403864 (BLCK)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 Wim
✓ u c s,•J r THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. _
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ;
Form 284208 (Rev. 1/80) DA WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
7
BUILDING PERMIT
Job Address
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
-
FIELD DST
.�
PERMIT NO,
0 3 8 6 4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
'
ESTIMATED CONSTRUCTION
SO. FT. $
UNITS
Comm ity
.@
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @
DRINKING FOUNTAIN:
SO. FT. @
URINAL
VALUATION $ �.t
WATER PIPING
NOTE: Not to be used os property tax valuation
ca o.
('
SWIM POOL, PVT
FLOOR DRAIN
_ MECHANICAL FEES
Pl. Ck. Fee S
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
S
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Le s riptionV
GARBAGE DISPOSAL �+
FURNACE UNIT WALL FLOOR SUSPENDED
Electrical Fee Dbl S w -
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Type '
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
Bond Am. s
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Inspector
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER. HEATER
7 /per/
S0. FT. RESID @ 1 t/,a
SEWAGE DISPOSAL
Sp. Insp. Fee S
S0. FT. GAR @ 3/4a
HOUSE SEWER
GAS PIPING '
PERMIT FEE
Demol. Fee S
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICROFEE
MECH. FEE
PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
Tel. Zip t
+ 1
Total Fe $
Address
](
•�-�'y �t
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 Wim
✓ u c s,•J r THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. _
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ;
Form 284208 (Rev. 1/80) DA WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
7
Job Address
Space Zip Owner
PERMIT NO.
403864
Comm ity
aluaiion
-_
Date 1 F.C.C.
$
MH Permit Fee $
Micro Film Fee Cop $
Use o ,Rerm51'
L s� V,
n
ca o.
('
'Use/Cas o.
Ck. By !
Mach. Fee Del S
Pl. Ck. Fee S
e Backs
Lot Size
F
S
S
R
Construction Fee Dbl $
Le s riptionV
A
t
Electrical Fee Dbl S w -
Zone Restrictions
Group
Type '
SMI Fee $
Plumbing Fee Dbl $
Bond Am. s
Plan No. r •^
71on Checker
Final.
Inspector
Unit `
7 /per/
Sp. Insp. Fee S
S
Demol. Fee S
Const. Lender
Branch
Supplimental Permit Numbers
Registr. Fee $
Mileage Fee S
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip t
+ 1
Total Fe $
Address
](
•�-�'y �t
City Zip
M. . E] N.C. Cash ❑ ClIfec
_
\'
1 Tai
Received b
raetor/"/.r—^. +`
,
Tel.
Licensell
( /
Trees require•-Qi't'
Sewage System
Address
<_
r
G a,;:d Zip '
'
TIS PER ITHLL BECE SOI F
ORK 5 NOS` MMENCE VMI N 1 0 D S.` -CE SATIO OF _ en, d by:
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 Wim
✓ u c s,•J r THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. _
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ;
Form 284208 (Rev. 1/80) DA WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
7
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
2
Set Back
Figs & Frms
%D
33
34
Ventilation System `
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
Q �
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
O� 7 %
L v
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.
n
43
Final
10A
Fireplace, T.O.
°o
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Batts)
128 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 Heoter
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
F
P/L P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
DWILIJssw rC6mss
$
PERMIT. NO. + "DEPARTMENT OF BUILDING. & SAFETY'
FIELD OFFICE DST
4038
164
COUNTY OF RIVERSIDE " ,.• ; J
.
CONSTRUCTION ESTIMATE, '
NO. :ELECTRICAL FEES
NO. PLUMBING. FEES'',
1ST FL.'
2ND. FL.
FOR.
GAR. '
` CAR P.
WALL
s•
ESTIMATED CONSTRUCTION -VALUATION
SO. FT. .@ $
UNITS d
Voluotibn Data
'
SQ. FT. @
YARD SPKLR SYSTEM
SQ. FT. MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. IT, @ ✓
DRAINAGE PIPING
SO. FT. @ - "
DRINKING FOUNTAIN
SO. FT. _
@
+ URINAL i
$ y
WATER PIPING
NOTE: Not to be used as, property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
r 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
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 f
BOILER B.T.U.
SO: FT. ,@ 'a
BATH TUB
Al
SO. FT., @ a
WATER HEATER '
• ,.
)
SO. FT. RESID, @'1!/aa
SEWAGE DISPOSAL '
M. . E] N.C. Cash I] C ec
'SO. FT. GAR @ 3/44
HOUSE SEWER
-.
Tel.
'-
GAS PIPING.;?
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
HM. FEE
MICRO FEE'.
MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE -
SMI,FEE
FEE PLUMB: FEE
'
PERMIT NO.
403864
lob Address
-
- Space Zip ` -; • - Owner f -y
-
Comm ity
Voluotibn Data
is. T Off. F.C.C.
�nr
n
MH Permit Fee S
Miro Film Fee Cop S
Use of t '
SIC
1 - cel o. • se/Cos
%
• / ✓
- - e ni
Backs
. o. Ck. ByZ '
'I'
tot
Mech. Fee Dbl S
PI. Ck. Fee S
Construction Fee Dist S
Leg es ription
F $ S R
(}
Electrical Fee Dbl $
��,
Zone Restrictions r Group
Type f
SMI Fee $
Plumbing Fee Dist S
Bond Arm Pion No.
S
Plan Checker
Final _
Inspec r
Unit '
Sp. Insp. Fee $
Demol. Fee $
Const. Lender
s Branch
Supplimentol Permit Numbers
t
t'
Regisir. Fee g
Mileage Fee . - S
Address ' City Zip
Witness Fee g -
Reinsp. Fee g
Owner/Agent.
-
Tel.
Zip
Al
Total Fee S
Address
• ,.
)
Ply -
Zip
M. . E] N.C. Cash I] C ec
Received b
roclor
-.
Tel.
'-
Licensell
Trees required
Sewage System • -
Address
at
Zip
T LL p THIS'PERMIT SHALL BECCIA01 V'OID'ff WbRK IS NOT CTiMMENCEO WITHIN 130 DAYS. CESSATION OF WCSRR '�Ieril'ied by:
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 WILH.
THE LAWS OF RIVERSIDE COUNTY AND.THE STATE OF CALIFORNIA: v
0 J
_-4-HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN '
Form 284.208 (Rev. 1/80) �w,7� Ng+'�= WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
DEPARTMENT OF BUILDING AND SAFETY
COUNTY'OF RIVERSIDE
APPLICATION CERTIFICATE
PERMIT N
Effective July 'l 1980, Chapter 1301 Section 19825•of the Health 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:
[_1 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 met L C-0h44�gkicense No. p �Og3R
Date CC-5cSQeW_ P . (et K1 Contractor IiilCt7�I,�?i, r ��1Qpl C9oJr�,Id2�r�f�
Q OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons:
[3 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.).
[:J I am exempt under Section , B.&P.C. for this reason:
Date Owner
Q 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. 3700 hags Insurance 4=-
Q Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
Q 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
r,71 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 tthe County of Riverside, Department of Building and Safety to enter upon the pro-
perty ,for wh .-h I h've applied for this permit for the purpose of making inspections.
Signature orfpp scant/ gent Date
S, / ,- 1 Ai�,o (
Print Applicant/Agent Name
284-2000 7/80
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
OwneArchitect __ _ Contractor_ -A-
Addrest Address___ Address_
City_ City_— _ City___
Phone Phone _ 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 law�sof the County of Riverside and the State of California governing said property.
DATE 0^ / 7 ^- --SIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
I SPACE NO. USE OF STRUCTURE
' /k j U�o f Z -t-' I /��
-- ___ y (
JOB ADDRESS G —_
- SINGLE FAMILY DUPLEX
>
_
LEGAL DESCRI TION OF PROPERTY—�2 ��`�(
APARTMENTS AGRIC.
vlr--� G�J�
Q
COMMERCIAL INDUSTRIAL n
'^
O
COMMUNITY a ALTERATIONS LJ
O
NO. OF SUBMITTED PLANS USE OF PERMIT Za
N0.
t3CASE
G Z
NO. OF P RKIN/G SPACES REQUIRED __ —_ NO. OF BUILDINGS NOW EXISTING —
ZONE �I ETBA(�KS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES 0 NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON S REET
DATE_ SIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: -YES ❑ NO ❑ NO. OF FEET-
F
-z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
r
oe
d
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
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAL—
_
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
rn FLOOD CONTROL
F-
W AIR POLLUTION
W
DIV OF HWY
YOUR PROPERTY MAY BE SUBJECT TO
O a —
a
Lu FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT