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418216 (RER) SupplementalPERMIT NO. DEPARTMENT OF BUILDING & SAFETY 416 2161 COUNTY OF RIVERSIDE FIELD CONSTRUCTION TI EXI5TI N3 DWLG NO. ELECTRICAL FEES NO, PLUMBING FEES IST FL. 2ND. FL. r POR. GAR. CAR P. WALL ESTIMATED CONS RUCTION SQ. FT. @p3.4 $ Cop S UNITS Dbl $ $ Dbl $ Dbl $ $ je 5-3.0 SQ. FT. @ YARD SPKLR SYSTEM jIn .. j MOBILEHOME SVC. SQ. FT. @ BAR SINK POWER OUTLET SQ. FT. @ ROOF DRAINS 2 SQ. FT. @ DRAINAGE PIPING ' SQ. FT. @ DRINKING FOUNTAIN SQ. FT. @URINAL $ VALUATION d WATER PIPING r NOTE: Not to be used as property tax valuation W" 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 0Cv FURNACE UNIT WALL FLOOR SUSPENDED R' LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET4 11 COMPRESSOR POLE,TEMP/PERM LAVATORY A PW 3*e2HP HEATING SYSTEM FORCED "GRAVITY AMPERES SERV ENT SHOWER r' w BOILER B.T.U. oL SQ. FT. @ t BATH TUB y SQ. FT. @ c WATER HEATER SQ. FT. RESID @1'/.c SEWAGE DISPOSAL SQ. FT. GAR @ 3%c HOUSE SEWER GAS PIPING PERMIT FEE _ PERMIT FEE PERMIT fEE DBL. TOTAL FEES MOB.HM.FEE MICRO FEE MEL•' �lf w PL. CK. FEE w I CONST. FEE ELE M ' SMI FEE FEE Sewer District A' Form 284-208 (Rev.8/78) ©s w • +. v v yr . v Y Y i • Y• a A.. - o 11 11 Job Address 49035 Space Zip Owner + !\ n MOLE tr n" fn Community Valuation Date S MODEL EXI5TI N3 DWLG d PERMIT NO. 41 82 MH Permit Fee s Micro Film Fee Cop S Mech. Fee PI. Ck. Fee Construction Fee I Electrical Fee SMI Fee Dbl $ $ Dbl $ Dbl $ $ Plumbing Fee Dbl $ Sp. Insp. Fee f Demol. Fee $ Registr. Fee f Mileage Fee $ Witness Fee $ Reinsp. Fee f Total Fees M.O. 0 N.C. $ Cash Received by Trees Sewage System T LL P Sewer District A' Form 284-208 (Rev.8/78) ©s w • +. v v yr . v Y Y i • Y• a A.. - o 11 11 Job Address 49035 Space Zip Owner + !\ n MOLE tr n" fn Community Valuation Date S MODEL EXI5TI N3 DWLG Legal Description F )AR 3 RS 5.0/43 Bond Amt. Plan No. Plan Checker I! $ Const. Lender Branch Address City Zip / Owner/Agent 4; -& Supplimental Permit Numbers RB0418216 Tel. Lot R .•t r Wss m dff. 1 F.C.C. Licenseif Zip Zip AddressI City Zip I ' 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. b�CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN T 44'' DANCE 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 Set Back 33 Ventilation System Ftgs 8 Frms 34 Plenums 8 Ducts r' 1 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.O. No ADDITIONAL INFORMATION rypt��� �,+ ` , �'� / --------'•------------------. ' SEWAGE SYSTEM SIZE & LOCATION 11 Exterior lath g✓/ _ 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION ,.R., Thick Value (07A Walls (Botta) 3 �` 12B Ceiling j8atse/ t 12C Ceiling (Blown) 14 1 Final PLUMBING APPROVALS - Ground Plumb 16 Water Piping 318 17 Rough Plumb 7 /3- 18Vents 19 Sewage L`ispe4,eP4 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank �Pit� / l L.Line p/L REAR OF PROPERTY LINE % ELECTRICAL APPROVALS 2if(GY� VV _ w91 �t p� O 9' 26 Power Pole 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 N Effective July 1, 1980, Chapter 1301 Section 19825'of the Nealth 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 7000) of Division 3 of the Business and Professions Code and my license is in full force and effect. License Class Aj ^ �_ License No. Date A' , i .ACU , IL, X i Contractory,'1A , i Q 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.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). Q I am exempt under Section , B.&P.C. for this reason: Date Owner M WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers' CompensationInsurance, or a certified copy thereof'(Sec. 3800, Lab. Code). Policy No. /."! � _ x'31;),<--.2- Insurance �A_iel l-!� ✓,nn �. /r' G4 C1 ` Lc G C-�'��"� 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 (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 bedeemedrevoked. ���� Date I a� �/C Applicant Y�•e/%��. 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 i6 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. 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 which I�h/ave applied for this permit for the purpose of making inspections. �1 Nt +V � / /' Y" I 1 I I Si,gnaturre of pp scant/, gent' Date �I ZX a �, f�-,� �„ U r nt Applicant/ gent Name X 284-2000 7/80 NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT i APPLICATION TO CONSTRUCT Permit No DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE /I 284 199 9/74 CANARY—FILE, PINK—APPLICANT Owner `&isl Architect Contractor�C Lam^ ( 2 �1 Address 7 J (441CAddress ► / Address_ 't 4 � City � C, t City City vti t 6_ -'1 Phone Phone Phone 01W 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 en:roachment 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 of the Countyofof Riverside and the State of California governing said proper �la,%ws , DATE ^-"'\ / v I SIGNATURE OF OWNER AND/OR AGENT� 'f kef_� Approval by Signature from the Following Departments Listed Belo Must_,B�Obtained Prior to the Issuing of a Construction Permit. 1 SPACE NO. r I USE OF STRUCTURE � � � ��Os JOB ADDRESS `� IiC"r SINGLE FAMILY DUPLEX ��� _�/v `O v E� LEGAL ESCRI'PTION OF PROPERTY APARTMENTS E] AGRIC. [l N HCOMMUNITY COMMERCIAL 0 INDUSTRIAL ❑ > O Z „� o - L` G LTERATIONS n NO. OF SUBMITTED PLANS — _ USE OF PERMIT C 1%`= „(1c� 4 CASE NO. p Z NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING -- ZONE e—'01 tETBACKS: FRONT SIDE `� REAR J m GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE SETBACK ORDINANCE ri __— OF FEET REQUIRED ON STREET DATE____ SIGNATURE OF LAND USE OFFICIAL75<' F DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___ CURB AND GUTTER REQUIRED: YES ❑ NO ❑ _STREET - 01t d CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET O AIMPROVEMENT? YES ❑ NO ❑ 01 °L DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL fSr. At/Eu.400/2r;RCnsoobc PW5L[ ' rF 4qm. iY►4,e ala" rEBe+4� ./6 - �� s IC ' Rt=.�+aoEc F� . = 7 W SEWAGE DISPOSAL4,9,o �� b J� �n S�l� E ECswZMZ7 n/ i_a/E _F vT If 6N.✓E C Ek/ 7- 5&A77C X I Zoas t S•YSr. t/ ZB 10thl ICV. 49t.06. DZ,4- 1 4Sd eoa0,i�oNntA-?PMEA4: 599.077�•TA+�-A'KS* E�Llii+PEf ` //-/0-67 WATER POLLUTION REMARKS ICI&Att Pn FLOOD CONTROL— z AIR POLLUTION W DIV OF HWY ~ oQ YOUR PROPERTY MAY BE SUBJECT TO — d o FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199 9/74 CANARY—FILE, PINK—APPLICANT PERMIT PERMIT NO. PERMIT NO.DEPARTMENT Space Zip OF BUILDING & SAFETY FIELD OFFICE Q U216 a COUNTY OF RIVERSIDE 1 FDST CONSTRUCTION TIM8, is NO. ELECTRICAL FEES NO. PLUMBING FEES Dist. Off. F.C.C. MH. Permit Fee UNITS IST FL. SQ. FT. @ $ agoQ 2ND. Fl. SQ. FT. @ Cop $ se of rmt YARD SPKLR SYSTEM Farce No. MOBILEHOME SVC. BAR SINK POR. SQ. FT. @ EMO t\t,t 'C XI S TI O DW (t 7 �I.tion Cr i1 d ,i ■ v 3 ,r„ GAR. SQ. FT. @ $ : POWER OUTLET ROOF DRAINS CAR P. SQ. FT. @ Set Backs Lot Size DRAINAGE PIPING WALL SQ. FT. @ Legal Description e DRINKING FOUNTAIN SQ. FT. @ Electrical Fee Dbl $ URINAL ESTIMATED CONSTRUCTION VALUATIONWATER Zone Restrictions Group Type 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 i HOOD i i zo SIGN WASHER (AUTO)(DISH) APPLIANCE r DRYER InspectorL Unit 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 SVCWATER CLOSET COMPRESSOR HP Supplimental Permit Numbers POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY _ AMPERES SERV ENT SHOWER BOILER B.T.U. Mileage Fee $ Address City Zip SQ. FT. @ c BATH TUB 2 54— �� j[' i(/ SQ. FT. @ c WATER HEATER ,// syr• Witness Fee SQ. FT. RESID @1'/.c SEWAGE DISPOSAL !t`� c.t, i. t•-•�+-��., SQ. FT. GAR @ s/. c HOUSE SEWER Reinsp. Fee $ 0-ner/Agenit GAS PIPING PERMIT FEE Tel. 01 PERMIT FEE PERMIT FEE DBL. TOTAL FEES MOB. HM. FEE MICRO FEE ME PL. CK. FEE CONST. FEE ELE SMI FEE FEE PLUMB. G.2 T T Received b 19 17 Ix /�071 Contractor PERMIT NO. Job Address35 Space Zip Owner 1 4182 161OS CIRCLE Community Valuation Date Dist. Off. F.C.C. MH. Permit Fee $ $ agoQ Micro Film Fee Cop $ se of rmt Farce No. se/Cose o. Ck. By Mech. Fee Dbl $ EMO t\t,t 'C XI S TI O DW (t 7 �I.tion Cr i1 d ,i ■ v 3 ,r„ PI. Ck. Fee $ : gal •� .4 ,1J •RJ Set Backs Lot Size Construction Fee Dbl S Legal Description e F 5 5 R Electrical Fee Dbl $ 0 r! RS i1 J 91 (/ ff U 50 /43 Zone Restrictions Group Type SMI Fee $ Plumbing Fee Dbl S Bond Amt. Plan No. Plan/Che ker final Date InspectorL Unit Sp. Insp. Fee f $ GtjLi 7-x.2 _ Demol. Fee $ Const. Lender Branch" Supplimental Permit Numbers Registr. Fee $ ` 41826 110 AS7 TJ V Mileage Fee $ Address City Zip �� j[' i(/ L� /+1 ,// syr• Witness Fee E i t: !t`� c.t, i. t•-•�+-��., 7' / it► +w' Reinsp. Fee $ 0-ner/Agenit Tel. Zip Total Fees Is Address Zip M.O. N.C. ,gig n C.shn Check G.2 T T Received b Contractor Tel. License# trees re9d Od ie -age System Address Ci ry 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 CAUSE PERMIT TO BECOME VOID. da S 'Y�+► r I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH r THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. ERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN arm 284-208 (Rev. B/78) ©s DANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. F verified by: