403895 (ELEC)BUILDING PERMIT
PER+AIT NO- DEPARTMENT OF BUILDING t& SAFETY FIELD Dsr
1403895 COUNTY OF RIVERSIDE �
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL.
2ND FL.
POR
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT, @
SQ, FT. @
SO. FT, @
50. FT.
50. FT. @
SQ. FT. @
SQ. FT. [a7
VALUATION
$
_
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
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
i
-
j �-
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.
SQ. FT. @ c
BATH TUB
SQ, FT. @ c
WATER HEATER
S0. FT. RESID @ 1'/4c
SEWAGE DISPOSAL
SO. FT- GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MOB. HM. FEE
MICRO FEE
MECH FEE
PL CK FEE
I CONST FEE
ELECT FEE
SMI FEE
FEE
PLUMB FEE
PERMIT Np
Job Addr/is Space
Zip
Owner ~
Commonly
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Date
it
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MH Permit Fee
S
Micro Film Fee
Cop
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Parcel No llse.�Ctas� No. Ck. By
Mach Fee
Dbl
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PI. Ck. Fee
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Set Backs
Lot Size
Construction Fee
Db
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Electrical Fee
Dbl
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Zone Restrictions Group
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Type
SMI Fee
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Plumbing Fee
Dbl
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Bond Amt. Plan No,
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Plan Checker
Finol Date
/ / n / Z ^
Inspector _
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Unit
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Sp. Insp Fee
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Demol Fee
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Const Lender Branch
Suppllmnnlol Permit Numbers
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Regior. Fee
S
Mileage Fee
5
Address City Zip
Witness Fee
S
Reinsp. Fee
S
Owner/Agent
j
Tel, ZAP
Total Fees
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Received by
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Sewage System
Address
Giy 21P
r
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.
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-
f I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 (Rev. 1/80) DANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA,
verilied b!
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & 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.
°o
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
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
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring ! — I Z~
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
v
• STREET NAME
BUILDING PERMIT ,
PERMIT'NO.' DEPARTMENT OF BUILDING & SAFETY
COUNTYOFFICE - ..DST. r
403855
COUNTY OF RIVERSIDE
-CONSTRUCTION ESTIMATE
'NO. ELECTRICAL FEES
Job Address
70/ r
NO. ,PLUMBING FEES
IST FL.'
2ND. FL.
POR. •
GAR._
Y
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO.. FT. @ $
' UNITS
Community s'T/.��//1 p+1Q
4,fj- S..�i lP{,/ ! T �+ -
`
SO. FT. @ YARD SPKLR SYSTEM
Dote
/D ��,('�..
SO. FT. @ MOBILEHOME SVC.- BAR SINK
OFF.
SO. FT. @ - .POWER OUTLET ROOF DRAINS
MH Permit Fee' S
SO. FT. @' } DRAINAGE PIPING
.� -
SQ. FT. @ r + + • '. DRINKING FOUNTAIN
1 �
SO. FT. @ URINAL
Use/Case No.-Ck.
�1
� 7
VALUATION .$ •• - WATER PIPING
..yam'
Mech. Fee � Dbl 5
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
Lot Size
FLOOR DRAIN
• .6
MECHANICAL FEES-
SWIM POOL, COMM
F
WATER SOFTENER.
Electrical Fee Dist. S
VENT SYSTEM FAN EVAP. COOL - HOOD
SIGN -
Type
- WASHER (AUTO)(DISH)
+ `
APPLIANCE DRYER
Dbl $
Bond Amt.
S ' •.
GARBAGE DISPOSAL
"Plan Checker
,. _
FURNACE UNIT WALL FLOOR c. SUSPENDED
Fi•ol Date -
/-//� U �r
D
! • LAUNDRY .TRAY
AIR HANDLING UNIT a CFM
IDLE METER
$
KITCHEN SINK
'
ABSORPTION SYSTEM B.T.U.
,TEMP,USE PERMIT SVC -
Registr. Fee St
WATER CLOSET
Address , City Zip
COMPRESSOR HP
POLE, TEMP/PERM
S
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
t
SHOWER
'
BOILER B.T.U.
SO. FT. @ a
BATH TUB'
Zip-'-- '
s
f
`SO. FT. @ a
WATER HEATER _
t • -
•
S0. FT. RESID @ 1 t/aa
SEWAGE DISPOSAL
Sewope System
• • _
- S0. FT.'GAR @ 3/ea
.
HOUSE SEWER '
r
GAS PIPING -
PERMIT FEE ' .. -
t PERMIT FEE
PERMIT FEE
DBL.
[�TOTA,I FESS
MOB. HM. FEE
MICRO FEE
.MECH: FEE Pl. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
', FEE
PLUMB. FEE
• ,PERMIT NO.
4.03895
s
Job Address
70/ r
Space
.Zip
Owner -
Community s'T/.��//1 p+1Q
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MH Permit Fee' S
Micro Film Fee `
Cop S.
Use of Permit ", -
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1 �
Parcel No.
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C) �, (/,
Use/Case No.-Ck.
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By
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Mech. Fee � Dbl 5
PI' Ck. Fee.: S
- Set Backs
Lot Size
„
Construction Fee , Dbl S
Legal Description
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e
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F
S 5 R
Electrical Fee Dist. S
Zone Restrictions
Group
Type
SMI Fee S-
Plumbing Fee
Dbl $
Bond Amt.
S ' •.
Plan No.
"Plan Checker
,. _
Fi•ol Date -
/-//� U �r
_
Sp, Insp. Fee S.
Demol.•Fee
$
Const. Lender Branch.
Supplimentol Permit Numbers
- -•
s
r '
i
Registr. Fee St
Mileage Fee L S t
Address , City Zip
Witness Fee S. _
Reinsp. Fee
S
Owner/Agent
Tel. - - -
Zip'
Total Fees
S
Add
-
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City • - -
'
Zip-'-- '
s
M.O. N.0 Cash Q Chtscrjo•
Received by
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Sewope System
Address
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City '. Zip,
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T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK 3 verified by: .
Sewer District 4
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.' -
_ 1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IWACCORDANCE WITH / L
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA..
` •� �: f� % I HEREBY CERTIFY -THAT THE INDIVIDUAL WHO PREPARED THE -PLANS AND SPECIFICATIONS HAS DONE SO�119 -
Form 284.208 (Rev. I/80) j RDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS, CODE OF THE STATE OF CALIFORNIA. f
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT / V
Permit No
284 199A 9/74
10
CANARY—FILE, PINK—APPLICANT
Owner Architect— __ __-_
Contractor
��—�dress___ Address
��Address——
v1x)7� '
City—�/Q
City_-- Citv_a��'"` ✓� _
Phone- Phone _ Phone— ?�✓�_J�Z —..—__
oC
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 y to a oc ed it I ve
complied wizhi laws of the County of Riverside and the State of California governing said propert
dr 2_0 ���
DATE SIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments Listed Below
7
Must Be Obtained Prior to the Issuing of a Construction Permit.
9 Z 2 53 I SPACE NO.
p
�O ( J �N i USE OF STRUCTURE
JOB ADDRESS—_
V_7 O - Z'c% SINGLE FAMILY DUPLEX
Z W
LEGAL D SCRIPTION OF PROPERTY _—� - APARTMENTS AGRIC. �]
SS L���f^'rn GoCF� t S� /L9
0 Q
-- -O --- COMMERCIAL INDUSTRIALIL
COMMUNITY ALTERATIONS n
c
Z
NO. OF SUBMITTED PLANS - USE OF PERMIT
Lu
y
CASE N0.L�l�`�
Z
NO. OF P KIN SPACES REQUIRED _— — NO. OF BUILDINGS NOW EXISTING
Q 0
ZONE ETBA(fKS: FRONT SIDE REAR
J
m
— GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # -- OF FEET REQUIRED ON STREET
60
DATE SIGNATURE OF LAND USE OFFICIAL_ -
t-
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___ t
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
1
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES ❑ NO ❑
O
ce
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
Z
SWIMMING POOLS PUBLIC
J W
SEWAGE DISPOSAL
2
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
&n FLOOD CONTROL
t -
Z AIR POLLUTION
tu
I
= F DIV OF HWY
c a — YOUR PROPERTY MAY BE SUBJECT TO
a
UA FLOOD. RIVERSIDE COUNTY ASSUMES
.q NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74
10
CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
APPLICATION CERTIFICATE
PERMIT #
Effective July 1, 1980, Chapter 1301, Section 19825,of the Heilth 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 Licese No. 2 % Z Z
Date /� - a — $ O Contractor C, ✓✓i 5 " l -e & X /1 (.ew
Q OWNER -BUILDER DECLARATION
I hereby affirm that I amexempt 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;'8.&P.C.).
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B.&P.C.).
[:I I am exempt under Section
Date Owner
B.&P.C. for this reason:
[] WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Worker�s'
Compensation In/ /
Insurance, or a certified copy thereof'(Sec. 3800, Lab, Code). l/
Policy No. l lY .;5LI/ZO Insmrance
Certified copy is hereby furnished.
5;I' Certified copy is filed with the County 1Aof/ Riverside, Department of Building -and Safety.
Date I -IS 'q / Applicant IIIJI G -., 1 S E (-c C - � I ) A r M
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ��Ao, LV
(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
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 a
comply with all state laws and county or
representative-of"the Co'u ft of rvers
perty for wliic A have b pli r this
/
Signature of Applicant/Agent
yam• s ,� L
>srint App7icant/ gent Name
284-2000 7/80
to that the information given is correct. I agree to
e!r relating to building construction, and authorize a
artment of Building and Safety to enter upon the pro -
for the purpose of making inspections. r
Date
-e (.