40301813UILOINU PERMIT
PERMIT NO, DEPARTMENT OF BUILDING & SAFETY FIELD °', .
0 3 018 COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES 77
IST Fl. SO. FT. .@ $
2ND. FL. SO. FT. @
FOR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. FT. @
WALL SO. FT. @
)fL._.—. s' SO. FT. @ T _ �!
- tESTIA6,CTj ' " 1ifu TION VALUATION $ '4r— �'"'"�"' n•
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used:as property tax voluation
SWIM POOL, PVT
FLOOR DRAIN
'MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER .3
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
lot Size
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ZR -
/I"
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.
SO. FT. @ a
BATH TUB
1” viot
g'7
SO. FT. @ a
WATER HEATER p,
Sp. Imp. Fee S
SO. FT. RESID @ 1 t/aa
SEWAGE DISPOSAL
Const. lender Bran It
S0. FT. GAR @ Y44
HOUSE SEWER
Supplimental Permit Numbers
Registr. Fee $
Mileage Fee $
GAS PIPING
PERMIT FEE
Witness Fee S
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
HM. FEE
MICRO FEE MECH. FEE
PL CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE PLU FEf-
e
PER NO.
403018
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Job Address M
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Space Zi Owner ,
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MH Permit Fee $
Micro Film Fee
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Pia No. �a'
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se/Case _
Ck. By
Mach. Fee Dbl $
PI. Ck. Fee $
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lot Size
Construction Fee Dbl S
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Electrical Fee Obi $
Zone Restrictions
Group
Type
SMI Fee S
Plumbing Fee
Dbl $
Bond Amt.
S
Plan No.
Plo s. Checker
1” viot
g'7
InspectUnit
Sp. Imp. Fee S
Dismal. Fee
$
Const. lender Bran It
Supplimental Permit Numbers
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee S
Reinsp. Fee
$
Owner/Agent
Tel. Zip
Total Fees $
M.O. N.C. Q Cash Q Check' ❑'
Address
City - i Zip
Received by "'R
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Tel.
Licensee
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Sewage System..
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T LL p � U THIS`Pf±RM'T'SHX[L/B2E3ME VOID`rIF WORK IS NOT COMMENCE VOIT1414r12(T DAYS. CESSATtSN t3ftdkKfwe<itied by:
Sewer District
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
-
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN,ACCORDANCE WITH '
THE LAWS OF RIVERSIDE COUNTY AND THEtST47E OF CALIFORNIA.
R.EBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Farm 284-208 (Rev. 1/80) ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums d Ducts
2A
Slab Grade
35
Furnoce,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
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
43
Final
IDA
Fireplace T. 0.
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ADDITIONAL INFORMATION
_______
SEWAGE SYSTEM SIZE 8r. 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
.PLUMBIN.G.APP.ROVALS __________. __
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
Z7—So
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
298 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
COUNT" OF RIVERSIDE
284 199A 9/74 f CANARY—'FILE, PINK—APPLICANT
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Owner Y00 '12 Architect Contractor -i LipL _) b Lw P(bq_ —
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Add , �-_ Address__' Address----%Y-3`J--_-
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City_— City_ t o 0R_
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Cit .y
Phone �7` �/ Phone3 c?41
-Phone _ _� _--_
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I (we) the undersigned, hereby certify and acknowlege 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
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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 occLQy said property and will not causo*said property to be occupied til I (we) ve
complied with all of the County of Riverside and the State of California governing said prope
gqlaws
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`h v-- SIG4ATURE OF OWNER AND/OR AG �C���!
DATE --
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Peior to the Issuing of a Construction Permit.
ISPACE NO
1951: OF STRUCTURE` JOB ADDRESS
- -- INGLE FAMILY DUPLEX Ej
LEGAL DESCRIPTION OF PRO,AERTYz�7--
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,���"� - APARTMENTS AGRIC, El
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COMMERCIAL INDUSTRIAL ❑
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COMMUNITY . Tl�
. ALTERA..I�NS LJ
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NO. OF SUBMITTED PLANS USE F.PERAIT _S
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CASE NO. C'L� -
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NO. OF PA KING SPACES,REQUIRED _- N0. OF BUILDINGS NOW EXISTING -
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ZONE SETBACKS: FRONT—__ SIDE REAR
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GRADING PERMIT REQUIRED? YES:❑ NO ❑ LOT SIZE
SETBACK ORDINANCE I$ OF. FEET REQUIRED ON ozSTREET -
DATE—G--�—V, SIGNATLRE OF LAND USE OFFICIA _ ---
DEDICATION REQUIRED: YES ❑ NO ❑ NC_ OF FEET_ _
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
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CAN CURB AND GUTTER FEASIBLY BE INST^LLED? YES ❑ NO ❑
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HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET"
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IMPROVEMENT? -YES ❑ NO ❑
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DATE — _ SIGN4,TURE OF ROAD DEPT. OFFICIAL
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SWIMMING POOLS PUBLIC
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SEWAGE DISPOSAL
S 0
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
%A FLOOD CONTROL
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W AIR POLLUTION
W DIV OF HWY
0 a YOUR PROPERTY MAY BE SUBJECT TO
_
'Q •``� FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 f CANARY—'FILE, PINK—APPLICANT
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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 exec..•
tion of the following applicable declarati m s prior to the issuance of a building permit.- Please
print or type and sign below. a
[] 'LICENSEES 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 r License No.
Date fContractor -
Q _ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for'the following reasons:
> Q 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. 70.31 .5, B.&P.C:). t '
Q I, as owner of the property, am t?xclusively contracting with licensed contractors to
construct the project (Sec..7044. B.&P.C.).
7ElI am exempt under Section B.&P.C. for this reason:
Date Owner
f Q r 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. Insurance t ,_
' 0 Certified'copy is hereby furnished.
Certified copy is'filed with.the •'_ounty of Riverside, Department of Building and Safety.
Date i, Applicant �.
0 CERTIFICATE,OF EXEMPTIOU 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 wort for which this permit is issued, I shall not employ
any person in any manner so as to become sub,-ect 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. -,ode).
Lender's Name
Lender's Address
DIVISION OF INDUSTRIA_ SAFETY PERMIT CERTIFICATION
®-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, falsevork, or demolition or dismantling thereof, will be
more than thirty-six (36) feet high. (Qhap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.)
[� As owner -builder, I will not employ anycne 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. f� '
Date fIl�;0 pplicant
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-
perrty for which I have applied for this permit for the purpose of makiin inspections.
or Signature, of Applicant/Agent Date f
Print Applicant/Agent Name
284-2000 7/80
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eRMir NoRr�rrr DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE MIS:
1463�018- COUNTY OF RIVERSIDE "
` CONSTRUCTION ESTIMATE
NO. ` ELECTRICAL FEES
NO. ' PLUMBING FEES
.1ST FL'
'2ND. FL. l
POR:•
GAR: _
• CAR P. -
LL •
j
,(22 �%/
/STIM;AT D TRU TION
SQ. FT. .@ $
•UNITS,
SQ..FT. @
YARD SPKLR SYSTEM
SO: FT. @ MOBILEHOME •SVC.
BAR SINK
POWER OUTLET
SQ. FT. ,�@
ROOF DRAINS
SO. FT. @ ° - - -
DRAINAGE PIPING {
SQ. FT. @ •
DRINKING FOUNTAIN
SO. 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
r WASHER (AUTO)(DISH)
APPLIANCE DRYER
SMI Fee S.. F' ,
GARBAGE DISPOSAL
FURNACE, ,'UNIT WALL FLOOR SUSPENDED
Plan No..
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.'
SO. FT. @' c
BATH TUB
•
SQ.. FT.. @ a
WATER HEATER
Owner/Agent
S0. 'FT. RESID @'1 /aa
SEWAGE DISPOSAL
Total Fees $
•''\
S0. FT: GAR. @ 3/<a'
HOUSE SEWER
'
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'foniriictor=-
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GAS PIPING'
PERMIT FEE
Tel. -
PERMIT FEE `
PERMIT FEE
DBL:
- TOTAL - FEE
MOB. HM. FEE
n MICROFEE
MECH. FEE PL. CK. FEE
CONST. FEE t ELECT. FEE
SMI FEE
FEE PLUM . F E
PERMIT NO.
403,0
• Job Address .. t Space Zip Owner - - -
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gq a. . -Ofp.. 'F .C.
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MH Permit Fee S
$ �„•,'..
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Micro Film Fee - Cop'g
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P e No.
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Use/Case Pfalf -*f-
Ck. By
Mach. Fee Dbl 5
PI. Ck. Fee - gJ
Set ck -
Lot Size
Construction Fee DbI S
ay -
Legal Description, ---��yii� ���
a 4.
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Electrical fee Dbl g:
Zane Restrictions
Group
Type
SMI Fee S.. F' ,
Plumbing Fee • Dbl $ s
and Amt. -
Plan No..
Plan• Chei:ker
Final f
Ins for
Unit
Sp.'lnsp. Fee g.
$
_�// l
(Numbers-
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Demol. Fee. $
Const: Lender Branch
Supplimental Permit ,
-• "`
Reglstr. Fee g
Mileage Fee $
Address + City Zip
Witness Fee g
Reinsp. Fee- g
Owner/Agent
Tel.: - Zip
Total Fees $
•''\
Address -'
Cify - Zip
M.O. ❑ N.C. Cosh' heck ❑
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Received by,
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Tel. -
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Trees required
Sewage System
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T LL P' ~ THIS PERAKIT SHALL BECOME VOID IF WORK IS NOT COMMENLTE[T WITHIN 120 DAYS. CESSATION OF WORK verified by:
Sower District FOR 120 DAYS SHALL ALSO CAUSE PERMIT. TO BECOME VOID.
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.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. -
`yAZkEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
For. 284.208 (Rev. 1/80) ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.