230113 (CRES)BUILDING PERMIT
1 ST FL. SQ. FT. �a _
DEPARTMENT OF BUILDING & SAFETY FIELD O.FFiC1:
COUNTY OF RIVERSIDE
E„� _. ELECTRICAL,FE,ESP�;,;a.. PLUMBING FEES DST
NO. NO.
2ND FL.
SQ. FT:
FOR.
$Q. FT. C%
MOTOR I OR LESS H.P.
GAR.
$Q.FT_
" MOTOR 5 OR LESS H.P.
CAR P.
SQ. FT. 'S--� Q
MOTOR,20 OR LESS H.P. DRAINAGE PIPING
WALL
SQ.FT. @a
r u DRINKING FOUNTAIN
SQ. FT.@
" URINAL
•
ESTIMATED CONSTRUCTION VALUATION $
0 K.W. UNITS WATER PIPING
NOTE: Not.to be used as property tox.voluotion
! FLOOR DRAIN .• r'
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD
SIGN I WASHER (AUTO) (DISH)
APPLIANCE
TRANS-. K.W,
FORMER GARBAGE DISPOSAL
D
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS LAUNDRY TRAY
AIR HANDLING UNIT . CFM
FIXTURE OR SOCKET KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONS-. SERV. ENTRANCE s WATER CLOSET
COMPRESSOR 0 HP
POLE LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT. SHOWER
ABSORPTION SYSTEM B.T.U.
SO. FT. Ga a -BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ a WATER HEATER '
HEATING SYSTEM ❑ FORCED. Cl GRAVITY
y`SQ. FT. RESID. @ 1 a ' SEWAGE DISPOSAL `
BOILER 0 B.T.U.
SO. FT. GARAGE @]�ya HOUSE SEWER
PERMIT FEE•
BALANCE OF MIN. FEE „' GAS PIPING "
MOBILE HOME HOOKUP FEE Is
PERMIT FEE . g .0 PERMIT FEE
F���tA1IT O.'
TOTAL FEES •.
MOB. HK. FEE MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE.
-.
FEE PLUMB. FE_E
DBL
'//�D
•7 1 J I.- F-. •M A I M I J.' L• *A -I S. 0 ' N D
J68 ADDRESS - - - - 'f.�- ...- ++•y.-
7
.OWNER
73
:12L-
% ,L v
h�ao T C-
. 74
USE OF BUILDING - - -
• F.C.
DATE
r
PERMZ3 0
1.3
75 r
1 r 1/
M.H. HOOKUP FEE ''
$
COMMUNITY
DST
UNITS
A ROOMS-
VALUATION -
SUPP. TO PERMIT
OFFICE ;
MC
MICROFILM FEE,. ..'COPIES
$
LEGAL D IPTION IL
diff
MECHANICAL FEE-,-.
..
RBL'
_.
$ -
SETBACK
LOT SIZE ZONE
USEN ,,.
GRP
TYPE
CKBY
F S �
.. I
— r� ..
J
;?PLAN CHECK FEE ...
....
$
•
BOND AMT.
PLAN NO.- .
PLAN CHECKER
INSPECTOR
JFINALDATE_
Cl
CONSTRUCTION.FEEDBL
$
NAME OF CONST; LENDER. - tis - BRANCH
OFFICE ": ' .NO
LENDER INVOLVED
ELECTRICAL FEE
DBL
$
' Y
V
.ADDRESS CIN
- STATE
SMI FEE s . _.
$-
-T+HIS PERMIT- SHALL- BECOME VOID IF WORK `IS -NOT COMMENCED WITHIN b0 DAYS. CESSA-
$
TION OF WORK FOR 120 DAYS SHALI`,ALSO CAUSE PERMIT TO BECOME VOID, t'
,° .;FEE
'
�-
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE 11,4 AC-
PLUMBING.FEE""
DBL
$ .:'.
CORDANCE WITH.THE'LAWS OF"RIVERSIDE• COUNTY'AND,THE STATE.OF CALIFORNIA' i ALSO
.
AGREE TO CARRY COMPENSATION INSURANCE"UPON MY EMPLOYEES. COMPLIANCE WITH,
-.
THE'LAWS OF THE STATE -OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED. '
• -
$
'1 HEREBY CERTIFY. THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
TOTAL FEESHAS
DONE SO IN ACCORDANCE "WITH `SECTION 5541 OF `THE BUSINESS AND PROFESSIONS.;
'
�a3ST•
TE F CALIFORNIA•.
'ONTRACTOR
' - -
/ '
CASH €,�/, CHECK ❑, M.O.: ❑�N.C. ❑t
OWNER_ t �;, Fsa
s.•,f' �. �r5' ��d
C-
� l
' ✓
-RECEIVED BY
., 3t B." �
AD E55 Is „
ADDRESS
SEWAGE SYSTEM7
LL . '
Poo
TV .. .. II ..
CITY ... s. ,
TREES REQUIRED -'YES
NO+t
¢ ti3 3t
- INFORMATIONero
-
TEL. NO. -
TEL. NO. - LICENSE
•
- -
FORM 284 208 IRev. 11/72)
�. �^� ,,,,,9 �y
FEB -17-2005 07:39 AM
CERTIFICA
AND
C TESTING
HER
COtiiying Signature ` Date
Street Address: _.7�.(5 ,�ir4s���-�! [�rele.
Copies to: Builder, HERS Provider
Date '
Builder NaMe
Plan Number
Sample Group Number
Sample House Number
HERS Provider:
City/State/zip; Z u . olq
P. 02
-4R
RATER COMeLIANCE-STAXEMENT
The house was: EIFTested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic tested compliance requirements as checked on this form,
Distribution system is fully ducted (I.e., does not use building cavities as plenums or platform returns In lieu
of ducts)
Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections,
dam' MINIMUM REQUIREMENTS FOR DUCT LEAKAGk REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
�LI�� Measured
Duct Pressurization Test Results (CFM @ 25 Pa)
values
Test Leakage Flow In CFM
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here
If fan flow is measured enter measured value here
�J
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fall (Pass -6% or less]
❑
Pass Fail
n
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
QLJ Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) Is Installed and Access Is provided for inspection
c�J ❑
Yes is a pass
�)
Pass Fail
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1, ❑ Yes M No ACCA Manual D Design requirements have been met
(rater has verified that actual Installation matches values In
CF -1 R and design on plan, 1j M%
2, ❑ Yes ❑ No TXV Is Installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow = If
C] 0
Yes for both 1 and 2 is a Pass
Pass Fall