403478 (BLCK)BUILDING PERMIT
PERMIT No. DEPARTMENT OF BUILDING & SAFETY FIELD DST
0 3P'"
7 8 COUNTY OF RIVERSIDE
Fi /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT..@ $
UNITS
MH Permit Fee
SO. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. 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
VEM SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Demol. Fee E
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
Receive by 1'..•,..
SO. FT. @ a
WATER HEATER
S0. FT. RESID @11/4c
SEWAGE DISPOSAL
Trees requir
S0. FT. GAR @ s/.a
HOUSE SEWER
Is ` \ s,
City Zip
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
�j
il—
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FFEEEy ELECT. FEE
/
SMI FEE
FEE PLUMB. FEE
p—,
PERMIT NO.
403478z
Job Address
Ca
/
u t
Space Zip Owner
1,41
Dot t. ff. F.C.C.
MH Permit Fee
Micro Film Fee Cop E
Use of •Per it
t
Parcel No. Use/Cos Ck. By
SEt cks Lot Sire
Mach. Fee Dbl E
PI. Ck. Fee E
Construction Fee Dbl E
Electrical Fee Dbl E J
lege ipi*41—jt
nom,...
f'F
V
4�,�
Zone RestrictionsGroup
Type
SMI Fee E
Plumbing Fee Dbl E
Bond'A-AT. I
E
Plan N
Plan Z+eikWrl
Final Da
Gl > ' d
InWqor
or
Unit
Sp. Insp. Fee E
Demol. Fee E
Const. Lender
Branch
Supplimentol Permit Numbers -
� ..
Registr. Fee E
Mileage Fee S
Address City Zip
'
Witness Fee S
Reinsp. Fee S
Owner/Agent
Tel. Zip
Total Fees S
M.O.0 N.C.Q. Cash ck
Address
City Zip
Receive by 1'..•,..
;�""�•,,.
Tel.
i
License#
Trees requir
Sewage System
Address
Is ` \ s,
City Zip
,
T W- P THIS P MI'T'Si1A 8EC0 ID I RK IS NOT COMMENCED THIN 120 D YS C 01F WORK
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
v THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
% _ ` �j, I REB CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Firm 28e•208 (`Re�v.�l/80) ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by:
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1Set
I Back
33
Ventilation System
2
t Ftgs 8 Frms
34
Plenums 8 Ducts
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.
No
___ _
ADDITIONAL INFORMATION
-_ __,
____..__. __ __ _ _ __ _ ---------
SEWAGE SYSTEM SIZE & LOCATION
11 '', Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final L �(
_ ,P_LUMBING_APPROVALS__
15
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
P/
—�
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
i i i _j STREET NAME
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
Owner-4)"ID l.(%t !_ v c K V ontractor—_
ddress_ — --
Address _—_ Address7_/ S^Q LB ,'Address--
city
City City��_��� City___----
Phone Phone�70���3 c� _ 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 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 property to be occupied until I (we) have
complied with
�all slaws of the County of Riverside and the State of California governing said property.
DATE _/ pl_._� _� SIGNATURE OF OWNER AND/OR AGENT _
Approval by Signature from the Following Departments Listed Below P
Must Be Obtained Prior to the Issuing of a Construction Permit.
�^7 PACE N0.
J �
/ USE OF STRUCTURE
JOB ADDRESS —_! D�
� _ AIMILY DUPLEX
LEGAL DESCRIPTION OF PROPERTY7 ^ — APARTMENTS AGRIC.
O t-
— //
—der—
Z'
COMMERCIAL INDUSTRIAL
G'^
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COMMUNITY .
ALTERATIONS ❑
Z
NO. OF SUBMITTED PLANS USE OF PERMIT
N Q
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING --
�
Q
ZONE/ ! SETBACKS: FRONT SIDE REAR
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m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBAC RDINANCE # OF FEET REQUIRED ON STREET
DATE — SIGNATURE OF LAND USE OFFICIAL —_
F,
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET—
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET.
h
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
O
C
IMPROVEMENT? YES ❑ NO ❑
°L
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
Z
SWIMMING POOLS PUBLIC
Q CL
SEWAGE OISPOSAL
su
FOOD ESTABLISHMENT
_
WATER POLLUTION _ REMARKS
FLOOD CONTROL—
z AIR POLLUTION
� W
_ DIV OF HWY
c a — YOUR PROPERTY MAY BE SUBJECT TO
0
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301, Section 19825 of the Health and Safety Code requires the execu- 1=
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 7000) of
Division 3 of the Business and Professions Code and my license is in full force and effect.
License Class C — 112 % License No. 40- ,,20F.0
Date 4. y -4_ k Contractor eVkyii/ A x=/-Aic.4 C0
0 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 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.).
[:1 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'
Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. Code).
Policy No./D/— "%'/,p 9/,1r/ — _-Z. Insurancej&l� 7-A (.lJeO <7',
Q Certified copy is hereby furnished.
® Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date ,9- 7 P o 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
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.)
Q 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.
[7 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 for wh/icFi I`haav''e applied for this permit for the purpose of making inspections.
Qv:�L —/ice✓ (�Gl/!/J/ 9 7.3-RO
$Fgnature bf pp is ht gent Date
Print Applicant/Agent/Name
284-2000 7/80
.f BUILDING PERMIT
PERMIT NO. '
03478
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE DST
COUNTY OF RIVERSIDE
7D
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. .@' $
UNITS
SO. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOSILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SO. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax voluotion
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE ` DRYER
Use/Cas No.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
PI. Ck. Fee S
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR His
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER.
BOILER B.T:U.
SO. FT. @ a
BATH TUB
SQ. FT. @ a
WATER HEATER
SMI Fee S
S0. FT. RESID @ 1 t/.a
SEWAGE DISPOSAL
Pion No.
S0, FT. GAR @ t/aa
HOUSE SEWER
Final Dote
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
An
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
I CONST. FEE , ELECT. FEE
�Ci
SMI FEE
FEE PLUMB. FEE
I—
PERMIT NO.
403478
Job Address
Space
Zip Owner
1
Co iDate
if.
F.C.C.
t
7r.ati;n'
-r
MH Permit Fee S
Micro Film Fee Cop S
Use of Permit
IN _
Parcel No.
r
Use/Cas No.
Ck. By
Mech. Fee Dist 4
PI. Ck. Fee S
bet Bocks
Lot Size
F
S 5
R
Construction Fee Dist S
Legal a 'Pt,
P
dz)
Zone Restric'
s
'
Group
1
Type
Electrical Fee Dist S
""�
SMI Fee S
Plumbing Fee Dist S
Bond mt. I
Pion No.
Pion C ecker I
Final Dote
Inspector
Unit
3'_51
c
Sp. Insp. Fee
S
S
L!/
Demol. Fee S
Const. Lender
Branch
Supplimantol
Permit Numbers
Registr. Fee S .
Mileage Fee S
Address City Zip
Witness Fee $
Reinsp. Fee S
Owner/Agent
Tel.
Zip
Total Fees S
Address .
`�
City
Zip
.C. Cash C ck
.O. �, N11�
1
Received y
C r
" /'
Tel.
License#
Trees
d
r/ ^
req.ir¢
I . .
Sewage System
,
Address
52C
City
Zip
!� N —
��
lel�
T " _ / t P THIS.PERMIT SHALL BECOMI WD I�NbRK IS NOT COMMENCED WITHIN 120 DAYS,. CESIFA 0 F WORK verified by:
Sewer District FOR 12Q -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
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
R'CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 -(Rev. 1/80) ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.