399421 (BLCK)BUILDING PERMIT. —
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY FIELD
13-994,21 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
t
-
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
' 2ND. FL.
POR.
GAR. _
CAR P.
WALL rSQ.
'
ESTIMATED CONSTRUCTION
SQ. FT. @ $
Valuation
S /C/;✓ •:/
UNITS
Dist.
-/
SQ. FT. @ ' ' •
YARD SPKLR SYSTEM -
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT': @ POWER OUTLET
ROOF DRAINS
so. FT. _
DRAINAGE PIPING i
�
FT. @J
DRINKING FOUNTAIN c
SQ. FT. @
URINAL
VALUATION $
WATER PIPING _
NOTE: Not to be used as property tax valuation
S S
SWIM, POOL, PVT
��� FLOOR DRAIN
MECHANICAL FEES
Zone Restrris s
'A
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
Plumbing Fee D61 S /
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
Final Dote
(/ �%
t
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Demol. Fee S
Const. Lender Branch
LAUNDRY TRAY
AIR HANDLING UNIT CFM
Mileage Fee $
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
Owner/Agent
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
Address y 'r J
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
Contr ro l
1� .40J_
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
Sewage System
Sewage
SQ. FT. @ a
BATH TUB
t
SO. FT. @ a
WATER HEATER
50. FT. RESID @ 1 t/4a
SEWAGE DISPOSAL
SO. FT. GAR @ s/a ' (
HOUSE SEWER
-
L
GAS PIPING
PERMIT FEE ,
PERMIT FEE s
PERMIT FEE
DBL .
TOTAI tF S)
MOB. HM. FEE
MICRO' FEE
MECH. FEE
• PL. CK. FEE „,
CONST. FEE ELECT. FEE
SMI FEE
•4E1s' PLUMB. FEE
-
PERMIT NO.
-
3994 2,.1•
t
-
lob Address � / i -� ----_� _ Space
//rn p�
-
-.`,,.,
Zip
�/ ^} r
Owne v ��
(/y, e•
`-F.C.C.
Community; �j
F. 1,I j •r✓
Valuation
S /C/;✓ •:/
Date
_ G' � G2
Dist.
-/
Off.
MH Permit Fee S
Micro Film Fee Cop S
�/ X, �,/��•-
Use of Permit �'� �i C.
/ G'`.7
16- :�,!r 'f{_ (f 1�646(e�� ,)'
Parcell NNNo. �, ��>> -
/ / �� (/.�-
Use/Case No.
C,k(.��y/n/
/! /b/ '
.
Mech. Fee Dbl S
PI. Ck. Fee 5
Set Backs
Lot Size
Construction Fee Dial S
Leg al escriPtion , r ? ,
/y ,L ..�j ,r7
!/ G CK /7 c+
F
S S
R
Electrical Fee Dal 5r2/
Zone Restrris s
'A
Group
Typo
SMI Fee t $
Plumbing Fee D61 S /
Bond Amt.
$
Pion No.
Plan Checker
Final Dote
(/ �%
Inspe for
1c—_
Unit
,
Sp. Insp. Fee S
Demol. Fee S
Const. Lender Branch
Sipplinfental Permit Numbers -
I
10
,
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee ' 'S
Reinsp. Fee S
Owner/Agent
Tel. ` '- Zip
�J
Total Fees $
Address y 'r J
City Zip
M.O. N.C. Gosh Check
Received , by! -'�'
Contr ro l
1� .40J_
Tel.' /
yj• "� t� .% 'LL7 / s
licenseR
.
Trees r_ aved��
Sewage System
Sewage
Address _ _
City ' ' ' W7 ,' Zip
t
'T LLTHIS7PERMIT SHALL BECOME VOID IF,WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK ,v a by:
Sewer District FOR'120 DAYS SHAII'A150`CAUSE PERMIT TO BECOME VOID,r .,4 r`
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITHJHI5'PERMIT'WILL BE DONE IN ACCORDANCE_ WITH
` THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF.CALIFORNIA.01
1 EBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED-THE:PLANS AND SPECIFICATIONS HAS DONE SO.1N, ;�' -+•
Form 284.208 (Rei. 1/80) � ORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS'CO_DE OF THE STATE OF CALIFORNIA
1/d
i
3Nn Alba OU 10 MV38
3WVN 143N1S
sa,nsx!j Oe
6uipuo8 96Z
anM 6wpunOAE) , V6Z.,
a3goitu3 a3waS 87,
impuo) LZ
alod iamOd 9Z
S1VA0HddV 1VJ1817313
1; d
isal so0
6Z
sa,nsx!j Oe
6uipuo8 96Z
anM 6wpunOAE) , V6Z.,
a3goitu3 a3waS 87,
impuo) LZ
alod iamOd 9Z
S1VA0HddV 1VJ1817313
l
f
isal so0
6Z
93!niaS JaloM i
£L
�h r
is
j1a19ak'SeicM'
IZ'.
aa. as
OZ
losods!Q a6omaS
61
t
"
stuaA
81
t
i
qwnld y6nod
Ll
-
6wdid JatoM
91
F
gwnld punojo
"St
bYswnia_
~sinn��dd�Ni
(umol8) 6uil!a)
Wl
Rzi
li` li
i)
(sito8) suoM
VL
• {{
- (
anloq
N p41
NOIlVI(1SNI
.. ?I
ap-o ys!u!j
- Cl
4
lioMR)a
VZl
p
I
tit�� �r•/Y G�
ytol louiatul
LI ;.
���
ytol joualx3
1l
NOIIVW?JOdNI WNO11140b °O
C]
•0.1 aDoldaa!j
Vol
14 loud eu
'Td a=jdanj
o1
POOH lon awwOD ep
i
IIoM anj a6omO,
6
03inat7 uO!tDa48(], aslowS lj--
e
' stuaA
8
. _
' r •. i jadwu(1 an j op
6u!woi j
L
aDuojoal� •IddV 6e
po(] {oo8
9
' 10ssaj8uio] gf
- - ' k
swoag puo8
g
t
nV
_ _ _
?
spo18 tno„J
uog' qwo:) LE
�-
4
staltn0 J sialul 9E
QQOB/g�j/'G/�
O17�� G ^(�
IaatS
E
i�
'podwo:) aoouinj cc
apoi0 golS
VL
sionp g T nuald I't
Xn
!✓
swj j V 04d
Z
e
wats6S uo!jol!tuaA L'E
''po8 $as
1
S1VAOiJddV 1VJINVHJ3W i{
S1VAOHddV Wining
N01D3dSNl
31VO
NOI1VN3d0 �� ON
801:)3dSNl
31Va
NOI1VN3d0^
ON
SAF ®�
;� plans shall of s
an aPProval anY
Of' the stat the job n
� f<eot on
Un FA1m.
of 0� mw• --
�rClG
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
GARDEN WALL SECTIONS
(THIS DESIGN IS NOT TO BE USED TO RETAIN EARTH)
1/2-1 cp BAR CONTrNVOOS
THRCJ EXD�'N'SfON JO�NTs
6" MINI
349 �� BARS
t� GfZADE
' I .
j.
uI
GONG. BLOCK
2-O
R CONT.
U
CONSTRUCTION: � �
All cells containin steel shall be filled solid with grout. All reinforcing steel
to 'lap a minimum 2 -0".
284-196 Rev. 5/79
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74
CANARY—FILE, PINK—APPLICANT
G
/;r7—
Owne Architect_---. —_—_ Contractor—_ , 2_
Addres 3 G PL__ Address___ Address -- /— --
e
City/,!_L[G City-- City_—_.— —
Phone S6 Of 333/ � Phone _ Phone— -
W
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 i agreed that I (we) will not occupy said property and will not cause said property to be occupied until I (we) have
complied ith all laws f the Counn of Riverside and the State of California governing said property.
DATY— —Q- - SIGNATURE OF OWNER AND/OR-'���=N,r I -
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
'(2z -S"3 (SPACE NO.
USE OF STRUCTUREJOB
V VG
ADDRESS SINGLE FAMILY �" DUPLEX
00
Z F
0
/ /� 1° APARTMENTS AGRIC.
LEGAL DESPT NOF ROPERZT� _��
2-Q
K7
�'
N
j _— — COMMERCIAL INDUSTRIAL
�Q v ��a
>
c
COMMUNITY `� ALTERATIONS ❑
Z
NO. OF SUBMITTED PLANS USE OF PERM T
Lu 4
6
CASE NO. --- -
G Z
NO. OF PARKING SPACES REQUIRED _ NO. OF BUILDINGS NOW EXISTING -
Q
ZONE —r sETBAC�KS: FRONT SIDE REAR
J
m
GRADING PERMIT REQUIRED? YES-;] ;NO ❑ LOT SIZE
SETBACK ORDINA�E # OF FEET REQUIRED ON S EET
DATE T �.Z �d SIGNATURE OF LAND USE OFFICIAL
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET—.
F-
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
oe
e
d
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
Ce
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
vt FLOOD CONTROL
H
W AIR POLLUTION
_ I DIV OF HWY
c — 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 APPLICATION 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.
[-1 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 /-? / License No. _? TeF % 3 9
Date '7 -� a rt - 0 Contractor ,,W,,-, X,.
0 OWNER -BUILDER DECLARATION f
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons:
0 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.).
[ ] 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).
T
Policy No. Insurancevol 1',' '0 r• , /*.,
0 Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
[-1 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 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).
Lender's Name -0,1,, 'e
Lender's Address
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
421 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 inconnection 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.)
Q 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.
Q 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-
i7� ` r perty for which I ha've.app.l'ied for this permit for the purpose of making inspections.
Signature of Appli.cant/Agent Date
Print Applicant/Agent Name C .
284-2000 7/80
PERMIT NO. F3994 21
PERMIT NO.
[� 9 4 2
J
Job Address V s Space Zip
-
DEPARTMENT OF BUILDING 8r. SAFETY .
COUNTY OF RIVERSIDE •.
FIELD OFFICE
DST
��
- CONSTRUCTION -ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
F.C.C.
1ST FL.
2ND. Fl.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
Parcel No. /�
�i / ,2
/ al
Use/Case No."
SQ. FT. @ YARD SPKLR'SYSTEM
Mech. Fee Dbl g r
SQ. FT. @ MOBILEHOME SVC. ` BAR SINK"
Set Backs
SO. FT. @ POWER OUTLET - ROOF DRAINS -
Construction Fee Dbl S
SO. FL DRAINAGE<PIPING.
F
�yFT1 DRINKING FOUNTAIN '
SQ. FT. @ URINAL •, _
Electrical Fee - Dist S '
VALUATION $ WATER PIPING
Group
NOTE: Not to be used os property tax voluotion
SWIM POOL, PVT.
FLOOR DRAIN
Bond 'Amt.Plan
S
MECHANICAL FEES
SWIM POOL, 'COMM
WATER,SOFTENER
Ins ector
VENT SYSTEM FAN EVAP. COOL HOOD.*
SIGN ,
WASHER;(AUTO)(DISH) ,
Const. Lender - Branch
APPLIANCE DRYER
Regrstr. Fee S.
-GARBAGE DISPOSAL
Address City Zip
..
FURNACE UNIT WALL FLOOR SUSPENDED
Reinsp. Fee S
LAUNDRY -TRAY
Tel. Zip
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
City - Zip
`�• '
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET,
Tel.
(
COMPRESSOR HP
POLE, TEMP/PERM
'LAVATORY -
Address •�. -
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER '
BOILER - B.T.U.
SQ. FT. @ a
.' BATH TUB
' SO. FT. @ a
WATER HEATER
•
S0. FT. RESID. @ 1 t/a
SEWAGE.+DISPOSAL '
SO. FT.. GAR @ 3/<a
HOUSE SEWER'.
-
-
GAS PIPING '
PERMIT FEE
PERMIT FEE
PERMIT FEE'
DBL.
TOTAL FEF�SJsM08.
//9
HM. FEE
i
- MICRO:FEE
MECH. FEE Pl. CK. FEE
CONST. FEE r'� ELECT. FEE
SMI FEE
�W PLUMB. FEE
PERMIT NO. F3994 21
Job Address V s Space Zip
-
Owne'r
Chi�titis-
Communiy/,(//)�',J •�-fJ
L:N (.J"^"
voluotion
Dote
/Dist.
Off.,
.••GGG+++
F.C.C.
MH Permit Fee S
Micro Film Fee Cop S
Use of. Permit -
(y U� G✓ i� /�✓ �. q' ,,� //� !"'•'
Low /C- yG ✓ •,wi ` •J
(/ b V
Parcel No. /�
�i / ,2
/ al
Use/Case No."
Ck. By
Mech. Fee Dbl g r
PI. 6. Fee 5
Set Backs
Lot Size
Construction Fee Dbl S
Legool Description/��//�/
v �7i ,(!�/ �y "'LG, c' e
is (,r U f:7
F
S- S
R
Electrical Fee - Dist S '
Zone Restrictions
Group
Type -
SMI Fee S
Plumbing Fee Dbl S
Bond 'Amt.Plan
S
No.
-
Plan Checker
Final Dote
/9 �V — V V
Ins ector
Unit '
Sp.' Insp. Fee S
Demol. Fee S
Const. Lender - Branch
Supplimentol Permit Numbers ,
= •' - - -
Regrstr. Fee S.
Mileage Fee S,
Address City Zip
..
Witness Fee $,
Reinsp. Fee S
Owner/Agent
Tel. Zip
Total Fees S
Address -
�� !
City - Zip
`�• '
" M.O. I] N.C. Cash.Check -
Ra`ea. cf
ntro or�G/.,
�.-w
Tel.
(
License�# r �-
Trees
Sewage System
Address •�. -
City Zip
t
- T LL P THIS PERMIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. ,t,
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDAN�E WITH
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFQRNIA.
1 H REBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS•AND SPECIFICATIONS HAS DONE SO IN '
Form 284.208 (Rev. 1/80)A RDANCE WITH SECTION 5541.OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.