413967 (MISC)BUILDING PERMIT
PERMIT NO.
413967�c
PERMIT'NO.
1413967
Job Address ,(//�/�
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DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
.
Owner
4^✓ �/
DST
/!
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR. -
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
F.C.C.
MH Permit Fee $
SQ. FT. @ YARD SPKLR SYSTEM
Cop S
SO. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
Use/Case No.
SO. FT. @ - DRAINAGE PIPING
Mach. Fee Dbl S
SO. FT. @ DRINKING FOUNTAIN
Set Backs
SQ. FT. @ URINAL
Construction Fee Dbl SF
VALUATION $ - WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
Electrical Fee Dbl S✓
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
SMI Fee S
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
Plan No.
APPLIANCE DRYER
Final Date
GARBAGE DISPOSAL
Unit
FURNACE UNIT WALL FLOOR SUSPENDED
Demol. Fee
LAUNDRY TRAY
Const. Lender
AIR HANDLING UNIT _ CFM
IDLE METER
KITCHEN SINK
Mileage Fee S
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
�/D {�
BOILER B.T.U.
SO. FT. @ a
BATHTUB
SQ. FT. @ a
WATER HEATER
Licensee
Trees req ' e
S0. FT. RESID @ 1 t%a
SEWAGE DISPOSAL
Address
-
S0. FT. GAR @ a/4a
HOUSE SEWER
GAS PIPING
U
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
ZTA&V
MOB. HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE
9MBsm
PERMIT NO.
413967�c
Job Address ,(//�/�
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/ �•+/ /.
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Space Zip ."
j� +'• '
Owner
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Community
'LIP &1%C
Valuation
Dote l
Dist.
F.C.C.
MH Permit Fee $
Micro Film Fee
Cop S
Use S Permit
Parcel No.
- / (/ v.l IS45-
Use/Case No.
Ck/.By
Mach. Fee Dbl S
PI. Ck. Fee $'
Set Backs
Lot Size
Construction Fee Dbl SF
t/J /J (/
- a f d
S S
R
Electrical Fee Dbl S✓
Zone e s
Group
Type
SMI Fee S
Plumbing Fee
Dbl S
oBond Amt.
S
Plan No.
Plan Checker
Final Date
Insp or
Unit
Sp. Insp. Fee S
Demol. Fee
S
Const. Lender
Branch
Supplimental Permit Numbers
Regisir. Fee S
Mileage Fee S
Address f City Zip
rt �/ �y ; T r 1)17 r f
Witness Fee S
Reinsp. Fee
$
Owner/Agent j
(/�
Tel. Zip
Total Fees
S 5a
Address
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City n , J 4"'�'i. Zip
/V i .✓ .
M.O. E] N.C. ❑ Cash Check
Received byContractor
-
Tel.
Licensee
Trees req ' e
Sewa a System
Address
-
City Zip
T �. P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
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.
RER Y C FY THAT THE INDIVIDUAL WHO+REPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284208 (Rev. 1/80) E WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
BUILDING PERMIT
PERMIT NO, DEPARTMENT OF BUILDING & SAFETY
413 9 6 7 COUNTY OF RIVERSIDE FIELD Dsr
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Ari ma
1ST Fl.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Community %%
1_./Vt l�/.1%/'.V
SQ. FT. @ YARD SPKLR SYSTEM
Valuation
S
SQ. FT. @ MOBILEHOME SVC. BAR SINK '
Date
SO. FT. r@ POWER OUTLET ROOF DRAINS
O/fj.-' -I
SQ. FT. @ DRAINAGE PIPING
MH Permit Fee 5
SQ. FT. @ DRINKING FOUNTAIN
Cop $
SQ. FT. @ URINAL
/i'�✓ " f 1T/tr✓f%�Gr
VALUATION $ WATER PIPING
Parcel %Nam% ° /
/ /'fJ.�I
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
PI. Ck. Fee S
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
Construction Fee Dbl S
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
S R
APPLIANCE DRYER
Zone e s
GARBAGE DISPOSAL
Type
FURNACE UNIT WALL FLOOR SUSPENDED
SMI Fee S
LAUNDRY TRAY
Dbl S t
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
Plan Checker
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
Const. Lender
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Witness Fee $
Reinsp. Fee
SQ. FT. @ a
WATER HEATER
'
(
S0. FT. RESID @ 1 t/aa
SEWAGE DISPOSAL
Total FeesS
S0. FT. GAR @, t/4a
HOUSE SEWER
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IJ
Of /� /t/7 g s
'VXi
GAS PIPING
M.O. E)N.C.❑ Cosh Check ❑/
PERMIT FEE
PERMIT FEE
PERMIT FEE
J
DBL.
TOTA�..FEE$
Mor OB. HM. FEE
MICROFEE
MECH. FEE PL. CK. FEE
CONST. fEE ELECT. FEE
SMI FEE
FEE Pl
B,QFE
PERMIT 110,
F4139 6 7
_ __ __ _ —
_lob Address -__pace
5/ �, s
Ari ma
�L�o a
Zip Owner
= S- -Zrr tr / ,
Community %%
1_./Vt l�/.1%/'.V
Valuation
S
Date
Dist.
O/fj.-' -I
F.C.C.
MH Permit Fee 5
Micro Film Fee
Cop $
Use A Permit
.7 ry .) /�
/i'�✓ " f 1T/tr✓f%�Gr
cam'
Parcel %Nam% ° /
/ /'fJ.�I
Use/Case No.
Ck. By
Mech. Fee Dbl $
PI. Ck. Fee S
Set Backs
Lot Size
Construction Fee Dbl S
Legal D cription
yJ T
S V
- i /^//,
/ ��/
h' e -e / 1
F S
S R
Electrical Fee Dbl S
Zone e s
Group
Type
SMI Fee S
Plumbing Fee
Dbl S t
and Amt.
S
PIon
No.
Plan Checker
Final Date
Inspector
Unit
Sp. Imp. Fee S
Demol. Fee
$
Const. Lender
Branch
Supplimentol Permit Numbers
-
1XN J
Regist, Fee S
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee
$
Owner/Agent
'
(
Tel.
Zip
Total FeesS
=
Address
�
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IJ
Of /� /t/7 g s
'VXi
Zip
M.O. E)N.C.❑ Cosh Check ❑/
Received by
Contractor
Tel.
Licenselt
Trees recl j e'
sewn System
I• r tdif
Address
-
/ •
City Zip
T Ltej,,1`'41P P 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. 1
CI• 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.
k
i 16 THAT THE INDIVIDUAL WHO'?REPARED THE' PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 484•208 (Rev. I/80( CCE WITH SECTION 5541 OF THE BUSINESS.'AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
w,
verified by:
NO.
OPERATION
DATE
INSPECP16R 'NO.
OFERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
ventilation System
2
Ftgs & Frms
34
Rlenums 8 Duct:
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Nets 8 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
Emoke Detectio■ Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
.ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE S LOCATION
11 Exterior Lath
12 Internal lath
12A Drywall r
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 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 11-47-81
25 C FinalZ 1_ /
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
'
PSL P/
26 Power Pole
27 Conduit 1
28 ( Service Entrance ,
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
DEPARTMENT OF BUILDING AND' SAFETY �?
COUNTY OF RIVERSIDE' s :�
OWNER -BUILDER INFORMATION
Dear Property, Owner.:
An application fora building permit has been s bmitted in your name listing yourself as the builder
of the, -property improvements specified. _ A
For your protection you should be aware that as owner -builder you are the responsible party of re-
cord on such'a permit. Building permits are not required -.to be signed by property owners unless
,they are personally performing their own work. If your work is being performed by someone•other
-,than yourself, you may protect yourself from possible liability if that person applies for the pro-
-t= 'per permit in his or -her name.
Contractors are required by iaw to be licensed and bonded by the State of California;and, where
required, to have a business license.from the city or county. They are also required by -law to put
their license number on all.permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to -subcontract,
you should be award' -6f the following information for your benefit and protection.
_If you employ or'�,otherwise engage_ony,persons other than your immediate.family, and -the work
(including materia -hs and.other'..costs is $200 or'more for the entire project, and such persons, -are
not licensed as.c6pi'l actors or subcontractors, then, you may be an employer.
J`"•"If you are ,ar,; employer; y'U,, st st ;with thestate and federal government as an employer and
you are subject to several'obligations including stte and federal income tax,wi'thhol:ding, federal
social security taxes, workers' compensation insurance, disability insurance costs, and unemploy-
ment compensation contributions.
,z '. w :+
There -may be.financial=risks for -you if you.do not carry out -these obligations, and these risks are
especially serious, wid respect to workers'.compensation insurance.
For more specific'information about your obligations under federal law, contact the Internal Revenue
Service (and, if,you wish, the'U.S. Small Business Administration). For more specific information
about your obligations under state law, contact the Department of Benefit Payments and the Division
of Industrial Accidents-',.:,-
If the structure is intended for sale, property owners who are not licensed contractors are allowed,,,,-,.
to -perform their work personally or .throughtheir own.emp.loyees, without a licensed contractor or ,
subcontractor, only under limited. conditions . - z3` _"";•
A frequent practice of unlicensed persons professing.to be contractors i -s to secure ani",,4 e1`
.builder!' -building permit',,erroneously implying that the property owner is.provelay.04 or tier own•.
labor and material, personally. "Building permits are not required to be'.signeeddyby:�.,,operty owners'
unless they are performing.,their -own work personally.
Information about licensed contractors may be•obtainedsby-;conontractor's' Stale 11 cense
Board in your community or at 1020 N Street, Sacr'amentolll 95814.
Please complete and return the enclosed-owner-bdj-10r vert"fication form°so that ,we can konfirm..fhat
you are ' aware of these matters. The bui 1 di rig' permi t w.i 'not be '..sued; unti 1, tfie veri,fA cati on is
returned. i . " �• �!'.,3"� `_
Sincerely, -
e`
DEPARTMENT OF BUILDING AND SAFETY.
<IIIrS„��� Sl,• ref r ,.• '� { .'
Leopoldo Rojo, Jr.
Dpi rector. ' • r. .,qr
284-2001 7/80
plj
DEPARTMENT OF BUILDING'AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATION
r
Address
An "owner -builder" building permit has been applied for in your name and bearing
your signature. •
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuin!+your
building permit. No building permit will be issued until this verification is
received.
1. I personally plan to provide the major labor and materials for con-
struction of the proposed property improvement (yes or no)
2. I (have/have-not) signed an application for building permit
for the proposed wort.
3. I have contracted with the following person (firm) to provide the pro-
posed construction:
Name Phone
Address City
Contractors License No.
4. J plan "to prov.i de 'porti oris of, ,the wtbrk,+ but I have ,hi red the following
,person to coordinate,1su0ervi"se,-and provide the major work:
Name Phone
Address City
Contractors License No. `r
;. 5. I will provide some of the work but I have contracted (hired) the fol-
lowing persons to provide the work indicated:
Name Address Phone Type of work
y
Signatures Property Owner Date
AT Security Number
284-2002 7/80
f ? NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT,
:._ DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
..: ,•.� .fix r�_x .• w
,
-
;Ct
y
Addr�s� V .,11 i t;f1�,F �1,�ZAddress_ 1,`ir f
A
4 ddress_
Cit -51-r-44 --rt .:,, rl<t v",Ilvrncit ,h�
Yy Y � - - '•.,City
DISTRICT
Phone l- �/-IJAf I r` Phone f ti'4 Phone ' e
'Permit No
-
�` �,. I (we) the undersigned, hereby certify and acknowledge that I (we) have read the aDGlication 'arid agree that' if CuOtry.and `Gutter; and
�
- W
Z
Paving;,and/or Dedication of right of way is required by the County of Riverside, the Riverside C,pj.(nty Department' of rBu lding and Safety"
3
shall n�t 'make a Final Inspection until said requirements have been met. I am also awareT.that,no;,, ork is to be 0one,within the Couhty•R/W
284 199 9/74 " - CANARY— FILL ,_. PINK-, APRLtCANT f*
OwnerA°rc#titect " 'Contractor. {
y
Addr�s� V .,11 i t;f1�,F �1,�ZAddress_ 1,`ir f
A
4 ddress_
Cit -51-r-44 --rt .:,, rl<t v",Ilvrncit ,h�
Yy Y � - - '•.,City
Phone l- �/-IJAf I r` Phone f ti'4 Phone ' e
-
�` �,. I (we) the undersigned, hereby certify and acknowledge that I (we) have read the aDGlication 'arid agree that' if CuOtry.and `Gutter; and
�
- W
Z
Paving;,and/or Dedication of right of way is required by the County of Riverside, the Riverside C,pj.(nty Department' of rBu lding and Safety"
3
shall n�t 'make a Final Inspection until said requirements have been met. I am also awareT.that,no;,, ork is to be 0one,within the Couhty•R/W
O,
without?,.n encroachment permit. �. ;
• -
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property J, 6 be•oc�upied untilI (we) have-•"(i,�
complied with all laws of the County of Riverside and the State of California governing said property. •,�� '•'
�'j f a rl
DATE SIGNATURE OF, OWNER AND/OR AGE
Approval by Signature from the Following Departments Listed Below,
Must Be Obtained Prior to the' Issuing of! a.Coiistruiaion .Permit.)", y .
SPACE NO.
USE OF STRUCTURE, r .
~JOB
ADDRESS _ !! SINGLE FAMILY DUPLEX
/{ +-��� �«.
}
Z F
LEGAL DESCRIPTION •6�F/PR PERTY" l�rc �rE. • i / INA
r-, APARTMENTS,.
w u , ,i — .� �- APARTMENTS, AGRIC..
-^
O
in Q
- r - .y -
-+' •-- �_ qa' +,5 f c.i• , ,p; - '+" COMMERCIAL 'INDUSTRIAL. •'_ C1
'^
COMMUNITY
a• r ALTERATIONS C
`
O Z
N0.}OF�UBMITTED PLANS — USE O�RERMI�} f - f �"�%--°%' = • _
CASE NO.
O Z
NO. OF PARKINGJPACES REQUIRED -? NO. OF BUILDINGS NOW EXISTING -
Q
Y .
ZONE f1_ SETBACKS " FRONT, C `} SIDE REAR,
j �f
+]j)�GR DLt=GsPEI I�T;REQUIREO?;�'r fESx ty�JV �*f k OT SI7rE i x. r t: } - 1 '.
-' •
Y. %.�•Yi S1 f i!• i
SE BACK OR ANCE # OF "` F T R OUI'RED ON ST EET
s
f
DATE —" SIGNATURE 0F'LAND.USE OFFICIAL
F
DEDICATION REQUIRED: YES' [-INO:p N01p 6F FEET.__' ;?
W .
CURB.AND GUTTER'. REQUIRED: YES p. -'NO, : —STREET '
y •r
CAN CURB AND GUTTER FEASIBLY BE `INSTALLED. YES ❑ NO.❑
r
HAS AN ACCEPTABLE APPLICATION 'BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND. SIT
Q
IMPROVEMENT? YES ❑ NO'E] n n 'x r �ti z 3
°L
DATE SIGNAT6RE -OF ROAD DEPT. OFFICIAI —"-- -= " iv
__
i
S
SWIMMING POOLS PUBLIC t•
•u
SEWAGE DISPOSAL t ' f•
= C
FOOD ESTABLISHMENT k A
e
I
WATER POLLUTION �`} .REMARKS
i FLOOD CONTROL
Z A R*POLLUTIONwo
_ DIV OF HWY'•
?: c' a . - PROPERTY MAY BE SUBJECT T�01,'
— JYOUR
FLOOD. RI.VERSIDE.000NTY,ASSUMES }�
,4 J; -
A NO RESPONSIBILITY IN EVEtJT OFLOD::'
284 199 9/74 " - CANARY— FILL ,_. PINK-, APRLtCANT f*
-DEPARTMENT OF BUILD&NG'AND SAFETY �,. APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT q
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,:'
[� 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 Lice6se,No.
Date Contractor
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lawafor, the following reasons:
[� I, as owner of the property, or'my employees with wages as thei,r.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.). s,
0 I, as owner of the property, am exclusively contracting with licensed contracrtor-s t6
construct the project (Sec. 7044, B.&P.C.). ==,
Q I am exempt under?Section B.r1&P.C. for this reason: ' r
Date 7 /�;') 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 thereof4(Sec. 3800, Lab. Code).
Policy No. Insurance
0 Certified copy is hereby furnished.
Certified copy is filed with the Countytof Riverside, Department of Building and Safety.
Date Applicant
M 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,theiwork for which'.,this permit is issued, I shall not employ
any person in any manner so as to'become subj'6A to=the'Workers' Compensation lamiof Californiaf
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 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).i
Lender's Name �{
Lender'.s Address 4 �"
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ~�
Q I'hereby certify that no excavation five (5) or more feet in depth into which a person is re- s
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, .0-11 be
more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title.8',9C.A.C.)
[� As owner-builder, I will not employ anyone to do work which would requ`i're a,permit from the
Division of Industrial Safety, as noted above, unless such person has aipermit to do such work
from that division.
Q Division of Industrial Safety Permit No.
Date Applicant '
CERTIFICATE OF COMPLIANCErAND AUTHORIZATION OF ENTRY
s
I certi-fy I have read this application and state that the information given is correct. I agree to
complytwiih 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 havvveelapplied for this permit for the purpose of making inspections.
ig ature o pp scant, gent._ Date
rent pp scant/ gent Name+�
� zli84-2000 ' 7/80