403892 (SFD)BUILDING PERMIT
PERMfr NO. DEPARTMENT OF BUILDING & SAFETY FIELD
03892
COUNTY OF RIVERSIDE `
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO,
PLUMBING FEES
15T FL. 443
2ND. FL. AE'
POR.
GAR. 5 P j
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT..@. '" f �
SQ. FT. @
SO. FT. @
SQ. FT. @ 7
SO. FT. @
SQ. FT. .@
SQ. FT.
VALUATION
$
i
1510
UNITS
`•'
Cyrfl
&(AF P.r
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
�� ?
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
-
URINAL
•:
G I'i
$ .-};
p^ 7 r;
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 OOD
SIGN
WASHER (AUTO)(DISH)
r4i,
APPLIANCE DRYER
s
GARBAGE DISPOSAL
?
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
r
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVC
r,
WATER CLOSET
L1 -
COMPRESSOR i FV19 HP
,,
POLE, TEMP/PERM
C
LAVATORY
r
th
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
;;
^
r
SQ. FT. @ c
WATER HEATER
{:
7
4,jCjp0 FT RESID @ 1'/,a
�.
SEWAGE DISPOSAL
-
�n
Ct py 4{ SO FT. GAR @ 3/4a
q�
HOUSE SEWER
GAS PIPING
PERMIT FEE
r 4
PERMIT FEE
7
PERMIT FEE
:7)
DBL.L
TOTAL FEES MOB HM FEE
- '�Z ][
-3? .--
MICRO FEE
P.0
MECH FEE
F- -'k
PI CK FEE
CONST FEE
ELECT FEE
SMI FEE
FEE
PLUMB. FEE
PERMIT NO
403892
1a6 Address
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Legal Description
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Dbl
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Witness Fee
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Ow er/Agent
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Total Fees
I
§
'
Address
v 1 y 0 X
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M.O. ❑ N.G❑ Cash ❑ Check
Received by t
i
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T�{,
Licensee
7
r
Trees required u f
Sewage System
.,-_
Address
City
Zip
T U. P 1 THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
5—et District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID,
d
,I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
1.,,e✓ THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA •~
li• -EBY _RTWY THAT—, HE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN 4 /
Form 284-208 (Rev. 1/80) E WITH SECTION 5541 OF TH6 BUSINESS -AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. W
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PERMIT NO.
03892
DEPARTMENT OF BUILDING & SAFETY
. COUNTY OF RIVERSIDE -
IDM AA/X'X0nn
FIELD OFFICE 17T
CONSTRUCTION ESTIMATE -
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Addres',— 7�{8.154
''
1ST FL. 443
2ND. FL.4-51'SQ.
POR.
GAR.
CAR P. '
WALL
284
• ESTIMATED CONSTRUCTION
SO. FT. .@ 18.4 $1530.4
UNITS
PERMIT NO.
403892
r
FT. @ fYARD SPKLR SYSTEM
'
_
SQ. FT. @ MOBILEHOME SVC. BAR SINK
p r, M-
SQ. FT. @ �l382 2 AP. POWER OUTLET ROOF DRAINS
` Dist.
SO. FT. @ DRAINAGE PIPING
F.C.C.
SO. FT. @ DRINKING FOUNTAIN '
Micro Jm Fee
SQ. FT. @ t URINAL
Use of Permit -
DWELLING AND
VALUATION $ 4 WATER PIPING-
9�
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Construction Fee Dbl S
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
SMI Fee g 7
!
VENT SYSTEM 2 FAN' EVAP. COOL POOD
SIGN •
WASHER (AUTO)(DISH)
rz
APPLIANCE DRYER
Plan Checker
GARBAGE DISPOSAL
Finol to
—
FURNACE UNIT WALL --'_fl, OOR SUSPENDED
Unit
LAUNDRY TRAY
50
AIR HANDLING UNIT - CFM,
IDLE METER
KITCHEN SINK
Bron<
ABSORPTIQN' SYSTEM B.T.U.
_' TEMP USE PERMIT SVC
WATER CLOSET
Mileage Fee S
COMPRESSOR 0 HP
POLE, TEMP/PERM
LAVATORY
e.
HEATING SYSTEM:3 FORCED GRAVITY
0, AMPERES SERV ENT
40
SHOWER
�'' -
BOILER ' B.T.U.
SO. FT: @ a
BATH TUB
Total Fees
$ ii,Address
SQ. FT. @; a
WATER HEATER
!City ` Zip
0. FT. RESID @1++144
SEWAGE DISPOSAL
f
Contractor -
,,,'
S0. FT. GAR @ 34a d
HOUSE SEWER
`
LicenseP - -
7e2,n API,
GAS PIPING
Sewage System
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
5
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
._
-,lob
Addres',— 7�{8.154
''
s i .. ..
Space" Lp,'
a
.
T4'
PERMIT NO.
403892
Community
T.A QTTNTAS
Voluation
p r, M-
Date
-
` Dist.
Off.
F.C.C.
MH P.,4 Fee $5,r
Micro Jm Fee
Cop S
Use of Permit -
DWELLING AND
ATT GARAGE
'Parte
o.
6173f
of ck Lot Size '
F S S R
2a^e Restrictions Group Type `
��
Mech. Fee Dbl S
PI. Ck. Fee S
Construction Fee Dbl S
Legal Description -
GS, 22. L& QUINTA GOLF #3..
.
Electrical Fee Dbl S
SMI Fee g 7
!
Plumbing Fee
Dbl S
Bond Amt.
S
Plan No.
Plan Checker
Finol to
—
Inspector
Unit
Sp. Insp. Fee S
Demol. Fee
S
Const. Lender
Bron<
Supplimentol Permit Numbers
2
Registr. Fee $
Mileage Fee S
Address _.w++' /City Zip
�... s�•�� ',�/,4
1// i r, 11..-
Witness Fee S
Reinsp. Fee
$
Ow er/AgenT•
-
�'' -
Tel. Z'
Total Fees
$ ii,Address
;, •
Q
_
!City ` Zip
M.O. Cash Q Check
Received by
f
Contractor -
,,,'
-
feel 7
LicenseP - -
7e2,n API,
Trees required
Sewage System
AW*_
Address
City Zip
- '
(/Y LL P& THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION. OF WORK verified by:
Sewer Distrix 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 1 '
'
THE - LAWS OF RIVERSIDE COUNTY AND THE STATE OF,CALIFORNIA.
F EBY RTIFY THAT THE INDIVIDUAL WHO PREPARED THE, PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 (Rev, 1/80( A CE WITH SECTION 5541 OF THE BUSINESS AND. PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
DEPARTMENT OF BUILDING AND SAFETY .y APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301 Section 19825'of the Health and Safety Code requires the execu-
tion of the following applicable deciaratioFis 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 fforce and effect.
License Class - 1 License No. -,?Q O n
Date
Q OWNER-BUILDERCDECLARATION ~ dr
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;'6.&P.C.).
[� 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 Owner
0 WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers',
Compensation Insurance, or 1 a11 certified copy thereof'(Sec. 3800, Lab. Code).
Polity No. �-i �'- X.3 -)- Insurance
Q 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 bedeemed revokede__� -
Date" -(X' +�0 ) IM
/� 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
L J 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.)
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.
�] 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
ro-
gert - f�orr which I Ra�vej/%applied for this permit for the purpose of making inspections. 7
�c.T *K r�w`^_,/i r,(�
ignaturev'of pp i.cant gents Date
Print pp i:cant/ gent Name
284-2000 7/80
NOTICE: THIS IS NOT A BUILDING PERMIT
r
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
7i
WATER POLLUTION
FLOOD CONTROL
AIR POLLUTION
DIV OF HWY
REMARKS
YOUR PROPERTY MAY BE SUBJECT TO
FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
f ` CANARY—FILE, PINK—APPLICAN
Own e �� �� rchitect�Contract 01.6
Addres ifl — Address %�J,� - !// Address % 9_S —`
A �1 .
a ser Cit
City --/,O City
/ � c.r
Phone' Phone,. Phone i 75 / ? s/
1 (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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W
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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
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 occupietil I ( have
complied with all laws of the County of Riverside and the State of California governing said proper-t,y. /
r
C / v
DATE SIGNATURE OF OWNER AND/OR AGENT -
Approval by Signature from the Following Departments Listed Bel w '—
Must Be Obtained Prior to the Issuing of a Construction Permit.
Must
I SPACE N0.
1 USE OF STRUCTURE
JOB ADDRESS5 `
SINGLE FAMILY DUPLEX
Z
LE' AL DESCRIPTION OF PROPERTY APARTMENTS AGRIC.
0L
l� COMMERCIAL INDUSTRIAL ❑
`^
C G—fv{
COMMUNITY .
�„�LTERATIONS CJ
SUBMITTED'PLANS USE OF PERMIT JT"�t�'"
NO. OF — +�
a
CASE NO.
,�'
p Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW E)� 11NG
JZONE—
SETBACKS: FRONT /'� SIDE o REAR
m
GRADING`PERIMIT REQUIRED? YES ❑ NO ❑ LOT SIZ 40
K 74
SETBACK ORDINANCE _— OF FEET REQUIRED ON �! STREET
DATE -- SIGNATURE OF LAND USE OFFICIAL -
EET__
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET---
F
�
CURBL e2 -ST-RZEJ-
CURB AND GUTTER REQUIRED: YES ❑ NO ❑,}� '_!;21-7
H
-
a
i
-
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR AND STREET
WI:AY
IMPROVEMENT? YES C,_NO ❑
DATSIGNATURE I ROAD DEPT. OFFICIA
WSEWAGE
DISPOSAL l/!I� �T"
=Adley
AI
7i
WATER POLLUTION
FLOOD CONTROL
AIR POLLUTION
DIV OF HWY
REMARKS
YOUR PROPERTY MAY BE SUBJECT TO
FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
f ` CANARY—FILE, PINK—APPLICAN
RIVERSIDE COUNTY rT_PA;:FJN„ x T OF
DiViSION OF ENW10NMENTAL HEALTH
Food Establishment f Sewage Disposal
Trailer Park'!; r `q jam: � _? JJ�— GA. Septic Tank
Mosel, Apt., Hotel ! -, _' ""' . Sq. Ft. of LUach Line
_ Dw. fling x Seepage Pit he
Commercial Building Connection to Sewer
Swimming Pool
No on-site regenerating water softening devices may be discharoed into the individual sewage disposal
system herewith spo::wed wit"."i out cicn�ance'trol ; the Wi�.icr Quality Control Board.
Wat-cr supply serving this instailatisri must be from an a;.)rovad source.
All sew7.n.a dis.:r..s:d installation mus" conform with requirements of current Uniform Plumbing Code.
_ Any cutttr.g, gracing, or fiiiing in excess of four. (4) fcci will nullify sewage disposal approval.
Approval his been obtaued from the Regional Water Quality Control Board for installation of the sew-
age disposal system.
This is to certify that the Riverside County Dar f Public 'ealth approves for occupancy, construction
or installation the item(s) checked above. J
Date— �Q By
C
RIVERSIDE COUNTY rT_PA;:FJN„ x T OF
DiViSION OF ENW10NMENTAL HEALTH
Food Establishment f Sewage Disposal
Trailer Park'!; r `q jam: � _? JJ�— GA. Septic Tank
Mosel, Apt., Hotel ! -, _' ""' . Sq. Ft. of LUach Line
_ Dw. fling x Seepage Pit he
Commercial Building Connection to Sewer
Swimming Pool
No on-site regenerating water softening devices may be discharoed into the individual sewage disposal
system herewith spo::wed wit"."i out cicn�ance'trol ; the Wi�.icr Quality Control Board.
Wat-cr supply serving this instailatisri must be from an a;.)rovad source.
All sew7.n.a dis.:r..s:d installation mus" conform with requirements of current Uniform Plumbing Code.
_ Any cutttr.g, gracing, or fiiiing in excess of four. (4) fcci will nullify sewage disposal approval.
Approval his been obtaued from the Regional Water Quality Control Board for installation of the sew-
age disposal system.
This is to certify that the Riverside County Dar f Public 'ealth approves for occupancy, construction
or installation the item(s) checked above. J
Date— �Q By
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W ' "APPLICATION FOR TREE PLANTING
I (we), the undersigned, hereby certify and acknowledge that I (we) have read the appli ' on 'an -4 agree that if trees are required under River-
side County Ordinance No. 457, the applicant agrees to install said trees prior to final inspgrcfion. It is understood that no final inspection
will be given until said requirements have been met or exception has beep granted by the County. Now, therefore, it is agreed that the prop-
erty owner shall cause the property lines to be surveyed in the event no survey stdkes can b`e-found. Further, it is agreed that the County of
Riverside shall assume n"responsibility should trees have to be removed due to lot line errois.
Owners Name son Building Per o.
MailingAddress Ci State zi
Job Address
Legal Description.. IV
Assessor's Map, Book & Page
Type of Soil3l�ls water available _ Road Dept. Plot Ian No.
Type of existing trees in road right-of-wo '
Trees preferred
by applicant (1) �
Date Owner's Signature
Structure _2(�,���
(3)
Planning Commission Case No. f/ 6/
ROAD DEPARTMENT APPROVAL
Approved species Number of trees_
Spacing of trees Distance from 1 t lines: F ontc;? j LSide —
Additional requirements �T7T7O 6 iZV� A(9- 4
ICI'rl /1/01v1 Ael i , Ili 1 rL n A, .`4- , /_/ % / , ,
Date Building and `Saf/ety notified ignattfr.e
Reason
Request for hearing:
Owner's Signature
YES ❑
REQUEST FOR EXCEPTION
(attach additionad page if necessary)
(Forward application to Planning Dept. if exception requested)
NO REQUEST FOR HEARING
Planning Dept.
Concur ❑ Non -concur ❑ Explanation
Date Signature
Road Dept.
Concur ❑ Non -Concur ❑
Date Signature
REQUEST FOR HEARING AND COMMITTEE DECISION
Date hearing established Date hearing notice mailed to owner
Approved ❑ Disapproved ❑ Date Owner notified of decision
Date Building & Safety notified Signature
Final Dote Inspector _
Job Address
Requirements for tree, plonting complied with
Remark s
APPROVAL BY BUILDING INSPECTOR
Building Permit No,
Community
(Detach and forward above information to Road Department Riverside)
284-230, REV. 1/74
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