Loading...
403010, 403167 (SFD)OVILU111W rescsnss PERMIT NQ,' 03010 DEPARTMENT OF BUILDING &'SA_ FETY FIELD OFFICE DST COUNTY OF RIVERSIDE CONSTRUCTION ESTIMATE O. ELECTRICAL FEES NO. PLUMBING FEES ' 1ST FL. - 2ND. FL. FOR. GAR: -CAR P. " WALL - ` • • ' ESTIMATED CONSTRUCTION SQ..FT. .@-�fla, a.2 17 UNITS. , SO. FT. @ YARD SPKLR SYSTEM SQ. FT. @ MOBILEHOME SVC. BAR SINK r SQ..FT. @u POWER OUTLET. , ROOF DRAINS SQ. FT. @ DRAINAGE PIPING SQ. FT. @ DRINKING FOUNTAIN SQ..FT. @: URINAL VALUATION• $'' �.1� rF�. WATER PIPING .NOTE:. Not to be used as property, tox valuation SWIM .POOL, PVT FLOOR DRAIN.- RAIN,MECHANICAL MECHANICALFEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL, HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE r DRYER GARBAGE DISPOSAL �. • FURNACE UNIT WALL FLOOR. SUSPENDED LAUNDRY TRAY AIRHANDLING UNIT "' • • CFM `IDLE METERL. 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.,` - - •SO. FT. @ e BATH TUB Mach. Fee Dbl $ w .. SQ. FT: @ a WATER HEATER t - SO. FT. RESID @ 1 t/4a SEWAGE DISPOSAL. r S0. FT, GAR @/4a. HOUSE SEWER • k Zone Restrictions GAS PIPING PERM(T FEE•'.,� PERMIT FEE - PERMIT FEE DBL. "' TOTAL'FEE MOB. HM. FEE MICRO'FEE MECH: FEE ,Pk CK. FEE CONST. FEE ELECT. FEE •$MI FEE FEE PLUMB. FEE . PERMIT NO. Job Address �, 1 ' - Space_ Zip Owner �ii�403010 Comm n ty' `p Valuation Date Dist. Off. F.C.C. 'F4 - far .: MH Permit Fee Micro Film Fee Cop $ se of Pe t y / :y- ��(r,/. V ! ' � fc A_ . / _ s Parcel No. ~ I - f Use/Coe o. . Cit. By Mach. Fee Dbl $ w .. Pit Foe S Set Backs Lot Size - /.. C s' Cons' Fee Obi $ _ Lego] Descnp on ,. / /, �,�. "/]• /�V f f S> S R Electrical Fee Dbl S Zone Restrictions Group Type SMI Fee $ Plumbing Fee Dbl g - Bond %AmL • g Plan No. Pldn Checker',, Finol Date ((x''. Inspector s Sp, Insp. Fee $ Demol. Fee $ .Const. Lender - Branch Supplimentol Permit Numbers ' Registr. Fee $ Mileage Fee S Ad dr s c t'i - City Zip Witness Fee Reinsp: "Fee .$ /Agent - - - h -' - - Zip Total FeesS •Cash (/ Mares rr - City Zip , M.O. N.C. Check Received b - Contractor _ '^ - Tel. Licensell , Trees re ` Sewage System r dd;ess • t; ., r - Ciry Zip - - - T LL �� P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN J20 DAYS. CESSATION OF WORK verified by: Sewer District. FOR 120 DAYS•SHALL ALSO CAUSE PERMIT Td 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: - • • . BY CERTIFY -,'THA; THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO' IN Form 284.208 (Rev. I/80) • ` ACCORDANCE WITH SECTION 5541 OF THE.BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 1 Set Back 33 Ventilation System 2 Ftgs 8 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. No ADDITIONAL INFORMATION r , �. 4 tr " SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Interngl•Lath f { l .y12A Drywall _ ,r+ '• �, 13 Finish Grade !�'• -r. INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) t 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 Semite 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 s STREET NAME • NOTICE: THIS IS NOTA BUILDING PERMIT DISTRICT --— APPLICATION TO CONSTRUCT Permit No' DEPARTMENT, OF BUILDING AND SAFETY COUNTY OF RIVERSIDE 284 199 9/74 CANARY—FILE, PINK—APPLICANT' t� WAIT EN-2-(FI Architect Contractor IIVV(( Addr Address Address- x\111.•• ity Phone Phone 01 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 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 prop t- •to be cupi until I (we) have ' - complied with all laws of.the County of Riverside and the State of California governing said property. t (� �J ` 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. f% Z USE OF STRUCTURE . JOB ADDRESSrO� � IE ° Sin-GLE FAMILY] DUPLEX TT- Z t- LE L DESCRIPTION OF PROPERTY"��''��C'--�__, AGRIC. � � ] a �, APARTMENTS O u. r COMMERCIAL Ej' 'INDUSTRIAL L� GG Z COMMUNITY �� J ALTERATIONS n NO. OF SUBMITTED PLANS --_-- USE OF PERMIT --- N Q CASE NO. .Z NO. OF ARKING SPACES REQUIRED NO. OF BUILGS N XISTING _. 10 .4 rc� ZON _ 'FTBACKS: FRONT 6 SIDED 17 REAR J Ito +' GRADING PERMIT REQUIRED? , YES ❑ — , NO ❑ LOT SIZE r SETBACK RDINA CE # _— OF FEET REQUI ED ON STREET 1 DATE �. SIGNATURE OF LAND'USE OFFICIAL 4-�4r= DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___ !Z CURB AND GUTTER REQUIRED: YES ❑• NOSTREET i dCAN CURB AND GUTTER FEASIBLY BE' INSTALLED?- YES [INO El l4 'AN `ENCROACHMENT CINY .HAS ACCEPTABLE APPLICATION BEEN MADE FOR PERMIT AY D STRE O ZFOIVE IMPROV MENT? YES J< --NO ❑ \°L DATE Z - �L� SIGNATURE OF ROAD DEPT.. OFFI n i QW_`U SEWAGE DISPOSAL C - �� ; % NT / x ° i ` WATER LLUTION REMARKS' �► FLOOD CONTROL— zAIR POLLUTION w DIV OF HWY o a _ YOUR PROPERTY MAY BE SUBJECT T'0 s � o FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD.;' 284 199 9/74 CANARY—FILE, PINK—APPLICANT' _r-c[.iw..w.,,.���e+...+.<w.:.7'"'�7v^!•:"w.•.�,.,,►xfi,y-*•-c:-.r�:,arr<;-n' a;x�t�'+i„-`'r-R'i`,�i7?.t�.�"�„�Si��i:�i„*�r,,;��, ri..„�c•r. 4�i.<� '",�Y��V .�•:� '6_.�0:;,7,".v'—�:r—,�"'�T . DEPARTMENT OF BUILDING'AND SAFETY APPLICATION CERTIFICATE ,COUNTY OF.RIVERSIDE. N y r PERMIT *# Effectivd 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: 'r print'cr type .and sign -below;. LICENSED CONTRACTORS DECLARATION I hereby affirm'that I am licensed under provisions of Chapter 9 (commencing wi•th�Section 7000) of Division 3 of the -Business -and Professions Code and my license is in full,force and effect. License Class License No7 _ Date i -P Contractor Q OWNER -BUILDER DECLARATION " I hereby affirm that I am.exempt from'the Contractor's License Law for the following reaso s:1 [� 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;'6.&P.C.). lJ 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 -Workers' Com pensation,Insurance, or -a certified copy thereof"(Sec. 3800, Lab. Code). Policy No. Insurance c*Vr7Mn;.r rg.r _. 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 - .fx (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 thispermit shall be deemed -revoked: � Date'- QE) Applicant (.✓: �°: r'".» 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 t Lender's Address Z.. DIVISION OF INDUSTRIAL'.SAFETY PERMIT CERTIFICATIONS 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.) 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. t �, �] 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 rel�ting'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 applied for this permit•for.the purpose of making inspections. Signature of Applicant/Agent -- r. -._. Date r Print Applicant/ gent Name.`. t, 284'2000 1 7/80 M s BUILDING PERMIT PERMIT NO. PERMIT NO. Jo�Address 54785 DEPARTMENT OF BUILDING & SAFETY X117^7% 403167 T ": f�1 ,t . FIELD DST . _ Commun y' {, Valuation S ba '�' �a ,. f T� COUNTY. OF..RIVERSIDE ; an se of Pe d ,P� D s LUNG AND T ATT1i' 4ARAG p 403-167 Mech. Fee Dbl S PI. Ck. Fee S ," 9�t ck F S S R Lot Sire M Construction Fee Dal S Legal Description it EWA CONSTRUCTI E A ,y NO. ELECTRICAL FEES NO. PLUMBING FEES /r �y �/ ,�{ ry SC Y LQ rf28 ' 1ST FL. ��":SO. FT. @ $ e 4-00 T. UNITS 2ND. FL. SO. FT. @ t4 l f Plumbing Fee Dist $ F YARD SPKLR SYSTEM Plan No. POR. SO. FT. @ 4fA T MOBILEHOME SVC. BAR SINK - GAR. 39C)SO. FT. @ h cam. POWER OUTLET ROOF DRAINS CAR P. SO. FT. @ 2 f u 1 '• DRAINAGE PIPING [Unit"} WALL SO. FT. @ Const. Lender - Branch DRINKING FOUNTAIN y SO. FT.. @ 4 Address s City Zip''���" URINAL r.. r ` ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING Reinsp. Fee $ Owner/Agent { Zip Total Fees - is d ress 'nOX 1A0A. i y`" Y M. 7S h'10,r. Zip ' M.O. aN,C.(3 Cash ❑ Check ` 1 Received by .r � f .,. f Contractor reL. _. Ucensett Trees required � Sewage System, 1�i Address _ City Zip �� LL p THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: Sewer District _ FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. 1 HEREBY AGREE THAT ALL: WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH t' THE LAWS OF RIVERSIDE COUNI'WAND THENATE OF CALIFORNIA. �I HEREBY CERTIFY THAT T4E `s 46IVMU61L VY,40, PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN' ?' Form 284.208 (Rev. 1/80) }ACCORDANCE, WITH SECTION,6541 OF THE.:USINBS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. r- Nei. ' r t6' OPERATION PATE INSP€CTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs 8 Frms 2Z� 34 Plenums & Ducts —� V 2A Slab Grade ZZ 35 Furnace Comport. 3 Steel 36 Inlets 8 Outlets Z� _ 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck (a. 7 .- 6 39 Appl. Clearance 7 Framing _ ��'J) o 40 Fire Damper 8 Vents 41 Smoke Detection Device �3- 9 Garage Fire Wall �_ _ S V 42 Commercial Hood 10 Fireplace P.L. 43 Final t� 10A Fireplace T. 0. °o ------------------,-----------------____ ADDITIONAL INFORMATION . ._. SEWAGE SYSTEM & LOCATION 11 Exterior Lath ;*. QQk 12 Internal Loth 12A Drywall 12 13 Finish Grade INSULATION Thick R Value 7A Watts (Batts)"nn�'`~"�- 12B Ceiling (Batts) l�/--- 12C Ceiling (Blown) 14 Final r3 $) ------ 15 Ground Plumb 16 Water Piping 17 Rough Plumb ��11 18 Vents 19 Sewage Disposal i'IryQ� 20 Sewer 21 Water Heater 22 Wafer Softener 23 Water Service Z-3—Ft 24 Gas Test 25 Final 2_ _ $ ,/SIZE Tank 2 Pit K L. Line REAR OF PROPERTY LINE P/L P/ �t ELECTRICAL APPROVALS 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring /, 29A Grounding Wire 298 Bonding 30 Fixtures 3 �- 31 ;Service lY 32 Final C w z 3 O at-* o � cc = W LL J Q N m 06 a8 f- a z "' zC Q Q J O a= 0 z z~ za Q W J � IL APPLICATION FOR TREE PLANTING I (we), the undersigned, hereby certify and acknowledge that I (we) Vave read the application and agree that if trees are required under River- side County Ordinance No. 457, the applicant agrees to install soid�s prior to final inspection. It is understood that no final insP�ction will be given until said requirements have been met or exception has bean granted by the County. Now, therefore, it is agreed that the prop- erty owner shall cause the property lines to be surveyed in the event no survey stakes can be found. Further; it is agreed that the County of Riverside shall assume no responsibility should trees have to be removed due to lot line errors. Owners Name 01 A B.itAin. Permit^No 03/67 Mailing Address CitylhlSta e ` Zip Job Address munity t 0. Legal Description V—'_2 Assessor's Map, Book & Page ! �r ` —L� SSD 1� Type Structure_�AU44, Type of Soil SIs water availableRoad Dept. Plot Plan No. Type of existing trees in road right—of— Trees preferred by applicant ( 1) / ` ✓� e (2) �w"��y'}-'/ (3) Date a—�.F 1jq 6 Owner's Signature Planning Commission Case No. -ROAD DEPARTMENT APPROVAL Approved species Wa.shingtonia filifera. (California fan palm) Number of trees 1 Spacing of trees Distance from lot lines: Ffont 2' in R/W Side Additional requirements Per plot plan on reverse, No street trees will be planted within 10' of driveways. Date Building and Safety notified- 9/80 Signature REQUEST FOR EXCEPTION Reason (attach additional page if necessary) Request for hearing: YES ❑ ' Owner's Signature (Forward application to Planning Dept, if exception requested) . Planning Dept. Concur Non-concu Date Road Dept. NO REQUEST FOR HEARING r M Explanation _ Signature Concur Non -Concur ❑ Date Signature REQUEST FOR HEARING AND COMMITTEE DECISION Date hearing established Dote hearing notice mailed to owner Approved M Disapproved F-1 Date Owner notified of decision ' Date Building & Safety notified, Signature �. DEPARTMENT OF BUILDING AND SAFETY APPLICATION,CERTIFICATE COUNTY OF RIVERSIDE PERMIT N 4n � / (4"? 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. Q 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 Q OWNER -BUILDER DECLARATION I herebyyaffirm 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 y 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.). Q 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: y- to Date _S,644_ o)- 1 9(O 0 Owner �,/A_ 0 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 Q Certified copy is hereby furnished. Certified copy is filed with the County of Riverside, Department of Building and Safety. Date Applicant Q 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 Q" 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.) 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. [] Division of Industrial Safety Permit No. /i Date _].•�1 9- Applicant _ wv� it//7I.�.✓s.�v�.� %NA�+�/%� ///� 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- pert�fp�h��have ap"plied for permit for the purpose of making, inspections. / ?�� Signature of AFp7)Ac%//aant/Agent Date � ¢ Print Applicant/Agent Name 284-2000 7/80 DEPARTMENT OF . BUILDI.NG,,.AND SAFETY COUNTY -OF ,RIVERSIDE OWNER -BUILDER VERIFICATION _;',Pwne D E b 11! e i Nl: L 4 W Address ,.,,.,,,,,,An."owner-builder" building permit has been applied for in your name and bearing Cr 91.yourgIs-ignature. C P I -I LQ b C, Eaq JC 9, f P ;3,J -,4:2G Cow," J6*C- nUcC;) it Please complete and returni this informatfon in the envelope provided. - at your cogs -a earl iest(,,o,pportun- ,i,ty�to,,avoid�unnecessa,ryr�delaycl.,piproc-es.s,ing -and issuing your J!jlr_Ll�illbui-ldingnpermi,t,.�-�,rNo:'bu - i 1 di- I ng . permit iwi:l I ube -i ssuedgun t i'A­ih i's -verifi-cati on received.. 3 IN personally p an to pro v'ide 'the* majbr17,labor`a`6d iffatehals,lftr)con-'-, q"k uc on of t DW! •d t' JJm'p'r­6eff16nt`.(,�es r str ii hepro�?seproper,y , J? "I 2'. I,(have/have not). signed an application for building permit "for .,the pr6 posed.,Work 0 ,of: �-Le 4,10) aLiz JQr *1 3. 1 have contracted with the following person (firm)" to proVide the pro-'­ i4L +"j v;cposed ,construction: ?�UC k. r 4 1- 101 Nane t, Wi, )Phone.,. !jol.6 .2 1. j " � -'t&. 4 , , Address '-41 , Contractors License No. 4Cs. -4) "4. '-'1 'p'l'a'n 'io p'ro'v' i de" por'ti ons 'of the 'w4o'r 'I have hi red' t e -folloWfng per5_on,to,coordinate, supervise, and provide the major work:. 'M Ivf _ _- / t) .4 Ua� L?vL lt.iu, t I q12vp1 jirj� Name.� inti. J UC I VC1. 0 6A) LA.'Wl S., Ph'pne qfr, P y m 1 -4,, Ad d re s s 46,. 4 f L-A i e :,r NF2 LGCtti; Contractors License No. k. _.JJ LJC 'It S+JF�L' NC0 ..A!A �G 91J 6WD.10A.,L' 5_.'' _V'will"-pr60de`�6m6 of th-el, work3but J- have'4'cbnt-.rac-ted-.,(hi're'd) ­,thd),fo�l`:< :?i s Flowing tper's67hslfto4p rbvi d6l:thel, Woirkhihdi &tdd �14 '13 t3y r L -j C�- t C�, I U L,..• 0GU64, 4 rAd8re!is P one-"- - `-,Type. of work .J.1 'UP -W '10LK " tQ j ! Ot NCi L40f12 �L cGA; G 1! re4iqiv L u u. n I J vtoxii;Je '6vj. '...14cp 1.�5A 300Jf.. ip.ti,!: r. zo i,Gu;1 1 :1bq P,\ 91' 1. C g,,,G c,,' -­,u,� b;,Q­`)r�i,i:'1, Stgna.ture tial�lbr �ope-rtyz;uwner , �, "C, 1,0c' V"') "UMA G S Date DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE OWNER -BUILDER INFORMATION 'Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of re- cord on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the pro- per permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and, where required, to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemploy- ment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. i For more specific information about your obligati -ons under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner - builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, DEPARTMENT OF BUILDING AND SAFETY Leopoldo Rojo, Jr. Director 284-x'001 7/80 ✓