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426921 (ELEC)PERMIT NO. DEPARTMENT OF' BUILDING & SAFETY DST /1 6 2 11 �COUNTY OF RIVERSIDE FIELD 6F P1. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. 2ND. FL. FOR. GAR. CAR P. WALL SQ. FT. @ UNITS ' Date Dim SQ. FT. @ YARD SPKLR SYSTEM MOBILEHOME SVC. SQ. FT. @ BAR SINK POWER OUTLET SQ. FT. @ ROOF DRAINS SQ. FT. @ DRAINAGE PIPING SQ. FT. @ DRINKING FOUNTAIN SQ FT @ ESTIMATED CONSTRUCTION VALUATION $ Set Backs Lot Size t URINAL WATER PIPING NOTE: Not to be used as property tax valuation SWIM POOL, PVT Electrical Fee Dbl $ j ° ��= FLOOR DRAIN - MECHANICAL FEES SWIM POOL, COMM SMI Fee WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN Plan No. WASHER (AUTO)(DISH) APPLIANCE - DRYER actor Unit - GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED y' y , , �- t� .. , j y 2� LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER Address City Zip KITCHEN SINK ABSORPTION SYSTEM ES. T. U. TEMP USE PERMIT SVC Owner/Agent WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM Is LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT .Receiv SHOWER BOILER B.T.U. SQ. FT, @ c LicenseN BATH TUB . " T SQ. FT. @ c Address-.- WATER HEATER v . SQ. FT. RESID @1 /.c Sewer District II ll 7 _ r Fbt,)284-208 (Rev e e ©s SEWAGE DISPOSAL SQ. FT. GAR•@ 3/, c HOUSE SEWER - GAS PIPING PERMIT FEEPERMIT FEET PERMIT FEE DBL. TOTAL FEES ;;, = ' MOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE 1 r SMI FEE FEE PLUMB. FEE , ' PERMIT NO. 426921 Job Address Space Zi r.., Owner Community , Valuation Date Dim Off. F.C.C. MH.Permit Fee.,, $ Micro Film Fee Cop $ Use of PeTrmi'tt // /' Q� CC.r< l Parcel No. 7 7-1/-,.;'-7,,/ �"'�• / 6 Use/Case No. .• tl Ck. yBy , l„'�-,� ;. i Meth. Fee Dbl $ - TPI. Ck. Fee $ Set Backs Lot Size t ' Construction Fee Dbl $ Legal Description - - ,. / y I /'- + i •+` i7 1 �' F S S R Electrical Fee Dbl $ j ° ��= Zone Restrictions Group Type SMI Fee 'Plumbing Fee Dbl $ Bond Amt. $ Plan No. Plan Checker Final Date actor Unit - Sp. Insp. Fee $ Dental. Fee $ Const. Lender Branch Supplimental Permit bets 2— Registr. "Fee $ Mileage Fee $ r Address City Zip Witness Fee $ Reinsp. Fee $ Owner/Agent Tel. Zip t Total Fees Is Address City Zip e- •'9`' M.O. N.C. n Cash n Chec .Receiv Contractor Tel. LicenseN " T LL - P Address-.- City Zip v . THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. r' 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. 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. Sewer District II ll 7 _ r Fbt,)284-208 (Rev e e ©s NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS �. 1 Set Back 33 Ventilation System 2 Ftgs 8 Frms 34 Plenums 8 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. E] 43 Final IDA Fireplace T. 0. NO. ADDITIONAL INFORMATION —Z SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Loth 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 PSL P/ 26 Power Pbie 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final / ..STREET NAME DEPARTMENT OF BUILDING AND'SAFETY APPLICATION CERTIFICATE COUNTY OF RIVERSIDE PERMIT # Effective July 1, 1980, Chapter 1301 Section 19825,of the Ne81th 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 -000) of Division 3 of the Business and Professions Code and my license is in full force and effect License Class License Date. Contractor_ , /-�6 i( J [� ( OWNER -BUILDER DECLARATION I hereby :affirm that I am -exempt from the Contractor's License Law for the following reasois: 0 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 vithin 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 �] WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Corkers'. Compensation Insurance, or a certified copy thereof'(Sec. 3800, Lab. Code). Policy No. �r� C% �' '—OInsurance Q Certified copy is Hereby furnished. Certified copy is filed with the County of Riverside, Department of Building aed 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 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 iri 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.) 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 Jo 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 foowhichI,,have applied for this permit for the purpose of making inspections.. Signature -of "p,` icant/ gent Date c l), ,40- A,) r ni DDlicant/Agent Name