354152 (SPIN)..�.., .I .��......+F.�...� ...,,.. ..•+sem•. �+� �...�....?ews.-arrw�:.s aa�vw.rc a�.�. ar+�+s��:��eaa:-.�:swrswe�e�r=mss
NOTICE TO APPLICANT
! In, conformity with the provisions of State of California Lab, Code Section 3800, the applicant shall have,on fileor file with the Riverside County
Department of Building and Safety a certificate as designated in Items I or II below, or shall indicate Item III, IV; or V, whichever is applicable.
CERTIFICATE OF APPLICANT `
Please mark the appropriate Block: , - ' • -
t
❑ 1. Certificate of Consent to self-insuie issued by the Director of Industrial Relations.
❑ Copy on file ❑ Copy submitted
❑ II. Certificate of Workers' Compensation Insurance issued by an admitted insurer. ,
P it { ❑ Copy on'file•• ...,,, . 0 Copy submitted . > ,.. , a ..- ,.:r..,.»; .+. ._ -. , •t �,
t r ❑ III. The cost of the work_to be performed is $100 or less.
r r
(t �' ❑ IV. 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 •
r subject to the Workers' Compensation laws of California. I further certify that, in the event I become subject to the Workers' Compensa-
tion provisions of the Labor Code that I will comply forthwith with the provisions of Labor Code Section 3700, et seq., and understand
that, if I do not comply, the permit shall be deemed revoked..
❑ V. I certify as the owner (or the agent of the owner) that. in the performance of the work for which this permit is issued
I hove engaged
contractor. (Contractor must have on file, or submit certificate required by I or II above.)
Applicant's Signature
,J ; Date
Address and location where work is to be performed
_Permit No.
284-141 Rev. 6/77
y� '.IBUILDING PERMIT -
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
354152 COUNTY OF RIVERSIDE _ . .
r
FIELD os•
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Owner
UNITS
Valuation
$
IST FL. SQ. FT. @
Dist
Off.
2ND. FL. SQ. FT. @
- -
YARD SPKLR SYSTEM
Use of Permit fJ/ ``++��
��� / r ✓�/"'� / ti' /t�"�/ / � r
•
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT- @
_
PI. Ck. Fee $
6AR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
+t
S S
DRAINAGE PIPING
'! CARP. SQ. FT. @
Zo^e Restrictions
/le -%
L WALL SQ. FT. @
SMI Fee $
DRINKING FOUNTAIN
"
Plan No.
URINAL
SQ. FT. @
Inspector
Unit
ESTIMATED CONSTRUCTION VALUATION
Demol. Fee $
WATER PIPING
wj NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
f MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Address. • . - • * . • _�,
Al"
GARBAGE DISPOSAL
FURNACE UNIT WALL fLOORII"0- SUSPENDED•%
'° "' xN.yl�t' "� � `""
s'�'LAUNDRYTRAY `� ".•:
AIR HANDLING UNIT CFM - j
IDLE METER
KITCHEN SINK
ABS 1RPTION 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
SQ. FT. @ c
WATER HEATER
S0. FT. RESID 611/44 _
SEWAGE DISPOSAL
SO. FT. GAR @ 31, 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 fi•• ti FEE PLUMB. FEE..,
(
/c
iv �✓
PERMIT NO,
j
3 5 415 2
Job Address space Zip
-�� - .�.� �. r.��.���•,..,.t.� �
Owner
Community
�f / '-" r!/r./�N
Valuation
$
Date /(f
Z/ _ /,r
Dist
Off.
F.C.C.
,MH.Permit Fee $
Micro Film Fee Cop $
Use of Permit fJ/ ``++��
��� / r ✓�/"'� / ti' /t�"�/ / � r
•
Parcel No. �+
! J ' -j"73, --
Use/Case No.
Ck. By
Mech. Fee Dial $
PI. Ck. Fee $
Set Backsr1ro-p
Lot Size
Construction Fee Dbl $Electrical
Lego[ Description F
J� /./ je �/� �r
t- 7�
S S
Fee Dbl $
Zo^e Restrictions
/le -%
Type
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
Final Date
4 '�
Inspector
Unit
Sp. Insp. Fee $
Demol. Fee $
Const. Lender + Branch
ntal Permit Numbers
Registr. Fee
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agen� /. ��. - ✓�
arc/✓
Tel. - Zip
J4 %
Total Fees $ �,• 'L)•
Address. • . - • * . • _�,
Al"
_City . , r .. .. ,... Zip. , ..
+ M.O. 'N.C. 171 Cosh rl Che
Received by -
Contractor
Tel.
License#
Trees required'
Sr eviage System
Address
,
City Zip
T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
Sewer District FOR 120 DAYS SHALL ALSO T TO,ECOME VOID.
I HEREBY AGREE THAT ALK INC NECTIrONWI�TH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
i - THE LAWS OF RIVERSIDE COUNTY AND HE STATE OF CALIFORNIA.
+ �l�
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PIANS AND SPECIFICATIONS HAS DONE SO IN
`t �� +• ACCORDANCE WITH'SECTI0N-5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF EAtIFORNIA.'- '
Form 284.208(Rev.8/78) t
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 L
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. C]
43 Final
IDA
Fireplace T. 0. C]
No
_
ADDITIONAL INFORMATION
-
.. .. r .«
/
- - -
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth -
12 Internal Lath
12A Drywall
13 Finish Grade
- .INSULATION.. Thick Vague ... . _. p
7A Walls (Botts)
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.
'-
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A •Grounding Wire
29B Bonding
30 Fixtures
31 ' Service
32 Final
STREET NAME
I