404438 (MECH)BUILDING PERMIT
PERMIT NO.
04438
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD
DST 1
1414 I�
f
CONSTRUCTION
ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. .@ S
UNITS
2ND. FL. SO. FT. @
F S S
YARD SPKLR SYSTEM
FOR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
F nal Doe
DRAINAGE PIPING
WALL SO. FT. @
$
DRINKING FOUNTAIN
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION 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
Tel. Zip
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Address
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET ,
COMPRESSOR r HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER ,B.T.U.
SQ. FT. @ 4
BATH TUB
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. ' ;,r';T,1. •+'{�
SQ. FT. @ c
WATER HEATER
i't
SO. FT. RESID @a 1 t/4c
SEWAGE DISPOSAL
S0. FT. GAR @a 11444
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO'FEE
MECH. E PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
i r
PERMIT NO.
404438
MH Permit Fee $
Micro Film Fee Cop $
Mech. Fee Dbl S
PI. Ck. Fee $
Construction Fee Dist $
Electrical Fee Dial $
SMI Fee $
Plumbing Fee Dbl $
Sp. Insp. Fee $-
Dental. Fee $
Registr. Fee $
Mileage Fee $
Witness Fee $
Reinsp. Fee $
Total Fees _ $
ftM:O'-Q N.C.0 Cash 0
Received by,/7,.j ;
T LL
Sewer District
Form 284-208 (Rev. 1/60)
lob
u
Zip
111 S7 x l G 3 TSA,4C %0
�- x
,-
Set B.WFl
Lot Size
1
Le¢UI Dexription'" •'
F S S
R
^ 1414/ �•.
Zone Restrictions
Group
Type
Bond Amt.
Plan No.
Plan Checker
F nal Doe
Insp for
Unit ,
$
Const. Lender s Branch
Supplimental Permit Numbers
Address City Zip
Owner/Agent _
Tel. Zip
Address
City Zip
Contractor.'.
Tel.
Licanself
Gry•G'N 47 Tip
r
`•41-115 ERMIT SHALL WOUE 16 - F ORIi; ISN NC I 20 SC OF WORK veri(ied'by;
�$ATI@N
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME V, ID. \i\
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. ' ;,r';T,1. •+'{�
H CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
A RDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. 1
•
i't
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport. `
3
Steel
36
Inlets & Outlets y g
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 z;2/f/
10A
Fireplace T.O.
°o
ADDITIONAL INFO M TION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
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 Service
24 Gas Test
25
Final
Tank Pit L. - Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
/
'
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE
OFFICE DATE TIME r() PERMIT NUMBER
/ -)- -- / 5r) �lG� INSPECTION
ADDRESS
J-/- M.. 3
OWNER
ITY
(SPACE N0. FORUESTED
I
BUILDING 1 PLUMBING I ELECTRICAL 1 WCHANICAt
REMARKS
OWN ER/CON TRACTOR TEL.NO.
�3
a
7UIES
-
0 WEt)
DTHUR
FRI
284-" tl/75
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
//'�
COUNTY OF RIVERSIDE
C".1 r
DISTRICT
Permit No
284 199A 9/74
CANARY—FILE, PINK—APPLICANT
Owner �'1 ` Architect --/D 0-0—o' Cor tractor_ jQ�i s ��.GE�
Address ��2 b-��-4�L_'P Z- Address___ Address_73-7
City �. kILS City-- —
PhonePhone
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I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
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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 v__rk 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 until I (we) have
lawwss of the County of Riverside and.the State of California governing said property.
complied with alllaws
[
DATE ®C--.- -( � SIGNATURE OF OWNER AND/OR AGENT 6L
Approval by Signature from the Following Departments Listel Below TT/� /�T
Must Be Obtained Prior to the Issuing of a Construction Permit.
9.01 I SPACE NO.
USE OF STRUCTURE
JOB ADDRESS �L�a .7�T'e 2- ( -
SINGLE FAMILY DUPLEX
LEGAL DESCRIPTION OF PROPERTY APARTMENTS
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01 AGRIC.
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'1- COMMERCIAL� INDUSTRIAL,
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COMMUNITY t
� ALTERATIONS n
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NO. OF SUBMITTED PLANS -- USE/OF ERMIT
W Q
j
CASE NO.
---
NO. OF P6R4LNG SPACES REQUIRED _ NO. OF BUILDINGS NOW EXIS-ING -
p Z
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ZONE SETBACKS: FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE N OF FEET REQUIRED ON STREET
DATEJ�
r/�3 —ARZ2_ SIGNATURE OF LAND USE OFFICIO/
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
H
ot;
a
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
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IMPROVEMENT? YES ❑ NO ❑
°C
DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL
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SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION _ REMARKS
FLOOD CONTROL
F
W AIR POLLUTION
W DIV OF HWY
c a — YOUR PROPERTY MAYBE SUBJECT TO
a
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 k
Effective July 1, 1980, Chapter 1301, Section 19825'of the Htalth 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: -
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 CTass 2� %Sr �'^ �� _License Noy, 2 -pap% r—C—moo
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.).
[� I, as owner of the property, am exclusively contracting with licensec contractors to
construct the project (Sec. 7044, B.&P.C.).
Q I am exempt under Section
Date Owner
B.&P.C. for this reason:
�] WORKERS' COMPENSATION DECLARATION
I hereby affirm that I,have a!certificate of consent to self -insure, or a Certificate of Workers'
Compensation Insurance; ora certified copy thereof' (Sec. 3800, Lab. Code).
Policy No. v Insurance
Q Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Bjilding and Safety.
Date Applicant
0 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) Air- 3 . )(+Vr) Applicant
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance cf 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 i6 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.)
[� 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 co-rect. I agree to
comply with all state laws and county ordinances relating to building constructioi, and authorize a
representative of the County of Riverside, Department of Building and Safety to enter upon the pro-
perty for,W ch I havefapplied for'this permit for the purpose of making inspections.
Signature of Applicant/Agent Da
ent v t
c-1. �n,,,.4 z o k. ?RQ of rr �2
r nt pplicant/ gent Name
284-2000 7/80