399286 (BLCK)BUILDING PERMIT ^;
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
9 9 2 8 6 COUNTY OF RIVERSIDE FIELD Dsr
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST Fl.
2ND. FL.
FOR.
GAR.
CAR P.
WAIL
ESTIMATED CONSTRUCTION
SO. FT. -@ $
UNITS
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. , @
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as 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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
SO. FT. RESID @1144
SEWAGE DISPOSAL
SO. FT. GAR @ t/<a
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
• V
PERMIT NO.
399286
MH Permit Fee $
Micro Film Fee Cop S
Mach. Fee Dbl S
Pl. Ck. Fee $
Construction Fee Dbl $
Electrical Fee Dbl $
SMI Fee $
Plumbing Fee Dial $
Sp. Insp. Fee $
Demol. Fee $
Registr. Fee ' $
Mileage Fee $
Witness Fee $
Reinsp. Fee $
Total Fees $
M.O. 11 N.C. n Cash n Check
Received by �.►�
Trees regeed;;;:�
Sewage System''✓"
T LL P
Sewer District
Form 284-208 (Rev. 1/80)
r
Job Address s
S
Space I Zip I Owner
Wins
is . F.C.C. -
Use of Permit Parcel No. Use/Case No. Ek. By
"16;;x' 140 w117 d fence, SiT Backs Lot Size
Legal Description F S
Zone Restrictions Group Type
lot 7 mlx-9� SCV 111 0-11
fi
Bond Amt. Pion No. Plon Checker ns Insp for Unit
Const. lender Branch r /Supplim;ntol Permit Numbers
Address City Zip
Tel. Zip
Amh Cit _ Zip
Star Route 8 L >,ata CA 92253
Contractor Tel. License#
Address City Zip
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.
^ 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.c
BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO INi�eJ,
CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
s3�
I- _
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS'
;MECHANICAL :APPROVALS
I
Set Bock
33
Ventilation System
2
Ftgs & Frms
-
34
Plenums 8 Docts t
�
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. 0.
[j
°O ADDITIONAL INFORMATION
. e
_
' `
`
v
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath s
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
.Value
7A Walls (Batts)
12B Ceiling (Botts)
12C Ceiling (Blown)
PLUMBING A ON ALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
f8 Vents
19 Sewage Disposal
20 Sewer
t
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
298 Bonding
30 Fixtures
31 Service
32 Final
)
STREET NAME
A
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATL,
COUNTY OF RIVERSIDE PERMIT 0
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 DECLAP,ATION
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
0IWNER-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 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:
Date %- $-to Owner.
C] WORKERS' COMPENSATION DECLARATION f
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
C7 Certified copy is hereby furnished.
Q Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' CO114PENSATION INSURANCE
(This section need not be completed if permit valuation is for $100.00 or less.)
'I certify that in the performance of the work for which this permit is issued. I shall not emplov
r any person in any manner so as to become subject to the ''Workers' Compensation laws of California.
I further understand that if after making this Certificate of Exemption, I should become subject to
• __ the Workers' Compensation provisions of the labor code, I must forthwith comply with such provisions
or this permit shall be deemed revoked.
Date Applicant
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. Code).
Lender's Name
I• Lender's Address
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
I hereby certify that no excavation five (5) or more feet in depth into which a person is re-
quired to descend, will be made in connection with work authorized by this permit, and that no
building, structure, scaffolding, falsework, or demolition or dismantling thereof, will be
more than thirty-six (36) feet high.
[� As owner -builder, I will not employ anyone to do work which would require a permit from the
Division of Industrial Safety, as noted above, unless such person has a permit to do such work
from that division.
Division of Industrial Safety Permit No.
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EIITRY
I certify I have read this application and state that the information given is correct. I agree to
comply with all state laws and county ordinances relating to building construction, and authorize a
representative of the County of Riverside, Department of Building and Safety to enter upon the pro-
perty for which I have ap lied for this permit for the purpose of making inspections.
%-$-&V
Signa re of Applic'aht/Alerky Date
vrinL i%ppiicant
284-2000 7/80
ti
so,
Owner Architect _ Contractor—
�b
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
%-., I ;.
' 1
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner Architect _ Contractor—
Add��a 4 re Address—
resp— ,—
dd
A 04
�
City Q� � . — -- 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
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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
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
4
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 7—� SIGNATURE OF OWNER AND/OR AGENT�� ��si
Approval by Signature from the Following Departments Listed elow
Must Be Obtained Prior to the Issuing of a Construction Permit.
iyn I SPACE N0.
I .USE OF STRUCTURE
JOB ADDRESS _, !/A7 rrSINGLE FAMILY DUPLEX
H
11 0
EG DESCRIPTION OF PROPERTY
Z
gLu
APARTMENTS AGRIC. 0
��______�_J_
a
—�C� --�F— COMMERCIAL INDUSTRIAL n
'^
CALTERATIONS
COMMUNITY G—
n
Z
NO. OF SUBMITTED PLANS — USE OF PERMIT %C
W Q
4A
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED — NO. OF BUILDINGS NOW EXISTING
Q _e
ZONE SETBACKS: FRONT SIDE REAR
J
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE -
SETBACK ORDINANCE OF FEET REQUIRED ON STREET
DATE _ SIGNATURE OF LAND USE OFFICI Aa
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_
w
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
oe
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
C
IMPROVEMENT? YES ❑ NO ❑
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
=
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
rn FLOOD CONTROL!
W AIR POLLUTION
DIV OF HWY
O ce
a _ - YOUR PROPERTY MAY BE SUBJECT TO
c FLOOD. RIVERSIDE COUNTY ASSUMES
_ NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
BUILDING PERMIT
PERMIT NO,
99286
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE DST
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. .@ $
-UNITS
Date
17-8-80
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $
WATER PIPING
:NOTE: Not to be used as 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
Plan Checker
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Sp. Insp. Fee S
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.
SO. FT. @ a
BATH TUB
Sewage Systems �
SO. FT. @ . a
WATER HEATER
S0. FT. RESID @ 1144
SEWAGE DISPOSAL
50. FT. GAR @ 3/4a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL:
TOTAL FEESMOB.
(�J
HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST, FEE ELECT. FEE
SMI FEE _F
FEE PLUMB. FEE
v
PERMIT NO.
399286
Job Address Space
-
Zip
Owner
CEJA aa�bR.
Community
TA QUIAMS
Valuation
Date
17-8-80
Dist.
11
Ofl.
F.C.C.
MH Permit Fee S
Micro Film Fee Cop S
Use of Permit
6 X 14o wood feAC6
Parcel No.
Q
Use/Gose No.
Ck. By
W
Mach. Fee Dbl S
Pl. Ck. Fee S
Set BacksLot
Size
Construction Fee Dbl S
r
Electrical Fee Dbl S
Legal Description
lo! % `ilk-/` WV UQ411
F S S
R
Zone Restrictions
R-1
Group
Type
SMI Fee S
Plumbing Fee Dbl S .
Bond Amt.
S
Plan No.
Plan Checker
Final Dote
RIO �
Inspe or Unit
e
Sp. Insp. Fee S
Demol. Fee $
Const. Lender Branch
Supplimentol Permit Numbe
-
Registr. Fee S
Mileage Fee S
Address / City Zip
Witness Fee S
Reinsp. Fee S
Agent` /` '
Air. ss -
1.
tar out* 12,028
Tel. Zip
City Zip
TA QuintM*CA 9M3
Total Fees S
M.O. ❑ N.C. Cash I] Check
Received by or I
Contractor
Tel.
License#
Trees reqs a �+
Sewage Systems �
Address
City Zip
T 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.
.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 BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284208 (Rev. 1/80) CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
1