418334 (BLCK)PERMIT NO.
418334
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
lRL'�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST fl.
2ND. FL.
_ FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
UNITS
Valuation
$
SQ. FT. @
YARD SPKLR SYSTEM
MOBILEHOME SVC.
SQ. FT. @
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. 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
Final Date
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Sp. Insp. Fee $
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.
SQ. FT. @ c
BATH TUB
Contractor )
f—_,6-' 1,,.f e"f
SQ. FT. @ c
WATER HEATER
Trees required
S0. FT. RESID @1'/.c
SEWAGE DISPOSAL
CityZip
f '
S0. FT. GAR @ 1%C
HOUSE SEWER
Sewer District
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
,Ir
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
o d
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
14183341
Job Address Space
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ner
Community
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Valuation
$
Date Dist.
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Off
F.C.C.
MH.Permit Fee $(,K
Micro Film Fee Cop $
Use of Permit
(3 J
Parcel No.3 /, //
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Use/Case No.
Ckk.. yBy
(.T
Mech. Fee Dbl b
PI. Ck. Fee $
Set BacksLot
Size
Construction Fee Dbl
$ Electrical Fee Dbl $
Legal Description F
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..Z ! 16 '11¢
S Sp1ro-P
Zone Restrictions
Type
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
Final Date
Inspector
Unit
Sp. Insp. Fee $
Dental. Fee $
Const. Lender Branch
Supplimental Permit Numbers
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel. Zip
Total Fees $ (,46
'Address
City Zip
M.O. N.C. Cash Chec
Received by i
Contractor )
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Tel.
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License#
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Trees required
Sewage System
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Address /} / /
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THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
6!-1
1 HEREBY AGREE THAT ALL WORK IN CONNECTION_VtSITRTHIS PERMIT WILL BE DONE IN ACCORDANCE WITH
Sewer District
Irlt LAWS OF KIVCKJIUt I.UUNIT ANU IFIL WAIL UF,',;ALIFUKNIA.
EJ l I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREF'AI ED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND'PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
I
Set Back
33
Ventilation System
2
Ftgs 8 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. 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.
NON
T
ADDIITION/AL( INFORMATION
,
_ _
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 Z,.-
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
PSL ,P/
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT •v
Permit No
284 199A 9/74 'Y_- CANARY—FILE, PINK—APPLICANT
-Owner' . %� Architect__ —. ___ Contractor_
,fir; rte, vv6z- 2
'`"� Addretss —_ Address___ Address./-�[!��'��,y,;
Ciry_— City_�_t_� `—
Phone Phone _ Phone—t-zv
W
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 work is to be done within the County R/W
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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 wii�th all laws of the County of Riverside and the State of California governing sat pro-peerjty.
I
DATE - SIGNATURE OF OWNER AND/OR AG NT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit
1 SPACE NO.
JOB ADDRESS �/ S, f/ Lel i �' r1i— r"�- L S 3 USE OF STRUCTURE
ZNGLE
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FAMILYi]" DUPLEX
LEGAL DESCRIPTION OF PROPERTY =° _ /�
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g 1—�-5� — v / APARTMENTS AGRIC.
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/-�-- COMMERCIAL Ej INDUSTRIAL ❑
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COMMUNITY ALTERATIONS ��
NO. OF SUBMITTED PLANS USE OF PERMIT
j Q
CASE NO.
l7
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NO. OF PARKING SPACES REQUIRED .—_ NO. OF BUILDINGS NOW EXISTING _
Q
ZONEr SETBACKS: FRONT SIDE REAR
J
Co
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATE `�
SIGNATURE OF LAND USE OFFICIAL
f
v
F
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -- —
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
09H
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
r
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HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
C
IMPROVEMENT? YES ElNO El
°C
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
—
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
H FLOOD CONTROL
t -
Z AIR POLLUTION
� W
= � t - DIV OF HWY
c a — YOUR PROPERTY MAY BE SUBJECT TO
LU
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD..
284 199A 9/74 'Y_- CANARY—FILE, PINK—APPLICANT
DEPARTMENt OF BUILDING AND SAFETYj. APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT it
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.
0 LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of then Business and Professions Code and my license is in full force and effect.
B
License Class C — 13 License No. 3S & 9-1/9
Date 4/a I -e5 7 —01 Contractor L )cE/l CC"' 3700- C! /< C 1-),e C,4e/o 10 ►7?C.n
O ,
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.).
Q 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
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. )(U)0 /3 ,5`'F / . Insurance 6WO o r`'p(,yo ( �/ Lvc 61!
0 Certified copy is hereby furnished.
0! Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date L//201 g / Appl icant (der F7diCP _ .51` t e &. C D -PO. 0e)
Q + 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 l.abor 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
n 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 in 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.)
0 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. r
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 y Applicant/Agent ' ate
`5,uCl QoLv) �Ae -evI-e
Print pp cant/ gent Name
284-2000 7/80
BUILDING PERMIT
PERMIT
3
4 80334
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
/Sr/
COUNTY OF RIVERSIDE r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
UNITS
SQ. FT. @
YARD SPKLR SYSTEM
MOBILEHOME SVC.
SQ. FT. @
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. 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
Construction Fee Dbl $
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. @ c
BATH TUB
Sp. Insp. Fee $
SQ. FT. @ c
WATER HEATER
Const. Lender Branch
SQ. FT. RESID @1'/.c
SEWAGE DISPOSAL
SQ. FT. GAR @ 3/4 c
HOUSE SEWER
Mileage Fee $
Address City Zip
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. yyFEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
14183341
Job Address ,
S �� ��/�. �.le,t
Space
Zip
caner
ccommunity
V
Valuation
Date
Dist.
F.C.C.
MH Permit Fee $
Micro Film Fee C0 $
Use of Permit
't �''
�{� I�+J M„� �
Parcel No. / %'
/ / ��1w./
Use/Case
No.
Ck. Byte\^
Mech. Fee Dbl E
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbl $
Legal Description
L ! / 47 4
V C7�) r�I_
�� V 4 e>•^'—'
F S S R
Electrical Fee Dbl $
Zone Restrictions
""
Group
Type
SMI Fee $
Plumbing Fee Dbl $
Bond Amt.
$
Plan No.
Plan Checker
Fina Date
Ins for
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 $
4/
Address
City
Zip
M.O. rN.C. Cash EI Chec
Received by
Contractor �'/,.�� % �J rw+�/y ')
�. r`" L `�� G J / 1✓ C..
Tel. `w+^
` .,5 M �jI
Licensse##
Trees required
Sewage System
Address /�
%4//,f �A� �.� j�e
Cit
y t- -(ale 4., -eiP
Z
T LL P
$ewer District
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
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.
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.