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0:42 9099552022 BS RECORDS PAGE 02
HEADQUARTERS
o%N DEPAWMAWOF BUILDING4 SAFETY
coumff of NVIM106
ifl I
""m
Am it, OL&ZK $ 9 41-1 --Ze JUNITs
'SO. Ft. d. YARD SPKLR SYSTEM
50. FT. moelkmmk $VC SARSINK
so. FT.
FOWEROWIV R" DAAir4S
SQ 1R. T MINACf PIPING
19a FT. 0 DRINKING FOUNTAIN
I -am FT. URINAL
NVALIJAWNCAVI
WATER PIPING
ftK wova— SWIM Pm, PVT FLOOR DRAIN
MM4ANICAL FEB $WI m PCKX' COMA wA'ER SOFTENER
_Q'tVAP. QXX X"mo slom WASHERMUTO.70ftii
GARBAGE 0($P'JSAL—
WAU C) IPLOM 0 SLWMDM LAUNDRY TRAY
CFM IDLE METER TCAEN SINK
S.T,U. TEMP USE PERMIT ., VC WATER CLOSET
)HP POLE, I`lw/PfRm LAVATORY PEW
GRAVITY AMPERES SERV EN' &MOWER
TLU. SO, FT. BATH TUB
$0. FT. (3 WATER MEATER
FLTLU
$0. FT, MID I fit G SEWAGE DISPOSAL
A SE SEWER
GA5 PIPING
....... ...
PERMIT FEf jPtRMIfFEE
C*o FCE 'ATC T. i ea 1 tL.E smllll E E Pkv b0
0 2-
. .............
�4 f
Qlf
v
L
12 -AM s �?'/
C.P.
v.,
.... ......
lye -
C-1 k
EEL- "•j'u,, _ � •i lids '�t�,A/MAI/�1�
08/06/2003 10:42 9099552022 BS RECORDS PAGE 05
-94
;. �.I;%lXM��T -BUILDtkd Ab $ AF TY
�r
,i'- :cotn."T�r OP''R'fER5iaE t
NOTICE T0. APPLICANT
the provisions of..$tate. of Cal.tfornia Labor Code Sec[.idn
Canx :afia11 'have on .f le.•dr. file wil.:h the Riverside Cdunty
ent•.oE::Builcting'And Safety a certificate an designated in Iteatis I or
b ...4c::.''hill indicate Item III, IV or V, whichever is applicable...,
CERTIFICATE OF APPLICANT
:'-mark-'the appropriate block: ,
c I.:: Certificate of Consent to self -insure issued by the
..Director of Industrial Relations.
Copy on file Copy s•ibmitted
ct' II. Certificate of Workers' Comperisa::ion Insurance issued by
ari.admitted insurer.
x:• Copy m file a Copy submitted
The cost of the Work to be performed is $100 or ,less.
Iy: I certify that in the performance of the work for which
this permit is' issued, I shall not employ any person in
any' manner so as to become s,ib j ec t to the Workerz'
Sy...; Compensation laws of California, I further certify that,
*.>••�1�l;"�:;::.: in the event I become subject to the Workers' Compensation
F,L 4•.. provisions of the Labor Code that I will comply forthwith
with therow
Tp+�. �:^,.,, •: p is ions of Labor Codc Section 3700, et seq. ,
and understand that, if I do not comply, the permit shall
be deemed revoked.
I certify as the owner
Y (or the aFent ^f the owner) that in
erf
the performance of the work for which this
.s• p permit is issued
,,�,'�X''•°•:::.::::::... I have engaged
contractor, (Contractor must have on file, or submit
certificate required by I or It above.)
'Cint's S ar e
}, tate Z 1971Permit No.
as and location where work is to be performed
fil" 4i Rev. 6/77
OM
08/06/2003 10:42 ..90.99552022 BS RECORDS PAGE 06
•,``•L , i � •° � . ho�.,��S�tM►aM•w4l �:M4:a•vA�+�.:,�.y,,,,;..h�,MMlta�,.w/�u i 2`� r.'.y i:'. ��..G':�., !
j-._W_IDTA�l� LDING 'PERMIT
iiiifom TO CpkSTRlJCT
`6ii�ltyhilky
!
;OF CUILDINq.AHo SAF il y
-COUNTY 6F llfrilt�II69:
A.
44
. ;ojoA_ D,
Address,---,
4ZT�l
.'City- -'—
bty_ CI
Phone_
wI,.0d.fir r*
mllicAliom And agree th.t if &�h Ar'td l5kitte s"
CIC�`14d bv the COLW*V Of ANCtside the Riverside Couniv
It -of 'ALAI�H-,Ol
h4we 5ters mcf:'. i a," 6;1� ...;4jji, that ml "fk I% to ba, jocka wlf(.lrs lho--cc�l�ilklw
Vier
*i,iQi`i*d that I twat —11 net OccuPy 14ill QPOCIC"Y and wit ru)f C4,,c aid promri
y !a be ";�o I j -(we)
RlvmWu Of CQIIIC�niil 00ve rlino 2ald t
Iry 0'
TURi'OF.OWNER A
4D /OR
pproval by Signature from the Following Di II)lttmenh
M II * Obtained Pril
t* Air 111111I Of 4 'Co"9111rioction Permit.'
S P A C E'P'Q,
G:+'•.
SINGLE FAMDUPLEX
FAMILY
APARTMENTS -AGII
ts COMMERCIAL INDUSTRIAL
wit"
ALTERATIONS
ED PLANS --.--:-]USE '.OF PERMIT __DVI
PACE$ REQUIRED
NO. OF SUfLOINGS NOW
kTGACKS, FRONT 201 IS�REAP
2I f
NO
LOT SIZE
OF-.-.-... . FEET REOUIRED Dq
0 %id
STREET
SIGNATURE OF LAND USE OF r )CIA L . .... .
10116kilON REQUIRED: YES E: NO 0 NO. OF FEET
UKII -AND GUTTER REQUIRED; YES (3 NO C STO E7
ST
it :• CA4N CURB
AND GUTTER FEASIBLY BE INSTALLED? Y5.-j C NC5
AN., ACCEPTABLE APPI 16 . TION BEEN MADE FOR ENCROA'04MENT PERMIT FOR- DRIVEWAY AND STREET',
N
OVVA
.0 NO
SIGNATURE or
AD:PTOFF
IAL
VC11 PC LIC
A*E DISPOSAL
OLLUTON REMARKS LUT
tl1c, -000 CONTROL----_
AIR POILL.UT11014
..............
Olv OF Hwy
YOUR PROPERTY MAY BE SUBJECT TO
. .. .......FLOOD. RIVERSIDE COUNTY ASSUMES
'40 RESPONSIBILITY IN EVENT OF FLOOD,
CANARY FILE. III APPLICANT
. . . . . . ..... ...