402729 (RPL)DVILLPImp rcrcmn
PERMIT No. DEPARTMENT OF BUILDING & SAFETY FIELD Mh
4 0 2 7 209'
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
lob Address - Space Zip Owner
Community Valuation r F.C.C.
$ ��,. /•
NO. PLUMBING FEES
Micro Film Fee Cop S
1ST FL.
2ND. Fl.
FOR.
GAR.
CAR P.
WAIL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
PI. Ck. fee S t!%
Construction Fee Dbl $ _
Legal Description
lot 7 a 1 QUTAta Go 17`F3
SQ. FT. @ YARD SPKLR SYSTEM
Zone Restrictions
SO. FT. @ MOBILEHOME SVC. BAR SINK
Type
SO. FT. @ POWER OUTLET ROOF DRAINS
Plumbing Fee Dbl S
SO. FT. @ DRAINAGE PIPING
Plan No.
SO. FT. @ DRINKING FOUNTAIN
Fi I Dote / n I ect r Unit
/G
e
SO. FT. @ URINAL
Dental. Fee $
VALUATION $ WATER PIPING
0
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
4�f
FLOOR DRAIN
Reinsp. Fee $
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
Address
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Cants /. a l
tb'r�(,i`'_•/t,✓;.�t'r �'i•.+{.•gt".�y..,...--
Add r - /r
P-0* 2208
WASHER (AUTO)(DISH)
Licenseg -
`..
S
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
BOILER B.T.U.
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
SO. FT. RESID @ 1 %c
SEWAGE DISPOSAL
S0. FT. GAR @ 3/4a
HOUSE SEWER
GAS PIPING
c.
PERMIT FEE
PERMIT FEE�1n
PERMIT FEE
Yui
DBL.
TOTAL FEESM
OB. HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
CONST. FEE CT. FEE
SMI FEE
FEE PL MB. FEE
1-4 "0 2 9
lob Address - Space Zip Owner
Community Valuation r F.C.C.
$ ��,. /•
MH Permit Fee $
Micro Film Fee Cop S
Use of Permit
2$X30 Swiii►
ii •1390with th spa
Parcel No. Use/Co " o. A7Ck. By
YA
A cks Lot Size
F S S ..... R
Mach. Fee Dbl S
PI. Ck. fee S t!%
Construction Fee Dbl $ _
Legal Description
lot 7 a 1 QUTAta Go 17`F3
Electrical Fee Dbl $r�
Zone Restrictions
Group
Type
SMI Fee $
Plumbing Fee Dbl S
Bond Amt.
$
Plan No.
Plan CheckerZ—M
Fi I Dote / n I ect r Unit
/G
e
Sp. Insp. Fee $
Dental. Fee $
Const. Lender Branch
Supplimental Permit Numbers
,-
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip
Total Fees Iss
M.O. ❑ N.C. ❑ Cash Check
Address
City Zip
Received by
Trees required`
Sewage system +
Cants /. a l
tb'r�(,i`'_•/t,✓;.�t'r �'i•.+{.•gt".�y..,...--
Add r - /r
P-0* 2208
Tel.
City Zip
Licenseg -
`..
S
..
T LL Is 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
^f pG THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 (Rev. 1/80) ORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verilied by:
y
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
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.
43
Final
10A
Fireplace T. 0.
P'
.. ____________
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE 8t. LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
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 Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
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
ZONE , - REAR YARD
_ LOT , AREA, ,
l _ - -DATE I�ECO20ED r�-`— r - LOADING
b .r) ----____FRONT YAF D
f �S %.d� !_M` CC.,,
)_DATE
eD.
APPROVE I
LAND USE DIVISIO�4 --
3
1A,
f I .........- . kt(lg i- LU)bow to TFR )+urs FF (�W)AAj. Qu i
10
R OM N EY POOLS
P. 0. BOX 2208 -
PALM DESERT, CA
341689
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT ,f',
APPLICATION TO CONSTRUCT Permit N
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
Owner Architect___--____ Contractor_-"-_- r.t
Address 41., `' /X09ress--- --- Address -
City j ! d r Al City------ - - City ---
Phone Phone --. _ _ Phone. _
WI
(we) the undersigned, hereby certify and acknowledge that 1 (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 laws 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 Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
SPACE NO.
I USE OF STRUCTURE
m 1
JOB ADDRESS / t If1/! -I; i
--- - SINGLE FAMILY, DUPLEXEl
}
LEGAL DESCRIPTION OF PROPERTY ___I_
- - APARTMENTS AGRIC. D
C
H H
COMMERCIAL INDUSTRIAL LE
COMMUNITY
ALTERATS C�
�z
N0. OF SUBMITTED PLANS --_-_ USE OF PERMITLa
H Q
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED __ NO. OF BUILDINGS NOW EXISTING
Q
,
ZONE tETBACKS: FRONT <.. SIDE ." REAR
J
m
GRADING PERMIT REQUIRED? YES ;] NO 0 LOT SIZE
SETBACK ORDINANCE # __- OF FEET REQUIRED ON _ _-____-.._ STREET
DATE ___. SIGNATURE OF LAND USE OFFICIAL
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET
~
LuCURB
AND GUTTER REQUIRED: YES ❑ NO ❑ _ -_STREET
H
d
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
u1
C
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
C
C
IMPROVEMENT? YES ❑ NO ❑
°L
DATE __ _ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
J ILW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT _
_
WATER POLLUTION _ REMARKS -
�n FLOOD CONTROL
z AIR POLLUTION
W
DI V OF HWY
o — _ YOUR PROPERTY MAY BE SUBJECT TO
d
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74 CANARY -FILE, PINK -APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N 4L/a;;_F7,�
Effective July 1, 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.
01__�_ 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,— `,; ?j License No. -5Z 0.537
Date Q/A0 Contractor_xA aa7c,a ,��� t,
Q r 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.).
Q 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
'-_ 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. 6 41 Insurance
0 Certified copy is hereby furnished.
" ,Certified copy is filed with the County of Riverside, Department of Building andySafety.
Date �'.'� la li Applicant
0 ` 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
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 in 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.)
[] 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. /^
0 Divisi`on of Industrial Safety Permit No.
Date �!�/Rr) Applicant '%Ji7i>`✓i1a��,l.r_,./,/
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 have applied for this permit for the purpose of making inspections.
Signature of"Applicant/Agent Date ,
1 G///
Print Applicant/Agent Name
284-2000 7/80
PERMIT NO,, -
402729 -
DEPARTMENT, OF. BUILDING. & SAFETY FIELD OFFICE DST
COUNTY OF RIVERSIDE " Il / I
CONSTRUCTION ESTIMATE-
NO.•., 'ELECTRICAL FEES
NO. PLUMBING,FEES-
. _
-
1ST FL.
2ND. Fl. ' .SO.
FOR.
GAR:
CAR P.
WALL • � '
ESTIMATE D'CONSTRUCTION
SO. FT. @ - $
UNITS
a
-
h
FT. YARD SPKLR SYSTEM -
.. r
`
�SO. FT. @ MOBILEHOME SVC. BAR SINK
POWER OUTLET i ROOF DRAINS
SO. FT, @
"
SO. FT. @ _ + .DRAINAGE PIPING
2 9
r _
SO. FT. DRINKING &OUNTAIN
� @ � � � '
SO..FT• @: URINAL
'
VALUATION $ • WATER PIPING -
D
'NOTE: Not to be used as property tax valuation -
SWIM POOL, PVT
�_� •
FLOOR DRAIN
MECHANICAL FEESSWIM
POOL, COMM,
WATER SOFTENER
Ck. By -.
I lot Size
VENT SYSTEM FAN ' EVAP. COOL HOOD •
is SIGN
Construction Fee Dbl S
WASHER (AUTO)(DISH)
Electrical -Fee
APPLIANCE. DRYER
'yy aa 9-
,iQ4
GARBAGE ,DISPOSAL
FURNACE UNIT WALL FLOOR i SUSPENDED
Group
LAUNDRY TRAY
Type
AIR HANDLING UNIT r CFM
'' IDLE METER'
-
j KITCHEN SINK
y
ABSORPTION SYSTEM B.T.U.
- TEMP USE PERMIT SVC
, WATER CLOSET
COMPRESSOR HP
., POLE, TEMP/PERM
Plumbing -Fee
LAVATORY
HEATING SYSTEM" FORCED' GRAVITY-'
AMPERES'SERV ENT
`PIonNo' -
SHOWER
• •
BOILER - B.T.U.
$O. FT. @ a
BATH TUB
Sp. Insp. Fee S
DemoL Fee y
SO. FT. @, a
WATER HEATER
Branch
S0. FT. RESID @ 1 1A a'
SEWAGE DISPOSAL
Regisir. Fee g
Mileage Fee, S
SO. FT. GAR @ 144
Witness Fee I g
HOUSE SEWER
g
Owner/Agerif
-
GAS PIPING
1-4
ITO—
PERMIT FEE - c-
PERMIT. FEE
O
PERMIT FEE
lop
DBL.
TOTAL FEES
7,7..
MOB. HM. FEE
- MICRO:
MECH. FEE PL. CK. FEE
, o
*CONST. FEE • T. FEE
Shy oa /
SMI FEE
�, T%
MB
FEE#2,
PERMIT NO.
Job Address.
�
. _
-
.. ..... .....
.•_._:. .. _.. SpoFeZip
-
.Owner- . _.
owner'
.. ,. -.-... •. ... ... _.. - _.-,
-
h
.. r
`
"
4 0 2 7
2 9
Community
ja Cent
Z') "'
Va,uatian
S " / �� G�%
,tiff.
MH Permit Fee' S. •
Micro Film Fee
Cop S
-
Use of Permit
r
25X-30
*w ra peal w0h .spa
Parcel No. - Use/Ca
- cks
F 0 S 5 R
Ck. By -.
I lot Size
Mach. Fee Dbl g
PI. Ck. Fee ,S�._
Construction Fee Dbl S
Legal Desgiption c y - -
Electrical -Fee
DblS
'yy aa 9-
,iQ4
+ MQ"e
-1& Y,.i
Ione Restrictions.
Group
Type
SMI Fee g+
y
Plumbing -Fee
Dbl $
Bond Amt:
S
-
`PIonNo' -
Plan Checker
• •
Final Dole ^y�CPJ�
/ ( s o tJ
Inspector
Unit
Sp. Insp. Fee S
DemoL Fee y
S
Const Lender
Branch
SupPlimental Permit Numbers
Regisir. Fee g
Mileage Fee, S
Address ., 'City . , Zip
+
Witness Fee I g
Reinsp. Fee
g
Owner/Agerif
-
.Tel...
Zip
Total Fees
S
Address
City
Zip
M.O. Q N.
�' Cash Check
Received by
Contrai
Tel.'
License# '
Trees required
Ad'_r
City
Zip
-
Sewage System
,�
P.O.
Box
r r
Palm n^o&,P+
T LL v P THIS PERMIT SHALL BECOME VOID'IF WORK IS NOT COMMENCED WITHIN 120 DAYS.. CESSATION OF WORK
'Sewer DistrictFOR 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. '
BY CERTIFY THAT'THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 (Rev. •1/80) _ WCC-ORDANCE WITH SECTION'5541' OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by: