413113 (PLBG)PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
13113 COUNTY OF RIVERSIDE FIELD V
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
.
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Dote ,�•r
~ sJ •�(%
50. FT. @ YARD SPKLR SYSTEM
Off.
SO. FT. @ MOBILEHOME SVC. BAR SINK
MH Permit Fee §
50. FT. @ POWER OUTLET , ROOF DRAINS
Cop S
SO. FT. @ DRAINAGE PIPING
ParcelNo. �J /; r^�
/ 7 41/ v 0Com`
SO. FT. @ DRINKING FOUNTAIN
No.
50. FT. @ URINAL
Mech. Fee Dbl S
VALUATION $ WATER PIPING
Set Backs
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Legal Description
� �, / � 's � 4 �
r! IJ'..F- t,
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
Electrical Fee Dbl §
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
Type
APPLIANCE DRYER
Plumbing Fee
GARBAGE DISPOSAL
nd Amt.
S
FURNACE UNIT WAIL FLOOR SUSPENDED
Plan Checker
LAUNDRY TRAY -
InI for
/(N7.Ch/
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
Demol. Fee
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
Witness Fee §
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
Tel.
BOILER B.T.U.
SO. FT. @ a
BATH TUB
$
ddressI/ /•
c
/ " y.
SO. FT. @ a
WATER HEATER
M.O. .C. ❑i Cash C] Check
Received b
50. FT. RESID @ 1 U<a
SEWAGE DISPOSAL
Liccennsse# /
Trees r � �„f "7r+
S0. FT. GAR @ Y44
HOUSE SEWER
Address
�f %r �� i' l ! sem''• r
City
/c.. i1 ,s F !C,
Zip
rf �•
/ GAS PIPING
j
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAFEES
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FE --
PERMIT NO.
413113
lob Address - r Space
A— ' �� tic � c'��Tr� �� �
Zip
A��'
Owner
x�����s•�.�%v
Community
�+ ;%, iy / i9 /
Valuation
S
Dote ,�•r
~ sJ •�(%
Dist.
17
Off.
F.C.C.
MH Permit Fee §
Micro Film Fee
Cop S
Use/of Permit �+-
y` -.1r'• .� . • �':' I cl r.%4✓L !'�
ParcelNo. �J /; r^�
/ 7 41/ v 0Com`
Use/Case
No.
Ck. By
Mech. Fee Dbl S
PI. Ck. Fee §
Set Backs
Lot Size
Construction Fee Dbl S
Legal Description
� �, / � 's � 4 �
r! IJ'..F- t,
F
S S R
Electrical Fee Dbl §
Zone Restrictions
Cf "•
Group
Type
SMI Fee S
Plumbing Fee
Dbl S `
nd Amt.
S
Plan No.
Plan Checker
Final Dotpe, pp
/ a�
InI for
/(N7.Ch/
Unit
Sp. Insp. Fee §
Demol. Fee
§
Const. Lender Branch
upp mental Permit Numbers
Registr. Fee §
Mileage Fee $
Address City Zip
'
Witness Fee §
Reinsp. Fee
§
Owner/Agent.'
Tel.
Zip
Total Fees
$
ddressI/ /•
c
/ " y.
City
Zip
M.O. .C. ❑i Cash C] Check
Received b
l
Contractor /feI '�
G /. ;< er+-
Tel.
Liccennsse# /
Trees r � �„f "7r+
Sewage System
"+
Address
�f %r �� i' l ! sem''• r
City
/c.. i1 ,s F !C,
Zip
rf �•
T LL THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified Eby:
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
�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.
H ERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 t6Rev. 1/80) ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
t .,
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS,--,
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slob 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. 0.
El
°o
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE 8t LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Botts)
12C Ceiling (B own)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Wafer Heater
22 Water Softener
23 Water Samice
24
zs
Gas Test
Final
a�-°-
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
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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
Owner Architect Contractor 21ALt
Address JAddress___ Address
City � �- City—_ City_ 4 -
' �� /� Phone
C
cc
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 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 occupieduntil I (we) ave
complied with all laws of the County of Riverside and the State of California governing said property.
r
DATE.-- --- SIGNATURE OF OWNER AND/OR AGENT le_ —
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
5 I SPACE NO.
v� I USE OF STRUCTURE
►„�V
4'T I
JOB �
ADDRESS J—_011.
-- SINGLE FAMILY DUPLEX
LEGAL DESSCCRRIPTION OF PROPERTY �! _/ �
Z t-
� APARTMENTS AGRIC.
0 Q
COMMERCIAL INDUSTRIAL
'^
COMMUNITY . 4 A _+.oq
L�ERATIONS n
Z
NO. OF SUBMITTED PLANE — USE OF PERMIT
jCASE
NO.
p Z
NO. OF PARKING SPACES REQUIRED .— NO. OF BUILDINGS NOW EXIST] _
Q _0
ZONF/'�SETBAeKS: FRONT SIDE REAR
J
m
GRADING PERMIT REQUIRED? YES 0 NO ❑ LOT SIZE
SETBACK t5DINANCE 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
1
F-
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
QO
IMPROVEMENT? YES ❑ NO ❑
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
_
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
FLOOD CONTROL
h
z AIR POLLUTION
W
= H DIV OF HWY
c a — YOUR PROPERTY MAY BE SUBJECT TO
�� c• _. FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APDLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT #
Effective July 1, 1980, Chapter 1301 Section 19825,of the Health 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; -
IS 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 . 9-1 License No. �l/� L/
Date 17101 L,9 Contractor I10d Z �„•ti,�l//, ,
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 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.).
IMI
Date
am exempt under Section
B:&P.C. for this reason:
[�] WORKERS' COMPENSATION DECLARATION
1 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
[J Certified copy is hereby furnished.
EJ Certified copy is filed with the County of Riverside, Department of Euilding and Safety.
Date Applicant
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, 1 shall not employ
any person in any manner so as to become subject to the Workers' Compensation lews of California.
I further understand that if after making this Certificate of Exemption, i Ihouid become subject to
the Workers' Compensation provisions of the labor code, I must forthwitVcomply with such provisions
or this permit shall be deemed revoked. 1 �j���/
Date 1 L/l.Qn Applicant if�i C
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 i6 connection with work authorized by thi3 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 correct. I agree to
comply with all state laws and count ordinances relating to building construction, and authorize a
representative of thg County of"Riverside, Department of Building and Safety to enter upon the pro-
perty for'whirch%I have p'lie'd ford this permit for the purpose of making inspections.
Signature of pp icantJ gent
lsrintApplicant/Agent Name
284-2000 7/80
BUILDING PERMIT
PERMIT NO.
413113
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE/ -1
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Owne. '
Community
'4
SO. FT. @ YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC. BAR SINK
SO. FT. @ POWER OUTLET ROOF DRAINS
Dist
SO. FT. @ DRAINAGE PIPING
F.C.C.
SQ. FT. @ DRINKING FOUNTAIN
Micro Film Fee
SQ. FT. @ URINAL
Use of Permit
j '4 3
VALUATION $ WATER PIPING
ParcelNo. .ry
` / ^' /7 � — 0;2
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Mech. Fee Dbl S
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
lot Size
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
F
APPLIANCE DRYER
R
GARBAGE DISPOSAL
Electrical Fee Dbl S
FURNACE UNIT WALL FLOOR SUSPENDED
Group
LAUNDRY TRAY
Type
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
nd Amt.
S
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
Sp. Insp. Fee S
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
Branch
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Registr. Fee S
Mileage Fee S
SO. FT. @ a
WATER HEATER
Reinsp. Fee
§
SO. FT. RESID @ I t%c
SEWAGE DISPOSAL
Tel.
S0. FT. GAR @ 3/4a
HOUSE SEWER
Total Fees
$
ddress
V f f
/ GAS PIPING
City
PERMIT FEE
M.O. .C. Cosh Q Check
PERMIT FEE
PERMIT FEE
5zocC
DBL.
TOTAL FEE,
I MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE
PLcM FEE—'
PERMIT NO.
413113
Job Address
- (JX J !✓/
Space
� /// r= --
Zip
Owne. '
Community
'4
-/
j% �V+g r
Valuation
S
Date
Dist
Off.
F.C.C.
MH Permit Fee S
Micro Film Fee
Cop S
Use of Permit
j '4 3
.� f N 7'U u�a� rr
ParcelNo. .ry
` / ^' /7 � — 0;2
Use/Case
No.
Ck. By
/.,,� ''r .
Mech. Fee Dbl S
PI. Ck. Fee S
s Set Backs
lot Size
Construction Fee Dist S
%
�' Ci r 'r '^� /y�
Legal Descriptionr LlJ
"' C . c{ e" }
F
5 S
R
Electrical Fee Dbl S
Zone Restrictions
� /
/
Group
Type
SMI Fee S
Plumbing Fee
Dist Is �..
nd Amt.
S
Plan No.
Plan Checker
Final Dote
/Z —91- �j
Ins actor',&
Unit
Sp. Insp. Fee S
Demo$. Fee
S
Const. Lender
Branch
Supplimentol Permit Numbe s
Registr. Fee S
Mileage Fee S
Address City Zip
Witness Fee §
Reinsp. Fee
§
Owner/Agent
1
Tel.
Zip
Total Fees
$
ddress
V f f
City
Zip
M.O. .C. Cosh Q Check
Received
Contractor
,r, /
v / L�r'l ,/ 1� ' '� r ft,,..
Tel.
/✓ f /
LicenseR
/G' G`
Trees
Sewage System
Address
City
Zip
T LL 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.
G[/l Gid' y/�[ I F CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-201 (Rev. 1/80) / re-eWITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by: