402746 (BLCK)BUILDING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD Mon
0 2746 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO: PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
<.,
ESTIMATED CONSTRUCTION
SO. FT. .@ $
UNITS
SQ. FT. @
YARD SPKLR SYSTEM s
SQ. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @ Tii
DRINKING FOUNTAIN
SQ. FT. @
URINAL
VALUATION $
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
Plan No.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Inspector
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
'
SQ. FT. @ a
WATER HEATER
Tel.
" f
SO. FT. RESID @ 1 t%a
SEWAGE DISPOSAL
Sewage System
SO. FT. GAR @ V4a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB..FEE'•�
PERMIT NO.
402746
lab Address --. - — -space
�" - -
zip _
Owner
C m nity t'
(p/ '
Off.
F.C.C.
MH Permit Fee $
Micro Film Fee Cop $
Use ol'Pe mit /(,./ / -
a el o. �` se/Case WV ,,.rte
..
Ck. By
Mach. Fee Dist S
PI. Ck. Fee $
Set /
Lot Size
Construction Fee Dbl $
Legal Description
`f [, /
F
s S R
Electrical Fee Dbl $ f
Zane Restrictions
Group
Type
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
Finovbto /gam
$^ 24nr Cl O
Inspector
Unit '
Sp. Insp. Fee $
Dismal. Fee $
Const. Lender Branch
Supplimee�ntal Permit Numbers
Registr. fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip
Total Fees $
Address
1 l I 1• '
Pty Zip
.
M.O. ❑ N.C. ❑ Cash ❑ e
Received by 7
Contractor
Tel.
" f
LicenseR •
Trees required
Sewage System
isj / i•�
v
City Zip
• "' T LL iJ(! ,qu1/11I 'PERMIT SFiAtr IfE&AE VO D IF WORK IS NOT COMMENCED WITHIN 12O'6A S. >C ATIO O OR - t v riWad by:
!Ower District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS. PERMIT WILL BE DONE IN ACCORDANCE WITH"3^��'
' L THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. •, z-` - (0
g
�RDAN
YCERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO U�"eii, S '"CE*WITH SECTION 5.541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA: F+4. -r �'
Farm 284.108 (Res•. 1/80)
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
%NSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Bock
x i �J -11
33
Ventilation System
2
Ftgs 8� Frms
— i 2� �j-�
V�
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
_/
36
Inlets & Outlets
4
Grout Blocks
,�'L2 ..
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.O.
°o
ADDITIONAL INFORMATION
r '
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final — ZZ 1
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
P/L P/
c!
1.
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT '
Permit
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner J Archite� —. _ Contractor_ -
A1
Address- ZCC)`/SLI o R Aclaiesss Address
--
City _r4// �? City--- _ City. -j -24-66,"z
Phone Phone _ Phone; -z3 � O Z 'Zi
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 ntil I (we) have
complied with all laws of the County of Riverside and the State of California governing said property.
DATE(-�O -- SIGNATURE OF OWNER AND/OR AGENT — —.
Approval by Signature from the Following Departments Listed Belo
Must Be Obtained Prior to the Issuing of a Construction Permit.
�� / 1 SPACE NO.
USE OF STRUCTURE
9a
}
S d%C'
JOB ADDRESS —/_� (/� �nSINGLE FAMILY DUPLEX
IJ�I
LEGAL DESCRIPTION OF PROPERTY % ❑
��'—_¢-
Z FF
O LL!O'/—�
APARTMENTS AGRIC. E]
N Q
COMMERCIAL INDUSTRIAL [j
j '^
COMMUNITY. ALT IONS ❑
C G
Z
USE OF PERMIT NO. OF SUBMITTED PLANS — -
H Q
CASE NO.
—
Z
,.NO. OF PARKING SPACES REQUIRED — — NO. OF BUILDINGS NOW EXISTING -
Q o
ZONEe SETBA(fKS: FRONT SIDE REAR
J m -
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE# OF FEET REQUIRED ON STREET
DATE" LJ'� SIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -- —
F
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
cc
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
cc
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
F
W
,
SEWAGE DISPOSAL
Q
_
FOOD ESTABLISHMENT
WATER POLLUTION — REMARKS
to FLOOD CONTROL
W AIR POLLUTION
W DIV OF HWY
c cc YOUR PROPERTY MAY BE SUBJECT TO
—
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND.SAFETY 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 declarations prior to the issuance of a building permit. Please
print or type and sign below. i
[7 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 e" - 1�-3 License No. % Sr / S Z -
Date r _ 7"r. 1°i., Contractor I n 1444.e2 f I . _ f r . . � -, s /c f` - _ ,4-n.5, Kr -i
F-1 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.).
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
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. Sf�/uG 715'5 rlt cL I n s u r a n c e 0 ,If- IJ -15 - -.%i's (F � , _T__. /t,G - �7f.'XAk4 F11Ad
0 Certified copy is hereby furnished. 0
E'r Certified copy is filed with the County of Riverside, Department of Building and Safety. /
Date ,6? 7-Z /- B / Applicant_—J#4---,- (4 R df -,-e ,
P rn 0 rtjA,7oirrr,/C'/L
[� 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.)
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.
[7 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 I have applied for this permit for the purpose of making inspections.
Signature'of Appl,ican't/Agent %( Date
� U
Print Applicant/Agent Name
284-2000 7/80
{' ,
.
NO.
461
PERMIT NO.
02746
DEPARTMENT OF 'BUILDING, &. SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL. ;
POR.
GAR.
'CAR P.
WALL 7
ESTIMATED CONSTRUCTION
SO. FT. .@ $
UNITS
SQ. FT. @
YARD.,SPKLR SYSTEM
s ' •
SQ. FT. @ MOIBILEHOME SVC. '
-
BAR SINK'
SO. FT. @ POWER OUTLET•
ROOF DRAINS
SQ. FT. .@
DRAINAGE' PIPING
SO., FT. @
DRINKING FOUNTAIN
/`9•�///' y +:-^�2 �i.Y J
URINAL
VALUATION $
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 t
WASHER (AUTO)(DISH) -
APPLIANCE DRYER
Const. Lender Branch
.,
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 1'
WATER CLOSET i
COMPRESSOR HP
POLE, TEMP%PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ a
BATH TUB
SQ. FT. @ - a'
WATER HEATER
'
SO. FT.' RESID @ 1 1/<a
SEWAGE DISPOSAL
`
SO. FT. GAR @ 1/ a -
HOUSE. SEWER
• -
City Zip
-
GAS•PIPING ^
PERMIT FEE
-PERMIT FEE -
PERMIT -FEE
^SMI
DBL.
TOTAL FEES
MOB. HM. FEE
• MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
FEE
FEE PLUMB.•FEE
{' ,
.
NO.
461
yr
1
lob Address
A.,PERMIT
C m nity
Space 'Zip Owner — -' - • ..
-
ot. Off.
_
,
[altatiFn
MH Permit Fee $
Micro Film Fee Cop S
Use of 'Permit -
^' ' i "�1v'� ,
Leg/al Description e _
a el No. se/Casa No.
T
Z77- 71,2
_ Set Bocks. ;Lot Size
-------------
F - 5 S R
Ck. By -
;
Mach. Fee Dbl S
PI. Ck. Fee S
Construction Fee Dbl $ -
Electrical Fee Dbl S
/`9•�///' y +:-^�2 �i.Y J
Zone RestrictionsGroup Type
'
SMI Fee S
Plumbing Fee Dbl $
Bond Amt.. -
$
Plan No.
Plan Checker
Final tey_
"fDd ^ou
Inspector
0A
Unit
Sp. In Fee $
Demol. Fee S
Const. Lender Branch
.,
Supplimentol Permit Numbers _
•, ` •
,
Registr. Fee $
Mileage Fee S
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel..
Zip -
Total Fees S
Address •' e <
City -
Zip
i^
r
M.O. ❑ N.C. Q Cash C]Check
Received. by
-•Contractor ` '.s'
Tel.
.Licensett
`
Trees required
Sewage System -
ss,
City Zip
,
f n n �r-
T LL 1/51?I [HIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WIIHIN 1{U DAYS. CtJSAIION OF WUKK verified by:
-Sewer District f WN FORt12O;DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
" .1 HEREBY'AGREEtTHAT ALL WORK IN CONNECTION 'WITH THIS PERMIT WILL BE DONE IN ACCORDANCEWITH f
/J THE LAWS, OF RIVERSIDE -COUNTY AND THE STATE OF CALIFORNIA.,
Y CERTIFY THAT_TFIE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO -IN
Form 284.208 (Rev. 1/80) G�� A CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OFJHE STATE OF CALIFORNIA.' .