A006562 (SFD)FIELD
DEPARTMENT OF•BUILDING & SAFETY
PERMIT NO. I PERMITTjPE t COUNTY, OF RIVERSIDE &.`_
d- e
a,
Additional Information:
FACTORY BUILT HOUSING
This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days
MOBILE HOME INSTALLATION
any mann r o3 t ecome su
Manufacturer,,
64
MH Monuf.
New ❑
Model Designation
Size Relocated ❑
Unit Serial No p
/// t
Total Fees $
.Plan Approval No.(�c
ns g. Serial No. -. 0/75-0.2-5: 06—
oving
Sewage System
T /D0®
/ 0�
Permission is hereby granted to move the
structure, described below, in
otoI Fees $ _ G,� %�/ /his ��1�
Width Length
Height
GRADING
#1
r,.
Number
of #2
Sections
#3
Cut
Fill
Total..Fees $
Present Location
Community County
RELOCATION INSPECTION
Destination
- -
c .
Present location
Community
County
Total Fees
$
Total Fees $
_.Pe _.iiNo_ ___.,
A.O0656
4. _._Job.A_ddress�
- �'"f—. ,.,SP_#_,_
Zip -1 -Owner
O
:509-;?o,�� �.. 7,1-3
Co munity Valuation
Q
Dote
Dist
Off
P.C.
:Plan Check
v A tN A $
I/ ~ci 7`?.?
/f
e
,-
Use of Permit
Parcel No_
Lot Size
Reinspection
�u 1A f...J W J
FOctory-
a
Set backs
Use Permit #
Built
...
Legal Description
Bond
zonerading
Grp
Type
UnitTby-
f�� % ��� z2z
k `
Engineer License
Final DateIns
ctor
Env. Assmt.
Mobile home
#
Requirement
.
Escrow Company
Branc
o.,
Relocations
Address
City
Zip
Total Fees
$�
Cash
I Check
MO
NC
Owner Agent �t
R.,
Tel.
Rece"ve ' by Dot
Add essCity
Zip
Related Permit(s)
Contra r/ Mover
Tela
.µ.At
l
!` workers' comp.
Address
City
Zip
yes ❑ no E3---
_
,I .certify that in the performance of a work for which th' permit is
This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days
ssued I shall not employ any person
any mann r o3 t ecome su
shall also cause permit to become void.
get to the workers' compensotio
of Califor
I hereby agree that all work in connection with this permit will be done in accordance with the lows of
.K
Riverside County and the State of California. I hereby certify that the individual who prepared the plans and
Owner Signature
lis 1 Builder Signature
/// t
sp9cificotions hos done so in accordance with Section 5541 of the Business and Professions Code of the
Sfate of California:'
FORM 284.208A 5-77
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
Q !fie
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
_
36
Inlets & 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 Detention Device —/
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L. E]
43
Final
loA
Fireplace T.O.
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade r
INSULATION
Thick R
Value
7A Walls (Batts)
12B Ceiling IBottsl
12C Ceiling IBlownl
14 1 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
J,
Tank 'QQQ Pit L. Line
REAR OF PROPERTY LINE
�7
^t
PA 1 Pi
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
-ItIR-29
29B Bonding
30 Fixtures J
31 Service
32 1Final 1-1,2 —.29
—e.
STREET NAME ASIIINC-t1'Or+`(
DEPARTMENT OF BUILDING AND'SAFETY 3,
COUNTIT, OF RIVERSIDE..
' a NOTICE TO APPLICANT
'.In conformity with the provisions•of State of California°Labor'Code Section,
3800, the -applicant shall have on file or file with the Riverside County+•'
e Departmentof.Building'and Safety a certificate as designated in Items I or
II below, or shall indicate Item III; IV.or V, whichever.is applicable.
CERTIFICATE ,OF APPLICANT41
Please mark +the appropriate block: Fs -•'x
CZ
;I. Certificate of -Consent to self -insure issued•by' the 1
Director-of.Industrial.Relations.
ED .Copy on file Copy' ^s ' bmit ted
s
t F-1 II. Certificate. of Workers' Compensation -Insurance issued by,y,
• t. an.admitted insurer. 4
Copy on file E-1 Copy ;submitted -R -
III. The .cost of -,the work to be; performed ' is '$100,,or 'less. �..
I certify that in -the performance of the work for-which-
this
or-which.this permit is issued, I shall not employ •any.,person-in h
any manner so as to become subject to the Workers
Compensation laws of California. I• further certify that,
!' in the event'I become subject to the'.Workers'•'Compensaton
u provisions of -the Labor Code that I will comply forthwith
.. with the provisions,of.Labor Code,Section 3700, et seq.;
and understand that, if I d'o_not comply, the'.permit'shall'-
' .'be ,deemed revoked.
V. I certify as the owner (or the agent of the owner) that in•
,r .the performance'of the work for which this permit is'is sued,
I have engaged
contractor. (Contractor must have on file;'or'submit '
certificate required by I or. II ove.
jj) + • p' c
Applicant'sSignat re 11.4+
Date Permit No. S,•
Address and location where work is to be performed `
i ® .. a•
• q
-75
o AY
284-141 . Rev.' -6/77
1 ri
.1= .01
N
r _ OTICE THIS IS":NOT AiBUI-,DING'PERMIT' • DISTRICT
APPLICATION, -TO, CONSTRUCT
Permit No
DEPARTMENT OF BUILDING AND "SAFETY _
„y 4 'COUNTY OF -RIVERSIDE
it #_ f,t!
Owne ArchitecttF f Contractor
Addre 0311!`�C��'��. EVOW. Addres ^^� Address _w,
City City /T� '� % City_ �t
Phone' "� Phone �f�' 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 ofjight 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 3_p_ermit.
NOW, therefore, it is a reed that we) will not occupy said property and will.not cause said property to be occupied until:) (we) have
complied with al' laws of a Cou ,ofRiverside and the State of California governing said property.
complied with all laDATE r SIGNATURE OF OWNER AND/OR AGENT'
Approval by Signature from the Following Departments Listed Be ow—'-
Must-Be
w Must -Be Obtained Prior;•Fo the Issuing -of a Construction Permit.
((SPACE N
' JOB ADDRESS( •, i �USE OF STRUCTURE
�
SINGLE FAMILY DUPLEX
LEG DES I TION PROPER �® ��� RTM ' fff
,Z W O e APARTMENTS AG RIC.
H 'Q COMMERCIAL . .� INDUSTRIAL []
j
in COMMUNITYALTERATIONS n
' Z N0. OF SUB — USE OF P IT
uWi a CASE NO.'; Y —
p Z NO. OF/ IN�SPACES REQUIRED- ..'� er -NO.^OF'BUILDINGS NO EXISTING -
- r
i- t 1
Q � ZONE' t'ETBACKS: FRONT _ c�:y •• SIDE REAR -
J
Cal GRADING PERMIT REQIyIfaED? YES �J NO ❑ LOT SIZE F
SETBACK ORD NANC=- OF FEET REQUIRED ON t STR
DATE Z' SIGNATURE,OF LAND USE OFFICIAL ---
t' .
�- C'r,tr,tis+a... Ju-. t&;.- �rx_. - t• ...i •' _ .,.:?j i .
DEDICATION 'REQUIRED: YES ❑ "N0 ❑SINO." OF 7 EET_" 1
CURB AND GUTTER REQUIRED:_',ii`ES ❑ NO ❑ STREET
d• AND GUTTEi��EASIBI 'BE
TALLIED? YES ❑ NO ❑ V r'
3t ' ''HAS AN ACCEPTABLE •APPL ION BEEN; MADE FOR ENCROACHMENT'PER 'ITJR DRIVEWAY A STREET
IMPROVEMENT? "YES NO,❑ t
C
°C DATE ..2' % SIGNATURE OF ROAD DEPT. OFF ICIA '
_ +SWIMMING POOLS PUBLIC
SEWAGE ;DISPOS�AL
= G Fpap g5.7A�L19" Y1,
• WATER P0LLUTIO� "' REMARKS
�n FLOOD CONTROE?,•
W AIR POLLUTION
DIY OF HWY
'YOUR PROPERTY MAYBE SUBJECT. -TP
FLOOD. RIVERSIDE COUNTY ASSUMES :'. .
'NO RESPONSIBILITY IN -EVENT OF'- FLOOD
1
r,,,�,
284)99 �, 9/74 a , �''E-i� ^• r+ CANARY—FILE,' PINK—APPLICANT
I
RIVERSIDE COUNTY DEPARTMENT OF PUBLIC HEALTH _
DIVISION OF ENVIRONMENTAL HEALTH
Food Establishment,�y Sewage Disposal
Trailer Park 7 Gal. Septic Tank
Motel, Apt., Hotel �� Sq. hof Leach Line y
Dwelling x Seepage Pit 'f,4'.4 �
Commercial Building Connection to Sewer
Swhn+wing Pool
No on-site regenerating water softening devices may be discharged into the individual sewage disposal
system herewith approved without clearance from the Water Quality Control Board:
Water supply serving this installation must be from an approved source.
_,_--_All sewage disposal installation must conform with requirements of current Uniform Plumbing Code.
_GAny cutting, grading, or filling in exzcss of four (4) feet will nullify sewage disposal approval.
Approval has been obtained from the Regional Water Quality Control Board for installation of the sew-
age disposal system. �(� �f
This is to certify that the Ri-veerrsidC County Department of Public Health approves for occupancy, construction
or installation the item(s) checked above.
Date_ �— 2 —^7 By_
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
'y IV
�LXtI'T
Address:
Account No. (OCT OCO
t(s) 27-
Service Address L30(:
CALLe- 0-51.5po
0 Meter(s) _50-q_75
0 Service(s)
0 Backflow(s)
0 House Laterals)
0 Detector Check(s)
1:1 Meter Surcharge
(314.1-itation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Traci -
Fee -
0 Plan Check Fees Water I Sewer -
Traci -
0 Bond Payment - A.D. --
Bond -
Assmt
k
11 Customer Deposit
b Other
* . s5nsi,
1,-
- Traci C 1-1?
G.A. Code
TOTAL S
Remarks:
odglp,y to:
lCash I 1 1.'�R7-3 Water Service
��
IOoneyCashier
Mrder I I I CMD.&MIRRI
.-�HAMMER PUMPING INC: JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
(610) 321-7448
DESCRIPTION OF MATERIAL USED
CUSTOMER'S ORDER NO.
DAI(f7r _4F,_
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TO
PHONE
ADDRESS
-Pumping Fee per,1000 gal'
MBNIC
CITY
HELPER
JOB Myli�ff
'ffDAY WORK
D CONTRACT
.0 EXTRA
DESCRIPTION OF
C)OO
Dumping Fee per 1000 gal.
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
-AMOUNT
co 0
Gallons
I'000
-Pumping Fee per,1000 gal'
C)OO
Dumping Fee per 1000 gal.
Out of Area Fee
L
Locating Opening Fee (per hour).
Size Sistem:'
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, -18% PER YEAR,
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER'30 DAYS.
HOURS
LABOR AMOUNT
TOTAL:'
MATERIALS
MECHANICS @
HELPERS @
TOTAL
LABOR,
I hereby acknowledge the
je:1, I o'y
completion of the'above cir�i work. 'ToTAL'LAB0
TAX
SIGNATURE
I_-- � V44�_�7
DATE COMPLETE)
':� /If '/ Itr-TOTAL
PJ
NOTICE TO OWNER
Under the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve your property, but is not paid for his/her work or
supplies, has a right to enforce .a claim against your property. This means that after a court
hearing, your property could be sold by a court officer and the proceeds of the sale used to
satisfy the indebtedness. This can happeA even if you have paid your contractor in full if the
subcontractors, laborers or suppliers remain unpaid.
To preserve their right to file a claim or lien against your property, certain claimants such
as subcontractors or material suppliers are required to provide you with a document. entitled
"Preliminary Notice." Original (or prime) contractors and laborers for wages do not have to
provide this notice. A Preliminary Notice is not a lien against your property. Its purpose is to
notify you of persons who may have a right to file a lien against your property if they are not
paid. Generally, the maximum time allowed for -filing a claim or lien against your property is
ninety (90) Days after completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MAY WISH TO TAKE ONE OR MORE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material supplier`s through
a joint control„ Any joint control agreement should include the addendum approved by the
Registrar of Contractors.
2) Issue joint checks for payment, made out to both your contractor and subcontractors or
material suppliers involved in the project. This will help to insure that all persons due payment
are actually paid.
3) After UPON making payment on any completed phase of the project, and before making
any further payments, require your contractor to provide you with unconditional lien releases
signed by each material supplier, subcontractor and laborer involved in that portion of the
work for which payment was made. On projects involving improvements to a single family
residence or a duplex owned by individuals, the, persons signing these releases lose the right
to file a claim against your property. In other types of construction .this protection may still be
important, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.