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402745 (BLCK)LSVILVING rtKMII PERMIT No. DEPARTMENT OF BUILDING & SAFETY 4027 4 5 COUNTY OF RIVERSIDE FIELD Dsr CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. 2ND. Fl. FOR. GAR. CAR P. WALLSQ. ESTIMATED CONSTRUCTION SQ. FT. @ $ UNITS Owner \ SQ. FT. @ YARD SPKLR SYSTEM SQ. FT. @ MOBILEHOME SVC. BAR SINK SQ. FT. @ POWER OUTLET ROOF DRAINS SO. FT. @ DRAINAGE PIPING FT. @ % '� DRINKING FOUNTAIN SO. 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 Gr ��/ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Electrical Fee Dist $ 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 Supplimental P mit Numbers S0. FT. RESID @ 1 t/ a SEWAGE DISPOSAL Mileage Fee S S0. FT. GAR @ t/4c HOUSE SEWER Reinsp. Fee S GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. - TOTAL FEE jMO8.HM.FEEj MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE SMI FEE FEE PLUMB. FEE PERMIT NO. " 402745- Job Address s - Space Zip -- Owner \ Community Voluation r✓ /"" Dote —/ �,,, 0O Dist. I� Off. F.C.C. MH Permit Fee $ Micro Film Fee Cop $ Us�e/o Permit I'//��.+'--•'/� y /s 1c ea, %�� Porcel No. ^� Use/Cole No. Ck. By Meth. Fee Del $ PI. Cit. Fee $ Set Bock, lot Size ` r Construction Fee Del $ Legal Description "-G�' L) ,Jy/b%—. Gr ��/ F $ S R Electrical Fee Dist $ Zona Restrictions le — / I Group Type ' SMI Fee $ Plumbing Fee Dbl $ Bond Amt. $ Plan No. Plan Checker Finol'Dote �7 C7 Z Z —?,0 Inspector Unit Sp. Insp. Fee $ Demol. Fee $ Const. Lender Branch Supplimental P mit Numbers u s 1, - Registr. Fee $ Mileage Fee S Address City Zip Witness Fee $ Reinsp. Fee S Owner/Agent i Tel. Zip `Zip Total Fees $ 1,—Address! S } - City M.O. I] N.C. Cash E) Check� Received by -Cotrtroctor _ " f .^ �" s 11 Tel. r� t Licenses , Trees requir Sewage S ,•A c1re s ". City 0. Zip T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK- verified 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 WITH /7 THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HE BY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN _ Form 284.208 (Rev. 1/80) DANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 8 (z 33 Ventilation System 2 Ftgs 8 Frms 8-�Z`p� 34 Plenums 8 Ducts 2A Slab Grade 35 Furnace Comport. 3 Steel �� Z-46 36 Inlets 8 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 IDA Fireplace T.O. No ADDITIONAL INFORMATION , ' r " SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Loth 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Botts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final Z2" _ PLUMBING _APP,ROVALS" 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 P/L 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 N s NOTICE: THIS IS NOTA BUILDING PERMIT DISTRICT /r APPLICATION TO CONSTRUCT Permit No DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE 284 199A 9/7.4 CANARY—FILE, PINK—APPLICANT Owne s sd Architect _. --_ Contracto _ U£ _ ,p,'A)AJ.� Addressf 'v 66, 47 -- Address_ Address_Z�� �4._%U L �•L�_5���2�s City a City-- - cty_ Phone Phone _ Phone -3 23'-�6_�-z—.—_ _ 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 occupi d until I (we) have • complied with all laws oftheCounty of Riverside and the State of California governing said property. - ^� DATE v-� _— SIGNATURE OF OWNER AND/OR AGEN Approval by Signature from the Following Departments Listed Below Must Be Obtained Prior to the Issuing of a Construction Permit. I SPACE NO. a� I USE OF STRUCTURE JOB ADDRESS SINGLE FAMILY DUPLEXEl LEGAL DESCRIPTI N OF%P OPERTY �`-__30_/ � Q� Z H - APARTMENTS AGRIC. [� ,Vr� Q COMMERCIAL INDUSTRIAL A COMMUNITY LTERATIONS C � Z NO. OF SUBMITTED PLANS - USE OF PERMIT Lu H Q CASE NO. _ Z NO. OF PARKING SPACES REQUIRED _— — NO. OF BUILDINGS NOW EXISTING -- - Q ZONE SETBACKS: FRONT SIDE REAR J m GRA ID NG PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE SETBAC RDINANCE OF FEET REQUIRED ON STREET DATE�� SIGNATURE OF LAND USE OFFICIA DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_— W CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET i H 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 ce DATE - SIGNATURE OF ROAD DEPT. OFFICIAI = SWIMMING POOLS PUBLIC aW SEWAGE DISPOSAL S FOOD ESTABLISHMENT WATER POLLUTION REMARKS to FLOOD CONTROL t- W AIR POLLUTION ag ^_ I- h DIV OF HWY c ce — YOUR PROPERTY MAY BE SUBJECT TO c FLOOD. RIVERSIDE COUNTY ASSUMES �I NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199A 9/7.4 CANARY—FILE, PINK—APPLICANT DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE COUNTY OF RIVERSIDE PERMIT # 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. F-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 rf - 6 License No. 3 % 5� S' 2- Date A - 1/ - f�$ a Contractor __1 AM _'. ,- A,L,n .n ., e . _ F' - _ 0 OWNER-BUILDEAJDECLARATION M 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.). 0 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 M 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. 9S.eA11q ,=SSPE C_( Insurance 0bA?4_t7S-k---q If ,1AC, Q Certified copy is hereby furnished. u Co' 9Certified copy is filed with the County of Riverside, Department of Building and Safety. `7 ;i�x�_Q ` Date 1_ ',uf Applicant .F_1 ,t," fJA n +./C F- _ rr rx, a -.1 Q CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIOA NSURANCE (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 kf, 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. [� 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%ic�ant/Agent " s y Date .ire Print Applicant/Agent Name + 284-2000 7/80 LSUILUIf4ta rLKmn 1PERMIT NO, 4-0,2745 DEPARTMENT OF BUILDING & SAFETY FIELD OFFICEDsr COUNTY OF RIVERSIDE F, CONSTRUCTION, ESTIMATE NO. ELECTRICAL FEES- NO. PLUMBING FEES 1ST FL. 2ND. FL. Y POR. GAR. • CAR P. WALL ESTIMATED CONSTRUCTION SO. FT. @ $ UNITS 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 t 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' t DRYER, x GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED No.t Ck. By LAUNDRY TRAY AIR HANDLING UNIT 'CFM, IDLE METER, KITCHEN SINK ABSORPTION SYSTEM - - '' B.T.U. + TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HIP POLE, TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ . a BATH TUB Group, 'SO. FT. @ a WATER HEATER SMI Fee ! S0: FT. RESID @ 1 %a SEWAGE DISPOSAL S0. FT. GAR @ 3/4a HOUSE. SEWER t• Plumbing Fee GAS PIPING PERMIT FEE Plan No. PERMIT FEE PERMIT FEE , .DBL. TOTAL FEES- MOB. HM. FEE MICROFEE MECH. FEE PL. CK. FEE I CONST. FEE.EELECT. FEE SMI FEE .FEE = PLUMB. FEE .. _ _.. �.._.... .. 'lob Addreis .. PERMIT NO. .,�. -' _- .. Spa<e 'Zip - - Owner .:T _.. • - - - 4027 Community Voluation" Date Dist. 0. F.C.C. ., a .. MH Permit Fee S s 1 g �•^'�. - —,//— s / Micro Film Fee Mech. Fee Cop S. Dbl Use of Permit •, Parcel.No. Use/Gose No.t Ck. By PI. Ck. Fee " $ - ,. ; 4 _ Set Backs Lot Size Construction Fee Dbl S I Legal Description AA F^, S $ R Electrical fee Dbl S [/,�'p Zone Restrictions ' - Group, T pe SMI Fee g Plumbing Fee Dbl- g.• - Bond Amt. Plan No. •Plon Checker., - -Finbl Date:; Inspector Unit Sp. Insp. Fee S $ f i t.DIO _XD .t .. Demol. Fee • $ Conat.'Lender r Brooch Supplimentol Permit Numbers o Registr. Fee S .., f • "" Mileage Fee g ''•- Address. 'City Zip Witness Fee• g i ,• Reinsp. Fee S. Owner/Agent - Tel, ,- Zip • Total Fees S Address a s ff•^ City_ - - Zip M.O. . N.0 Cosh Check f }�s,e2 �s'ti.•f 1 ZT�•+6+,.4' ` Ivs.• ¢'.'• +• L•,. s.-` h q Received byi • Tel:, + License# Trees requir d �,••- ( w- /•t t r }r- I . . , s % •� -o— Sewage S - 11 ides .. City Zip . T - _ LL P THIS PERMIT SHALL `BECOME VOID IF WORK' IS. NOT COMMENCED WITHIN 120 DAYS._ 6 ATION 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 /� THE LAWS OF. RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.' /rG//�/GI!{ I HEBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN, Form 284208 (Rev. 1/80) DA ;, 5NCE WITH SECTIION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. - • verified by: 1