIONS
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NO. OF SUBMITTED PLANS USE OF P RAjjT
tD
CASE N0.
l7
f Of
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NO. OF PARKING SPACES REQUIRED _- N0. OF BUILDINGS NOV EX TING -
Q
ZONE SETBACKS: FRONT SIDE R E A F r
J m
`` PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
GRADING
SETBACK ORDINANCE N OF FEET REQUIRED ON STREET
DATE- SIGNATURE OF LAND USE OFFICIA
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_-
t-
--
CURB AND GUTTER REQUIRED: YES El NO ❑ _STREET
t -
a
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
cc
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
ka.
WATER POLLUTION REMARKS
%A FLOOD CONTROL
H
W AIR POLLUTION
_ DIV OF HWY
c a — YOUR PROPERTY MAY BE SUBJECT TO
a
c FLOOD. RIVER:IDE COUNTY ASSUMES
- - NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
0