413111 (ELEC)PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
13111 COUNTY OF RIVERSIDE FIELD [it I
Dsr
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
Job Address
NO. PLUMBING FEES
1ST Fl.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
SQ. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC.
BAR SINK r
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SO. FT. @
DRINKING FOUNTAIN r
SO. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Set 15cks
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Electrical Fee Dbl SAZone
WASHER (AUTO)(DISH)
APPLIANCE DRYER
i
SMI Fee $
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ei �,I6>
O
LAUNDRY TRAY
A'R HANDLING UNIT CFM
IDLE METER
Inspector
A&6z4—
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
S
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
Supplimental Permit Nunbers
�
-
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
Witness Fee S
SHOWER
BOILER B.T.U.
SQ. FT. @ a
BATH TUB
Tel. Zip
SQ. FT. @ a
Total Fees
WATER HEATER
Address r'
SO. FT. RESID @ 1 t/4a
SEWAGE DISPOSAL
M N.0 sh Check
S0. FT. GAR @ 3/4a
HOUSE SEWER
vi L
Tel.
r
Licensee
GAS PIPING
PERMIT FEE
PERMIT FEE
/n
t� A -L
PERMIT FEE
D8L.
TOTAL FEESj
MOB. HM. FEEMICRO
FEE
MECH. FEE PL. CK. FEE
CONST. FEE EL CT. FEE,
.
SMI FEE
FEE PLUMB. FEE
.
PERMIT NO.
413111
Job Address
,���� .� J
Community
Valuation
Date
Dist
Off.,,..
F.C.C.
MH Permit Fee S
Micro Film Fee
Cop S
Use of Permit
v k Q% C
J
Parcel No.
/ , 5 Oe W
Usa/Cole No.
Ck 8
Mech. Fee Dbl E
Pl. Ck. Fee S
Set 15cks
I Lot Size
Construction Fee Dbl $
legal Descriptionr
to --,z \'%/—
F
S
S R
Electrical Fee Dbl SAZone
Restri s
Group
Type
SMI Fee $
Plumbing Fee
Dbl S
Bond Amt.
$
Plan No.
Plan Checker
Final Date
/a z*8'9
Inspector
A&6z4—
Unit
Sp. Insp. Fee S
Demol. Fee
S
Const. Lender
Branch
Supplimental Permit Nunbers
�
-
r. Fee $
e
Mil
Mileage Fee 5
a
Address r City Zip
Witness Fee S
Reinsp. Fee
S
Owner/Agent
Tel. Zip
Total Fees
S
Address r'
City Zip
M N.0 sh Check
Received b
Co ror
vi L
Tel.
r
Licensee
Trees requiredaff
Sewage System
Address
/n
t� A -L
Ciry Zip
�. 'r � l V.�'r.-•..r.+`I G. \ l'S �--�
I
K Sewer District
I. Form 284-208 (Rev, 1/80)
THIS PERMIT SHALL BEC04 VOICJ IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK veryied by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
r
I HERE6Y 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.
CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
CE 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
33
Ventilation System +
2
Ftgs & Frms
34
r
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 Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
Fireplace T.O.
OW
O.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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 Service
24 Gas Test
25
Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
+
P/L i P/L
t
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
G�
29B Bonding
30 Fixtures
31 Service
32 Final
DEPARTMENT OF BUILDING AND SAFETY . COUN
OFFICE DATE TIME D PERMIT NUMBER
OF RIVERSIDE
AtfRESS
v ( —tFQ—
SPACE NO.
I
OWNER
COMMUNITY
a
BUILDING
PLUMBING
ELECTRICAL
ANICAt
REMARKS:
OWNER/CONTRACTOR TEL.NO.
INSPECTION
REQUESTED
FOR:
A.M.
P.M.
MON
TU>ES
3S
a WED
rITOUR
FRI
28446 11/15
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT ~
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Contractor_'O�
Owner Architect— —. __—_ .
Address-'neddress--- Address_G: -9 E-16 �q
CityCE,/yEity-- city_ r4zC�
Phone / Phone _. _ Phone --St int!c_4if_
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
C
W
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 occupied until I (we) have
-complied with all laws of the Countv of Riverside and the State of California governing said property.
DATEy ___-d — SIGNATURE OF OWNER AND/OR A G E N
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
JOB ADDRESS j-7/=9V�JeSINGLE
FAMILY DUPLEX
z F
LE AL DESCRIPTION OF PROPERTY Z_7/ —f—��- - APARTMENTS AGRIC. E]
0 L6
H Q
COMMERCIAL INDUSTRIAL L]
j '^
C
COMMUNITY ALTERATIONS n
NO. OF SUBMITTED PLANS — US OF PERMIT
W Q
�+
r w
CASE NO.
p Z
Q 0
NO. OXKIN G SPACES REQUIRED _— N0. OF BUILDINGS NOW EXI ING
ZONE cETBACKS: FRONT SIDE REAR
J
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE N OF FEET REQUIRED ON -- _ STREET
DATE SIGNATURE OF LAND USE OFFICIAL
t
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ _STREET
t-
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
C
IMPROVEMENT? YES ❑ NO F-1
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
S
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
rn FLOOD CONTROL
t-
z AIR POLLUTION
W DIV OF HWY
o a — YOUR PROPERTY MAY BE 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 N
Effective July 1, 1980, Chapter 1301, Section 19825,of the Heilth 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: -
0 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 G / U License No. ,,,�S' s 2 / /g r
Date ss -r, Contractor is IZ, - . _ -ee- 7"/ 45.1
Q OWNER -BUILDER DECLARATION
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 comple-ion, I understand I will have the burden of proving I did not build.or
improve for.the purpose of sale (Sec. 7031.5;'8.&P.C.).
[� I, as owner of the property, am exclusively contracting with licensed contractors to
construct the Froject (Sec. 7044, B.&P.C.).
I am exempt uncer Section B.&P.C. for this reason:
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I haw_ 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
71 Certified copy is hereby furnished.
M Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
CERTI=ICATE 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 *f 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 /,?P <_ — � - R V Appl s cant
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issuec (Sec. 3097, Civ. Code).
Lender's Name
Lender's Address
DIVISION OF INDUSTRIAL'SAFETY PERMIT CERTIFICATION
0 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, faisework, 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 %ill 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 pernit to do such work
from that division.
M 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 pp scant/ gene Date
Print Applicant/Agent Name
284-2000 7/80
BUILDING PERMIT
PERMITsNO.
413111
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE DST
COUNTY OF RIVERSIDE I � IN I '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Community
s s
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
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
F
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
X)d JL Q
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
Demol. Fee
SO. FT. @ a
WATER HEATER
Branch
S0. FT. RESID @ 1'44
SEWAGE DISPOSAL
Registr. Fee $
S0. FT. GAR @ t/a
HOUSE SEWER
Witness Fee $
Reinsp. Fee
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL F
13�'
MOB. HM. FEE
MICRO FEE
MECH. FEE Pl. CK. FEE
CONST. FEE ELECT. F�EJ
SMI FEE
FEE PL -MB. FEE
-
PERMIT NO.
413111
Job Address
/ " �P,3
, v o� z i�
Space
Zip Cswner
9 A)s
Community
s s
Valuotion
S
Dote ^
V 4D
Dist
Off
F.C.C.
MH Permit Fee S
Micro Film Fee
Cop S
Use of Permit
`' tz �.ER. C
&-e �I
-
�+ V
Parcel No.
rc
/ , "
,� b ,-2vl
Use/Case No.
I
Ck. B
Mech. Fee Dbl $
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbl $
Legal Description
(�
r^�J� ��i'^
Cf� _01a
F
S
S
R
Electrical Fee Dbl S��(((\^''(((��,
Zone Reori s
l
Group
Type
SMI Fee S
Plumbing Fee
Dbl $
Bond Amt.
S
Plan No.P
Ion Checker
Fin I Dote
/ F !
"�
In p ctor
Unit
Sp. Insp. Fee $
Demol. Fee
$
Const. Lender
Branch
Supplimentol
Permit Numbers
Registr. Fee $
Mileage Fee $
Address ! City Zip
Witness Fee $
Reinsp. Fee
$
Owner/Agent
Tel.
Zip
Total Fees
$
Address.
City
Zip
M C] N. h Q Check
Received by
Coj r ctor
L
Tel.
//
! IQ
License«
Trees required,.
Sewage System
Address
kA -- a
�
City��t•••J//
A Zip
`T C y L' 1;,)-
)4 3
T LL THIS PERMIT SHALL BECOM VOld IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
L) 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.
I HE Y CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 (Rev. 1/801 RDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verllied by: