360164 (SFD). `. PERMIT NO. -
PER&ft 10.
706 i4ddress r - - -. _ .... .: . .... ...-'Spo'ce Zip
DEPARTMENT OE •BUILDING '& SAFETY;
FIELD
T
COUNT 6P RIVElift
-
.Commuriliy , l ; e, •,.- _ , _
3 6 16'4 _
F.C.C.
" MH.Perrriit Fee S 'V/
- - - -
CONSTRUCTION
ESTIMATE-'
NO.
ELECTRICAL"FEES
NO. I PLUMBING FEES
1 ST PL SQ. FT: 4
-
UNITS
'
2ND: FL_ '. SQ.. FT. @-
-
- _
YARD'SPKLR SYSTEM
_
POR Fl �.. "
MOBILEHOMf SVC .,
BAR.SINK
GAR. SQ. FT. @POWER
-OUTLET ,"
ROOF DRAINS
CAR P SQ. FT. @
i
Const,6ion,.Fee Dbl S
DRAINAGE PIPING
w�r �.
i ;r , , t
rt N ,ti S
DRINKING' FOUNTAIN
SQ. FT. Q
• h r
Elachicall.Fae; D61 $
URINAL
ESTIMATED'CONSTRUCTION VALUATION''
Group Ype
WATER PIPING
-;X NOTE: toot to -be used as property idx.valuafiom
SWIM POOL, PVL
FLOOR DRAIN.
MECHANICAL FEES
SWIMIPOOL; COMM
WATER SOFTENER
VRSfSTEAI - 'FAN": EVftiP: COO .`"'„' ,HOOD
SIGrV _ ?` `
WASHER (AUT )(DISH)
dPP,LIANCE ` RYER' =
Bond Amt:
-Plun No, ' `
GARBAGE DIS SAL
FURNACE ,-” UNITWDLL , FL • R SUSPENDED
Inspector -
t
411, LAUNDRY TRAY
AIR `HANDUNG.'UNIT : CFM
t
IDLE -METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U:
�%/��.
TEMP -USE PERMIT SVG °- ,' '
WATER CLOSET
COMPRESSOR HP
.Conif. lencle - - -•Branch,
POLE;TEMP/PERM`
LAVATORY
HEATING SYSTEM ;FORCED-. ' GRAVITY-,
39
AMPERES SERV ENT •'
11
SHOWER
BOILER, 8.x:.U..
..Mlleoge:.Fee f -
SQ:,FT: Q , "•t
BATH TUB
7;, < ,
u46.
+
SQ'. °FT` ®' -nC-rap dj
_ WATER HEATERA.
SQ, FT.,RESID @,l t/�t -
SEWAGE DISPOSAL
`
y -
SQ, FT'. GAR ®.,i.^F •'
HOUSE SEWER
Reinsp- e,e, $
OW - '�
16& -PIPING
PERMIT'FEE
PERK_11TFEE
PERMIT,FEE
DBL:
TOTrtrtA,LppFEES�+
MOB'HM`FEE
- MICRO ff€.
+. ! Wv k- -..PI. CK., FEE „
CONST:, FEE
- SMI'FEE
FEE
. .
IRA
';Received tiy.•
Contractor ...• ' t '
, �Te ; - -
License N'
Treea'r8quirBd - �es�.: ,r
�r`-. .r• � � . - .� . + ., ... . a
. �e
f Sewage•Systerri - -
A
City - Zip
. `. PERMIT NO. -
706 i4ddress r - - -. _ .... .: . .... ...-'Spo'ce Zip
Owner
3,610:16' 4
-
.Commuriliy , l ; e, •,.- _ , _
V,pjuption r _ - Date �' - _ +sr
F.C.C.
" MH.Perrriit Fee S 'V/
- - - -
3 -
ak al
.Micro Film Fee. .� Cop :
i
-
Usa/Fo o:
Ck.
Me+ch..Fee' - fir. Dbl-
PI. Ckc Fee _
et
Lot Size
Const,6ion,.Fee Dbl S
Lig ol escr pt on
F S S
R
-
• h r
Elachicall.Fae; D61 $
-
Zohe. eitriction _
Group Ype
SMi,Fee Is
-
Plumbing :Fee'. DbI $
Bond Amt:
-Plun No, ' `
- an eckerr' / 'Flno
` e
Inspector -
nil
Sp -Insp- Feq t
•S. - -�
I I��
�.s�i��"
�%/��.
.Conif. lencle - - -•Branch,
:Supplim n Permit Numbers
Regislr. Fee.' - f
-
i
..Mlleoge:.Fee f -
Address - City, --Zip.
+
Witness
.F
Reinsp- e,e, $
OW - '�
Zip
Zip
-less
v,• •
Zip "
Totol'.Feas _. -
"
:�
M O. + C. • `Cosh
Chec�
. .
IRA
';Received tiy.•
Contractor ...• ' t '
, �Te ; - -
License N'
Treea'r8quirBd - �es�.: ,r
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f Sewage•Systerri - -
A
City - Zip
--
:4410 rA
f -
11
Dow*$ 92m
THIS PERMIT SHAH BECOME.VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
verified by:
L Sewei Di' ler
FOR 120, DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
a
I HEREBY'AGREE TH Op��'THIS'.PERMIT WILL BE DONE IN ACCORDANCE WITH
THE LAWS OF`RIV Fti TY,A THR'STATE F IFORNIA
rig -
- ko ''
,i
I HEREBY CERTIFY -THAT THE,1,0 W1 PREPARED THE PlANS'AND SPECIFICATIONS HAS DONE IN '
i ACCORDANCE WITH SECTION 5541, OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
d
Form 2B4 208 (Rey.e%78)
NO.
OPERATION
DATE
INSPECTOR
NO. OPERATION
DATE INSPECTOR
13UOLDOMO APPROVALS
APPROV,%ILS
I
Set Back
7 -/9-M
33 Ventilation System
2
Ftgs 8 FrMs
--10-
34 Plenums & Ducts
2A
Slab Grade
8 r�0„�i9
35 Furnace Comport.
3
Steel
36 Inlets 8 Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
39 Appl. Clearance
7
Framing
—ZS•
40 fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
9� .T•
42 Commercial Hood
10
Fireplace
P. L.
43 Final x
l0A
Fireplace
T. 0.
ONP'N AD®OTOOMAL ONFORMAT90M
--
SEUVAGE SYSTEM SOME a LO(CAT00M
11 Exterior Loth
12 Internal Loth ,
12A Drywall I•� I ..
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Batts)
I/
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final Z x NO
PLaDMBIWO APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb —Z l
18 Vents on
19 Sewage Disposal
20 Sewer
21 Water Heater��
22 Water Softener
23 Water Service
24 Gas Test
25
Final
z.^.zri•-
Tank Pit LLine
REALS OF PROPERTY LINE
6 /
PSL L P/
[ELECTRICAL APPROVAU
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring .z -
29A_ Grounding Wire
29B” Bonding
30 Fixtures
31 Service , 7.Z ! 5,ftvoi--:t,71
32 Final
STREET NAME
1s
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT' OV BUILDING AND- SAFETY
'COUNTY OF RIVERSIDE
DISTRICT ,
Permit No
q
I
3
CANARY—'FILE, PINK—APPLICANT
— .
)C�r ,+�1 ef2:�i`,clt-'` NUL A,c • '/►:i,.�
Owner - Architect Contractor
h ++ 'S
'Add[eS< <!� l t�7 `` `_ dUa f '1' ,Address Address_
City Y� ri. - A L ( f..I� ►
Tity City_
Phnrtta •. Phone Phone
I (we) the undersigned, hereby' certify and ackreowiedge that 1 (we) have read the application and agree that if Curb and ,Gutter; and
z
- Paving; and/or Dedication of right of way is; required 15 - the County of Riverside, the. Riverside County Department of Building and Safety -
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 -1 '(we) Will not occupy said property and will not cause said property to be 'occupied until I (we) have
complied with ali laws' of the County 'of Riverside and the State of.California. governing said property,
t _ '2 �� " ' �4�'' oe
DATE SIGNATURE OF OWNER AND/OR AGENT.
-
Approval by Signature, from the Following Department 4'sted Below('"
Must Be Obtained Prior, to the Issuing of a Construction Permit. fJ
tS'PACE'NO;
•7 fS k_ USE OF STRUCTURE.
I Q
JOB-ADDRESSl lI [y DUPLEX
f I (i &w
Z
LEGA OPER
S � j APARTMENTS AGRIG.
0�f
COMMERCIAL, Q INDUSTRIAL El-
y .:
L7
OF PERMIT t;?L ` re l NO.
NO. SUBMITTED' PLANS
OF VS•E
CASE NO.
N.
p Z -
NO. OF KING'SPACES REQUIRED NO. OF'BUILDINGS NOW EXISTING -
Z
ZONE r SETBACKS: FRONT �I SIDE r REAR - Z --
m
GRADING PERMIT REQUIRED? YES NO p LOT SIZE'.
SETBACK ORDINANCQ -- OF FEET REQUIRED ON """`C `I^ STREET
DATE �_ i SIGNATGRE OF LAND USE OFFICIAL � --
DEDICATION REQUIRED: YES, - C ' NO ❑- .'y0. OF .FEET ti r�
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑- r TREET
W
CAN CURB AND GUTTER FEASIBLY BE.•INSTALLED? YES ❑ NO ❑
HAS- AN ACCEPTABLE APPLICATION BEEN' MADE- FOR ENCROACHMENT PERMIT FOR DRN_%EW AND :STREET
IMPROVEMENT? ES0.❑..
°f
DATE_ ^`..� SIGNATURE' OF ROAD, DEPT. OFFICIA -
- 7
X.
r
SEWAGE DISPOSAL, /4 , a61290 C/Aor
0
_
T
IF
WATER POLLUTION REMARK
FLOOD CONTROL
_ jar
m W' AIR POLLUTION
DIV OF.NWY
YOUR PROPERTY MAY BE SUBJECT TO
c FLOOD,` RIVERSIDE' COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
q
I
3
CANARY—'FILE, PINK—APPLICANT
— .
I ?:
a .
WEIGHMASTER'S CERTIFICATE OF WEIGHT AND MEASURE
T.his.is to ceitlfy that the following described. merchandise was weighed, measured or counted by a Private Weighmaster„and his signature Is a recognized authority of accuracy as
lirescdbed by Chapter7.3 (commencing with Section 12740) of Division 5 of the California Business and,Profeasiona Code, Administered by the Division of Measurement Standards of the
Department of Food and Agriculture of the State of California.
+ - - MASSEY SAND & ROCK CO.
i
CONTRACTOR'S LICENSE�=1769 PHONE 347.8536
INDIO PLANT ❑ PALM SPRINGS PLANT ❑ ELSfNTRO PLANT
38115 MONROE 215001NDIAN AVE f4.. 51-E. HWY.80
PHONE347-3232 PHONE 325-5222• PHONE 352-3152
❑ 43.850 MONROE ❑ OCOTILLO PIT
MSR Cust. No. MSR Job No.. GIL Item Sub Date Weighmaster No.
L fly I-(,/ I f I l I_ �.'” I 1 1 12-06130
SOLD TO z. � � `.., f � T • � . _ -
_ORDERED BY
JOB ADDRESS t
Gross -
Cement
8.
Tare VS
�.
t.
Rock
^$ V
•
i -
•
Water at Plant
Rock
• MASSEY'SAND & ROCK CO.
Private Weighmaster
yBy.ti�j•
PHONE.# OUST. JOB #
Prod. Zn Class.= Quantity Price
Amount
Codeunit
, - .:.. =•
149KMIX,
COWL TE
YD
CONCRETE
•
•
•
•
ASPHALTIC
TN
CONCRETE
•
•
•
•
SAND
TN
MIMIMUM LOAD
f
TN
SALES TAX
}
TnTO f
Driver tEmpl #. I I I
Truck # Lel Trailer# L r I I Load # II
Left Plant I Arrive Job I Start Pour
Pour Leave Job Arrive Plant
LMIXER DRUM REVOLUTIONS
Plant Job I Dlscharae
M
UNLOADINGTIME: A maximum of 5 minutes per yard of read ora maximum of` 1:5 minutes per load of dry material will be free:
Additional unloading time will be.charged 4curreht prevailing"rates.
WARNING NOTICE: Use of readymix concrete without protective clothing could cause bodily injury. Every effort should be taken t& avoid
contact with the.skin. Also, water or other=Ingredients added to this concrete may reduce�lts-strength and quality and shall.be�added only at
customer's request. Customer hereby agrees to Indemnify MASSEY from any claim arising, from such additions.
RELEASE: I hereby agree not to hold MASSEY or any of its employees liable :for damages ihside.curb or property lime caused by any of their
equipment, as I have requested delivery on the property for the material listed and.hereby acknowledge receipt of same.
CUSTOMER FtELEA'SE_SIGNATURE CUSTOMER MATERIAL RECEIPT SIGNATURE-
11,47
IGNATURE-
RIVERSIDE COUNTY DEPARTMENT OF BUILDING AND SAFETY
CORRECTION NOTICE
To: / Permit No.
Address- �� _/ /l.P 7'2f X Date:
LATH INSPECTION - U.B.C., 1973 EDITION
1.. Backing wire shall be stretched taut. Maximum spacing 6'inches vertically attached every 32
inches horizontally. [47061.
2• Add furring nails, maximum spacing 6 inches apart vertically, 16 inches apart horizontally.
[47061.
3. Wire shall lap one full mesh at all joints [4705(c)l .
4• Building paper shall cover all wood. [1707(a)] [4706(d)] .
5• Wire on exterior corners shall be pulled out minimum % inch. [4706(e)] .
& Recheck gyp, lath nailing. [Tables 47-b, 47cl .
7•: Lap cornerite minimum one mesh. [4.705(c)) .
B. Self -furring stucco wire to be attached at indicated places only. Use furring nails around all
openings. [47061.
9• Fire wall to be -perforated type lath dan approved equal. [43021.
10. Area_around.shower and tub with shower to be cement plaster. [Ord. 4571 .
11. Use metal lath .over joints where two ,or more are together. Use on voids 3/8' or more.
[4405(b)].
12: Correct'bad ceiling joist in- room. [2312(a)] .
DRY WALL INSPECTION
1. Maximum spacing single nails- Ceiling seven inches; walls eight inches. [Table 47-g] , [4705(b).] .
2. 5/8" type X gyp. board used for 1 hr. firewall; nails to be 7" o.c. Joints taped and finished.
[Table 43-b, Sec. 47111.
X 17 /VDT /6
Inspector
CORRECT THE ABOVE CIRCLED, ITEMS AND CALL FOR RE -INSPECTION
284-235. REV 4/74
RIVEASfiDE COUNTY DEPARTMEIIT OF BUILDING AND SAFETY
-CORRECTION NOTICE
To: Permit No.
Address: S 3_ 0 t/ Dated r-/7-7.
FRAME INSPECTION - U.B.C., 1976 EDITION
1. Approved plans,shall be on job for inspection. [302(b)] .
2• Changes from approved plans must; be made on all plans and approved in Plan Check. (302(a)1.
3. Add shots where indicated per Research Recommendation Card.
4. Maximum spacing of stuffs 24" p.c. [2518(f),31.
5. Horizontal" stabilizing blocks to be placed in all stud walls over 6' `in height to conform to
Ordinance 457.
6• Double.top plate joints at least.4' apart. (2518).
7• Ceiling. joist. overspan ned. [2518(k)21.
8• 3-8d nails joist, to plate. Nail top�prates together- 16d 16" o.c. 125181 Table 25-P.
9. 348d nails rafters to plate. (26181. Table 25-P.
10. Nail corner studs 16d - 24" o.c. [25181. Table 25-P.
11: Rafters overspanned,at [2518.(h)21.
12. Purlin overspenned at [2518 (h)51.
13. Slope of struts not to.be less than a 45' angle -from the horizontal. 12518(h)51.
14. Add backing at (4706(c)] .
15. Rafters do not fit'ridge-- fix. 12518(h)31.
16. Nail ceiling joist to rafters. Add cross ties, Max.4'.o.c. 11518,(h4)).
17. Add brace at [2518 & Ord. 4571.
18. Shim and nail trimmers. 12501(b)1'.
19• Metal -strap on studs and plate where pipet -are located: [2518(9)81.
20. Install windows as per approved plan. 114041.
21. Fasten post to concrete. Use "T" strap post to beam. [ 2310(e)]_.
22• Attic access minimum 22" x 30" [3205(a)] .
23. All plywood exposed to weather to be exterior grade [_32021.
'24. Replace short trimmers in [2518(9)71.
25. Foundation ventilation. [2517(06j.
26. Install sway braces in.garage. [.2312(a)].:
27: Provide flashing and counter -flashing at junction of roof and vertical surface: 13208).
28. Secure chimney straps at ceiling line to frame (1704(c)],.
29• install solid sheathing and 15 lb. feitbetween masonry and wood studs at planter. [2517(c)71.
30. Plumb all walls [2309(a)1 •
31 • Install screened attic ventilation ratio 1 to 150: [3205(c)],.
32• . Bath requires vent,to outside air.(1405(a)) .
33. Provide adequate -spat for comfort heater.
CORRECT THE ABOVE CIRCLED ITEMS
284-231 REV. 3/17
FOR RE -INSPECTION.
RIVERSIDE COUNTY,DEPARTMENT OF BUILDING AND SAFETY
CORRECTION NOTICE
To: Permit No.
Address: �.� ^ d Date: 10 " 17 -.1c
LATH INSPECTION — U.B.C., 1976 EDITION
1. Backing wire shall be stretched taut. Maximum spacing 6 inches vertically attached every 32
inches horizontally:
2. Add .furring nails; maximum spacing 6 inches apart vertically, '16 inches apart horizontally.
(47061.
3• Wire shall lap one full mesh,at all joints [47051c)),
4. Building paper shall cover all wood. [1707(a)1 [4706(d)] .
5. Wire. on exterior corners,shall be pulled out minimum 'A, inch. (47,06(d)).
6. Re -check gyp: lath nailing. [.Tables 47-b, 47-cl .
7. •Lap cornerite minimum one mesh. [4705(c).] .
8. Self -furring stucco wire to be attached ,at indicated places only. Use furring nails around all
openings. (4706).
9• Fire wall to be perforated type lath or an approved equal. [43021.
10. Area around shower and tub with shower to be approved material s.r711 (a1.
11. Use metal lath over joints where two or more are together. Use on voids 3/8' or more.
[4705(b)]
DRY WALL INSPECTION
1 • Maximum spacing single nails: Ceiling seven inches; walls eight inches: [Table 47-g) , 14705(b)).
2• 5/8" type X. gyp. board used for 1 hr. firewall; nails to be 7" o.c. Joints taped and finished.
[Table 43-b,Sec. 4711,] I.J.
" t_� r os Lt. ("IN, .�l Ed;&A ts S kbwt-_
Inspector r9tA_
CORRECT THE ABOVE CIRCLED ITEMS AND CALL FOR RE -INSPECTION
284-235 REV 3/77
0
APPLICATION -FOR TREE PLANTING
I (we), the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if trees are required under River-
side.County Ordinance No. 457, the applicant agrees to install said trees prior to final -inspection. It is understood that no fiAl inspection
will be given until said requirements hove, been met or exception has been granted by fhe County. Now, therefore, it is agreed that the prop-
erty owner shall cause the.property ,lines to be surveyed in the event no survey stakes can be found. Further, it is agreed that the County of
Riverside shall assume no responsibility should trees have to be removed due to lot line errors.
Owner's Nams
Mailing Address y
Job Address 47,3 91? C5
"
Legal Description -4 / e/
.Assessor's Map, Book & Page
Type of Soil .4; Is water available
Type of existing trees in road right—of—wo
Trees preferred by applicant (1)
Building Permit o. .36o1&.1
City Z-446tate
C.R/ (4>-09_tryQ/Z%N�ommunity Liy �V i
1 f 7 St" V L
Type Structure L L-i—Cf~.,—_
_Vd� --) Road Dept. Plot Plan No..
Date . `2 "� / Owner's Signature
Planning Commission Case No.
ROAD DEPARTMENT APPROVAL
Approved species Jacaraada acutifolia (Jacarnada) Number of trees 1
<a Spacing of trees Distance from lot lines: Front 2' in R/W Side
°'a
WAdditional requirements Per plot plan on reverse.
Date Building and Safety notified 5/79 Signitur.e
REQUEST FOR EXCEPTION
Reason
0.%-
Z I-
J
(attach additional page if necessary)
On 'A Request for hearing: YES [:1
Owner's Signature
(Forward application, to Planning Dept. if exception requested)
NO REQUEST FOR HEARING
Planning Dept.
vConcur
Non -concur M Explanation
Z G
Date
Signature
Z
Road Dept.
d a
Concur C] Non -Concur O
Date
Signature
REQUEST FOR HEARING AND COMMITTEE DECISION
z -
rr
Date hearing established
Date hearing notice mailed to owner
J W
Approved ❑' Disapproved M
Date Owner notified of decision
IL
Date Building & Safety notified
Signature
PERMIT NO. - • , Job'Addrest .. , ., ;- - Sp`,uca YpOwner
3,6..0164
- - -
PERMITNO.
'3 6,016 4
- • . ^
DEPARTMENT OF BUILDING & SAFETY
'COUNTY OF RIVERSIDE
rI Lu vrrit ¢
D
i
CONSTRUCTION
ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
14T FL. WAS
' 2ND. 'fL•
POR',
GAR.
CARP
WALL
ESTIMATED CONSTRUCTION'
SQ: FT.
SQ, FT,
UNITS
YARD SPKLR'SYSTEM
SQ FT, @ 4 do 31 ooMOBILEHOME SVC.
BAR SINK
SQ: FT. @ io 61 POWER OUTLET
SQ. FT.. @
ROOF DRAINS
,DRAINAGE PIPING
.. r "r
SQ . FT. @
DRINKING FOUNTAIN
SQ. FT. @.
URINAL
VALUATION $
WATER PIPING. "
NOTE: Not•to be used as property lax.voluation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES.
SWIM POOL, COMM
WATER;SOFTENER
VFNTSYSiEM ' - FAN•! EVAP: COO . -• - "HOOD
'• ` SIGN' -
WASHER (AUT ))(DISH)
APRLIANCE DRYER oc
An
GARBAGE DIS SAL
FURNACE UNIT WALL FLOOR SUSPENDED
lAA
LAUNDRY TRAY
AIR HANDLING:UNIT CFM
IDLE:AAETER'
KITCHEN SINK
ABSORPTION.SYS,TEM. ; B.S.U.
TEMP" USE, PERMIT SVC-
WATER CLOSET
COMPRESSOR' " HP' . `,
POLE;TEMP/PERM
LAVATORY
MEATINGlYSTEM- FORCED GRAVITY"
a AMPERES TiSERV EN
SHOWER
BOILER BT.U..
SQ.FT.. Y. c.
BATH TUB
"Plan No. P ae ck&, - f
SQ: FT. @ t
WATER HEATER
Unit
54. FT. RESID @1 /.c
SEWAGE DISPOSAL_. '
SM. FTj. GA
HOUSE SEWER
GAS PIPING
PERMIT' FEE
PERMIT FEE'
PERMIT FEE
DBL."
TOTAL FEES
MOB.HM.FEE
MICRO FEE
.. PL. CKi. FEE"
CONST. FEE, - E _- .
SMI FEE'
'
_; FEEInA
PERMIT NO. - • , Job'Addrest .. , ., ;- - Sp`,uca YpOwner
3,6..0164
- - -
- • . ^
•Chmmlinfty • "_• « . -
-V.o'1Uatlon -. • •• • • ti' Dote _ st.F:C.C.
'MH,Permis'Fee.
s
-
$ '
Mlcro-Film•Fee
Cop s.
d A"
f
Use/ o. 4kk
Ck. B
Me_ ch:.'Fae
Dbl $!
22J
IRD
A
's PI; Gk. fee
S.
-
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:Lot•Size
- Conitruction'Fee.
•. �Dbl s'
Lega escrip ion -
_
F . - S S. R
lAA
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Elettr(caLFeio
Dbl s:
'- -
Zane estrictiont
Group ype
SMI Fee'
s
-
- -
Plumbing, Fee
Dbl' V '
Band "Amt.
"Plan No. P ae ck&, - f
Finn "� --,_e
l or
Unit
Spr Insp;'Fea'
_-
///
D'emol'.'Unit-
LenderSupplitnental
Permit'Numbeis
riRegitl?: Fee
s
:. Mllgdge Fee
_
s'"
Aadr? - City ZIP
•
I
.''Wiilnest'Fee
s;,
.✓� l ^ 1
r.
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THIS PERMrr SNALI BECOME,VOID IF -WORK IS NOT COMMENC� WITHIN 120 DAYS• CESSATION OF WORK veriFie(1 by:
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FOR 120'DAYS SHALL. ALSO ' USE PERMIT TO BECOME"VOID. '
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I HEREBY AGR IOPIrOVITH THIS'PERlJIR WILL BE GONE IN ACCORDANCE WITH
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LAWS OF RIYERSI, NTY T' STATEOF CALIFORNIA ,.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAIi D THE PLA AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCE WITH SECTION 5541', OF 711, i SINESS' PROFLSSIONS CODE OF THE.STATE OF CALIFORNIA.
Form"384708'(Rev,l3%7B)