418211 (PLBG)PERMIT No. DEPARTMENT OF BUILDING & •SAFETY FT
418 211 COUNTY OF RIVERSIDE FIELD
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
SQ. FT. @ $
UNITS
nit /ly/��
Comm� t/ (,.�'
SQ. FT. @ YARD SPKLR SYSTEM
POR.
GAR.
SQ. FT. @
MOBILEHOME SVC.
BAR SINK
MH.Permit Fee E
SQ, FT, @ POWER OUTLET ROOF DRAINS
Micro Film Fee
Micro
CAR P. SQ. FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
Use of Permit
I ♦
�� 1 A
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
Parcel No. Use/Case No.
'j
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Set Backs
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
F 5
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
Type
APPLIANCE DRYER
Plumbing Fee
GARBAGE DISPOSAL
r
Bond Amt.
E
FURNACE UNIT WALL FLOOR SUSPENDED
Plan
LAUNDRY TRAY
Final Date
— Z I O
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
Dental. Fee
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
Supp l imental Permit Numbers
'
COMPRESSOR HP
POLE,TEMP/PERM
LAVATORY
Witness Fee E
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
E
Addre 1 �
`7 ...�i7✓
SQ. FT. @ c
WATER HEATER
Received b
Trees required
–
SQ. FT. RESID @11/4c
SEWAGE DISPOSAL
Tel.O License N/'r
Sewage System
SQ. FT. GAR @ s/. c
HOUSE SEWER
��r' r � Zip
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBI.
T AD
�i
MOB.HM.FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE
PLIJMB�
PERMIT NO.
4182 11
Job Add ss yl�
«/r/�S Space
�`,s Owner ���•/�/�/� �} / �y
nit /ly/��
Comm� t/ (,.�'
Valuation
E
Date -02
14 (J��
02
D'st.
/
F.C.C.
MH.Permit Fee E
Micro Film Fee
Micro
Cop E
Use of Permit
I ♦
�� 1 A
//
Ao .'
Parcel No. Use/Case No.
'j
C y
,��
Mech. Fee Dbl E
PI. Ck. Fee E
Set Backs
Lot Size
Construction Fee Dbl S
Legal Descriptio ��
//L,/A �r •y17� ,
r`/7 v�. �� I7"" /
F 5
S R
Electrical Fee Dbl E
ZoneJ(RReest/rryctions Group
' �,/
Type
SMI Fee E
Plumbing Fee
Dbl E 54
r
Bond Amt.
E
Plan No.
Plan
Checker
Final Date
— Z I O
Inspe or
Unit
Sp. Insp. Fee E
Dental. Fee
E
Const. Lender Branch
Supp l imental Permit Numbers
'
Registr. Fee E
Mileage Fee E
Address City Zip
Witness Fee E
Reinsp. Fee
E
Owner/Agent
Tel. Zip
Total Fees
E
Addre 1 �
`7 ...�i7✓
City Zip
M.O. .C. ash Check
Received b
Trees required
–
Contra ,�
–�+�
Tel.O License N/'r
Sewage System
Address .` � v
��r' r � 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.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
T LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
r RTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 (Rev.8/78) @s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF"THE STATE OF CALIFORNIA.
verified bW,
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System t
2
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. E
43
Final
IDA
Fireplace T. 0. 0
FI
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
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 — Zl
25
Final
Tank Pit L.Line
PSL
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
PERMIT
O.
418211
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE mil
COUNTY OF RIVERSIDE
CONSTRUCTION
ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES , ,
IST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ, FT. @ $
UNITS '
D st
SQ. FT. @ YARD SPKLR SYSTEM
MH.Permit Fee $
SQ. FT. @ MOBILEHOME SVC. BAR SINK
Use of Permit
�y / /` _ t (/
/!,� / .��' �` ) ,
SQ. FT. @ POWER OUTLET ROOF DRAINS
Mech. Fee E
FDb
SQ. FT. @ DRAINAGE PIPING
Set Backs
SQ. FT. @ DRINKING FOUNTAIN
Construction Fee Dbt $
SQ. FT. @ URINAL
F S
VALUATION $ WATER PIPING
R
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Type
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
Plan No.
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
Unit
APPLIANCE DRYER
Demo 1. Fee $
GARBAGE DISPOSAL
Supplimental Permit Numbers
FURNACE UNIT WALL FLOOR SUSPENDED
Mileage Fee $
LAUNDRY TRAY
Witness Fee $
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
M.O. .C. ash F1 Check.
COMPRESSOR HP
POLE,TEMP/PERM
LAVATORY
Sewage System
' T LL P
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER ¢
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
SQ. FT. RESID @ 11/. c
SEWAGE DISPOSAL
SQ. FT. GAR @ 'G c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBI.
TQTAL FFFC
MOB.HM.FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE
PIL g.
PERMIT NO.
41 211
Job Add r ss / ./,/��P1R`.,,,�w, Space
w � � � ✓ � / 7'f ��! ��
Comm oily
act
Valuation
Date
D st
F.C.C.
MH.Permit Fee $
Micro Film Fee $
Use of Permit
�y / /` _ t (/
/!,� / .��' �` ) ,
Po�r�cyl/�N/yoy •� ,,,��j Use/Case No. C y
�LA 1 �,✓D V/ I�
Mech. Fee E
FDb
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbt $
Legal Description •
F S
S
R
Electrical Fee Dbl E
ZoneJRy��/, coons
" �,/ �..
Group
Type
SMI Fee $/,/�;•
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan `Checker
Final Date
y�/--(�/
Inspe
Unit
Sp. Insp. Fee $
Demo 1. Fee $
Const. Lender Branch
Supplimental Permit Numbers
Regisir. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip
Total Fees $
Addre
City - Zip
M.O. .C. ash F1 Check.
Received b -
Trees required
Contr
Addresyw.y
Tel. LicenseM-
Zip
Sewage System
' T LL P
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.
Sewer District
r.
Form 284-208 (Rev.8/78) @s
IFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
�'-A O ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF -THE STATE OF CALIFORNIA.
DEPARTMENT OF BUILDING`AND SAFETY APPLICATION CERTIFICATE
COUNTY''OF RIVERSIDE PERMIT #
Effective July1, 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:
x.:11 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 pf�orce and effect.
License Class rL'cense No. ,o2 jdo 0
Date 4/20/X/ Contractor !/s��i�s %'��'si
Q OWNER-BUILDER'DECLARATION
I hereby affirm that I am.exempt from the Contractor's License Law for the following reasons:
Q 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.).
[:] I am exempt under Section , B.&P.C. for this reason:
Date Owner
ID 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
Policy No. ,S c %,e Z%— 0CQ Insurance
0 Certified copy is hereby furnished.
Certified copy is` filed with the Cou�/J��nty of Riverside,Department of Building and Safety.
Date ���/ Applicant A� �,ti�j
0 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE
(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
EJ 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 which d have applied for this permit for the purpose of making inspections.
Signature of Applicant/Agent Date
Print Applicant/Agent Name
284-2000 7/80
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT '
e
Permit No
284 199A 9/74 + CANARY—FILE, PINK—APPLICANT
Ow er G Architect —. --_ Conr r
Address, _ /Address___ Address——liJ /57'___
City_ a City_- City-
-
Phone Phone _ Phone —3� _3C@,—_.._
cc
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
W
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 la s of the County of Riverside and the State of California governing said property
DATE -- SIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments ed Below
Must Be Obtained Prior to the Issuing of a Constru ton Permit.
I SPACE NO.
USE OFRUCTURE
JOB ADDRESS C
_`6-U
SINGLE FAMILY DUPLEX
Z W
LEGAL QESCRIPTION OF PROP TY
1 APARTMENTS AGRIC.
h. Q� <-.�
B. Q
-—� - r COMMERCIAL INDUSTRIAL ❑
`^
G
COMMUNITY
ALTERATIONS
Z
NO. OF SUBMITTED PLANS USE OF PERMIT
6 Q
CASE NO.
NO. OF tKINJ SPACES REQUIRED — NO. OF BUILDINGS(N+ EXISTING
G Z
Q 0
ZONE SETBACKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANC # OF • FEET REQUIRE �N� STREET
/
DATE ~' ` SIGNATURE OF LAND USE OFFICIAL\ ) —
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET—
F-
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
oc
,
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
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DATE SIGNATURE OF ROAD DEPT. OFFICIAI
I
SWIMMING POOLS PUBLIC
H
SEWAGE DISPOSAL
Q W
_
FOOD ESTABLISHMENT
WATER POLLUTION t REMARKS
to FLOOD CONTROL—
z AIR POLLUTION
WDIV
OF HWY
ce"
r" YOUR PROPERTY MAY BE SUBJECT TO
O .4 —
FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 + CANARY—FILE, PINK—APPLICANT