404012, 404069 (AR)BUILDING PERMIT
0 PERMIT 11, DEPARTMENT OF BUILDING & SAFETY FIELD DST
COUNTY OF RIVERSIDE
4012
k 1h]
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED C09R§.CtN
SO. FT. .@ $
UNITS
VoluV$n
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 $
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM*
--7
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
lon No.
t -e7 t
I P ) Z
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. @
BATH TUB
M.O. 0 N.C.E] Cash C) teec
SO. FT. @
WATER HEATER
Tel.
7
SO. FT. RESID @ 1114 4
SEWAGE DISPOSAL
Swage System
SO. FT. GAR @ 3/4 a
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM! FEE
PERMIT FEE
DBL.
TOTAI. FEES
LE
MOB. HM. FEE
M, CRO FEP
MECH. FEE PL. CK. FEE
C ONST. FEE ELECT. FEE
Sm, FEE
FEE PLUMB. FEE
ERMIT NO.
4PO401
Job Address space
6 tic-
Zip
ner
Comr6drity
VoluV$n
—t.
Off.
I !.C,C.
MH Permit Fee
Micro Film Fee Cop S
Use of Permit
Po - rcerNo.
7)f
use/CosA No.
Ire-
Ck. By
Mach. Fee DbI S
Pl. Ck. Fee S
'at Back.
L t Sitte
Construction Fee DbI $
Legal Description
r
F R
Electrical Fee DbI S
Zone Restrictions
Group
Type
SMI Fee is
Plumbing Fee DbI IS
Bond Amt.
S
lon No.
t -e7 t
I P ) Z
Plon.Ch cker
Final DbTe
-s—
Inspector
Unit
Sp. Insp. Fee S
I
Darrel. Fee S
Const. Lender Bronch
Supplimentol Permit Numbers
Regist, Fee S
Mileage Fee $
Address City Zip
Witness Fee $
Rain,p. Fee $
O.ner/Agent
Tel. Zip
Total Fees $ j
AjcJ,e,,
!City Zip 7
M.O. 0 N.C.E] Cash C) teec
Received bt,_-
Tel.
7
Licon.all
Swage System
A,7ddr.,,
ffli
; f '; '- Z
Cite I Zip
- ::"(!� j ) 7-
T LL P
Sewer District
Form 284-208 (Rev. 1/80)
THIS PERMIT SHA:LL BECOME V61D IF WORK IS NOT COMMENCED ViTRA I'l 2d6AYs. —CeSSA:TION'CfF Wbk< verified by:
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
TH E LAWS OF RIVERSIDE COUNT�. AND THE STATE OF CALIFORNIA.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCE 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
I
Set Back
33
Ventilation System
2
Ftgs & Frms
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. Cleoronc
7
Frommg
40
Fire Damper
8
Vents
41
Smoke Detection De�ice
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T. 0.
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
if Exterior Loth
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Botts)
12B 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 Ser�ice
24 Gas Test
25
Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
I
STREET NAME
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD
04069 COUNTY OF RIVERSIDE Dsr
CONSTRUCTION ESTI ATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Zip
I -
11 ST. FL.
Ts�w. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ 1 $
i �
UNITS
Valuation
S • .vim
Iek-�-,. Cie
Dote
-�3
Dist.
SO. FT. @ YARD SPKLR SYSTEM
F.C.C.
t
SQ. FT. @ 1 MOBILEHOME SVC. BAR SINK
Micro Film Fee
SQ. FT. @ POWER OUTLET ROOF DRAINS
Use of Permit L- �1
'� �'`'� LI? ��.f - �:3/>?, 'i `�"�
k-.1 s L
= � r
SQ. FT. @ DRAINAGE PIPING
Parcel No.
�j 3 � " _ 0
SQ. FT. @ _j DRINKING FOUNTAIN
No.
r L URINAL
•
Meth. Fee Dist b ,!!
VALUATION $ y �so ,e,/ WATER PIPING
Set Backs
NOTE: Not to be used os property tax valuation
'
t
SWIM POOL, PVT
Legal Description
e
1+" n Vs t'1 c �i �.. S-• 1':.
FLOOR DRAIN
F
E I S
MECHANICAL FEES
R
SWIM POOL, COMM
f Electrical Fee Dbl ,$
WATER SOFTENER
Group
Type
VENT SYSTEM FAN EVAP. COOL HOOD
rSMI Fee E �'
SIGN
Dbl E r
WASHER (AUTO)(DISH)
PlA No.
Plan Checker
APPLIANCE DRYER
Finol Dote f oe Q /
'' • a /
Inspectors
/ c
GARBAGE DISPOSAL
,.Sp. Insp. Fee E
FURNACE UNIT WALL FLOOR SUSPENDED
E
Const. Lender Branch
LAUNDRY TRAY
'
AIR HANDLING UNIT CFM
I'Mileoge Fee E
1Witness
IDLE METER
Fee E
KITCHEN SINK
E
Owner/Agent
ABSORPTION SYSTEM B.T.U.
Tel.
TEMP USE PERMIT SVC
Zip
WATER CLOSET
;Tocol Fees
• O. E) N.C.
E
C ih E3hec
COMPRESSOR��,+•' HP
.z 4HEATING
��
POLE, TEMP/PERM
LAVATORY
L Received b
i+Trees required\tj•
SYSTEM O CED GRAVITY
%
AMPERES SERV ENT
SHOWER
^ �;
BOILER B.T.U.
Addd,&, `•� '
SIN -i _?�„r' !ice.
SO. FT. @ a
City
••". .G�.-
BATH TUB
SO. FT. @ a
WATER HEATER
SO. FT. RESID ea l t/4a
SEWAGE DISPOSAL
S0. FT. GAR Ca s/4a
HOUSE SEWER
. >
GAS PIPING
PERMIT FEE
'
PERMIT FEE
0�
PERMIT FEE
(
v J
DBL.
TOTAL FEES
22,
MOB. HIS. FEE
MICRFEE
MECH.�
Pl. CK. FEE
CONST. E
EL T. FE`
SMI FEE
FEE
PLUMB.,
u
PERMIT NO.
404069
Job Address /` - -
wr: l s /� /� /�
G.� J f` / �lLIY�J�,1/
Space
Zip
I -
Owner.
�J
Community
t,,% s r j
Valuation
S • .vim
Iek-�-,. Cie
Dote
-�3
Dist.
O f.
F.C.C.
t
MH Permit Fee b
Micro Film Fee
Cop E
Use of Permit L- �1
'� �'`'� LI? ��.f - �:3/>?, 'i `�"�
k-.1 s L
= � r
Parcel No.
�j 3 � " _ 0
Use/Case
No.
Ck. By
Meth. Fee Dist b ,!!
PI. Ck. Fee b
Set Backs
Lot Size?
'
t
`Construction Fee Dbl S
Legal Description
e
1+" n Vs t'1 c �i �.. S-• 1':.
F
E I S
R
f Electrical Fee Dbl ,$
ZoneR strictions
"
Group
Type
-
rSMI Fee E �'
'Plumbing Fee
Dbl E r
Bond Amt.
E
PlA No.
Plan Checker
Finol Dote f oe Q /
'' • a /
Inspectors
/ c
Unit
,.Sp. Insp. Fee E
11—T. of. Fee
E
Const. Lender Branch
Supplimental Permit Numbers
'
Regior. Fee E
I'Mileoge Fee E
1Witness
Address City Zip
r
Fee E
Reinsp. Fee
E
Owner/Agent
Tel.
Zip
;Tocol Fees
• O. E) N.C.
E
C ih E3hec
Address/ `
J/•''
City
Zip
L Received b
i+Trees required\tj•
Co iroct±o,.
\ •`�
1 .
Tel.
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Licensen
1; wage System
t•
Addd,&, `•� '
SIN -i _?�„r' !ice.
City
••". .G�.-
Zip q
"10
T LL <i•A p 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
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 284208 (Rev. 1/80) CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by: '
77d,�
NO. OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1 Set Back
33 Ventilation System
2 Ftgs & Frms j „�_ T
v
34 Plenums 8 Ducts r,
2A Slob Grade I —3�
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 Detection Device ,
9 Garage Fire Wall
42 Commercial Hood
10' Fireplace P.L.
43 Final
10A Fireplace T.O.
NOADDITIONAL INFORMATION ,
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal lath
12A Drywall
i7--4-?O
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Batts)
•
12B Ceiling (Batts)
/_ 1 ,may /�—
l7 6 to
12C Ceiling (Blown)
/
14 Final �� ZS(
?-
_ _ _ ._ _ . PLUMBING APPROVALS
15 Ground Plumb �.-
16 Water Piping
17 Rough Plumb — —
18 Vents ,,,, 14 _ 66
19 Sewage Disposal
20 Sewer
21 Water Heater. ..2 7-
22 Water Softener
23 Water Service
24 Gas Test
25 Final �� Z/'f $I
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
j
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
`i �( U
29A Grounding Wire
29B Bonding
30 Fixtures
%
31 Service
32 Final
I—Z (
NOTICE: THIS IS NOT A BUILDING PERMIT
DISTRICT
APPLICATION TO CONSTRUCT Permit No P"
DEPARTMENT OF BUILDING AND SAFETY
v
COUNTY OF RIVERSIDE
•
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Own���1.�L�!_tG'r�� A��rj�jch��itect —. —.__ Con tracto���y�-._/��h�'�
Address��lFYd 3iess___—
CityG-7 I/?— City--- Citylf��/�/�ryJ��.IP
��`� Phone _ Phone2=J_._��i__—.�. _
W
1 (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 tha0l (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 AGENT96��LQQ
------
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
I SPACE N0.
USE OF STRUCTURE
4�o
JOB ADDRESS v�r
SINGLE FAMiLYA DUPLEX
IALpESC� TION OFPROPERTY
Z W
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_� s� APARTMENTS AGRIC. C]
M�(s' /—^rf-�-- /—
W
N Q
- oe�b ��� COMMERCIAL INDUSTRIAL
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COMMUNITY . ALTERATIONS ❑
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NO. OF SUBMITTED PLANS _— USE OF PERMI
4 Lu Q
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CASE NO. — �C•
O 0
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N0. OF PARKING SPACES REQUIRED N0. OF BUILDINGS NOW EXISTING'�1ylL_
p
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_�
.— _ _
ZON ETBACKS: FRONT SIDE
J
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATEr SIGNATURE OF LAND USE OFFICIAL -
~
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__
uZ,
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
f-
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CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
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HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
C
IMPROVEMENT? YES ElNO ❑
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
Z
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
H FLOOD CONTROL
H
W AIR POLLUTION
W DIV OF HWY
c a — YOUff PROPERTY MAY BE SUBJECT TO.
a
Lu 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 R
Effective July 1, 1980, Chapter 1301, Section 19825•of the 4<h 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:
El 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 License No. 7e�9 7
DatContractor
Q OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons: l
0 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.).
Q I am exempt under Section , B.&P.C. for this reason:
Date Owner
0 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.,*�¢ -> Insurance
0� Certified copy is hereby furnished.
IY I Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date /�'- Applicant /'.
C 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 iri 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.)
Q 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 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:appi,ied for this permit for the purpose of making inspections.
ignature of Applicant/Agent Date
P—rint Applicant/Agent Name
284-2000 7/80