403694 (CPWU)BUILulrvU YtKMII
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PERMIT NO.
4036
kPERMIT No.
o 3 694
DEPARTMENT CF BUILDING & SAFETY
COUNT`! OF RIVERSIDE
FIELD
Dsr
CONSTRUCTION ESTIMATE
ISO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST Fl.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. .@ $
UNITS
V tin
S
,f
SO. FT. @ YARD SPKLR SYSTEM
MH Permit Fee $
SO. FT. @ MOBILEHOME SVC. BAR SINK
,
SO. FT. @ POWER OUTLET ROOF DRAINS
j
SO. FT. @ DRAINAGE PIPING
Parcel No. / Cesar Ndf.-
et s' lot Size
SO. FT. @ DRINKING FOUNTAIN,
Mech. Fee D61 s
SO. FT. @ URINAL
r
VALUATION $ WATER PIPING
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
<
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
'6
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
r
APPLIANCE DRYER
Plumbing Fee Dbl s
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
Demol. Fee $
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
Mileage Fee $
BOILER B.T.U.
SO. FT. @ c
BATH TUB
Owner/Agent
SO. FT. @ a
WATER HEATER
3
•Zip {
S0. FT. RESID @ 1 t/<c
SEWAGE DISPOSAL
Address
S0. FT. GAR @ 3/44
HOUSE SEWER
City
Zip ;.
M.O. ❑ N.C. EjCash.O Che
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GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
�'lv_,}m
DBL.
TOTAL FE
MOB. HM. FEE
MICRO'FEE
MECH. FEE P-.. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE
FEE PBg�FjiE✓j1�]
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PERMIT NO.
4036
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Community
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F.C.0 ,
MH Permit Fee $
Micro Film Fee Cop S
Use of Pe mi
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Parcel No. / Cesar Ndf.-
et s' lot Size
Ck. By
,,.
'
Mech. Fee D61 s
PI. Ck. Fee s
F 5 S R
Construction Fee Dbl S
Leg A icr$Wn y
j
'6
Electrical Fee Dbl S
Zone Restrictions Group Type
V
r
SMI Fee $
Plumbing Fee Dbl s
Bo d mt.jkjh'ffo.—•
Plaa Ch ck F
Final Dotel In ector Unit
Sp. Insp. fee $
$
10-19
Demol. Fee $
Const. Lender
Brom°h
Supplimental Permit Numbers
'
4
'
Registr. Fee $
Mileage Fee $
Address City Zip
Witness Fee $
Reinsp. Fee $
Owner/Agent
Tel.
•Zip {
Total Fees S .,i
t
Address
City
Zip ;.
M.O. ❑ N.C. EjCash.O Che
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Received by
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Tel.
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Trees required
Sewage System
Addre
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City ,J _ Zip,^
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T LL %P U `THIS PWITNSRXLL BACbA1rVbIJ IF *CiRK 1S NOT COMMENCE D=VAfHI1N11Tf-JDA,)Sj 06$SATI(3t4�5FT•WoW
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 THE STATE -OF CALIFORNIA.
K/,•��) THEREBY CERTIFY THAT THE INDIVIDLAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284-208 (Rev. 1/80) NCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIOIJS'CODE OF THE STATE OF CALIFORNIA.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPCTOR
tt
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs $ Frms
34
Plenums & Ducts
2A
Slab Grade
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
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
,
10
Fireplace P. L.
0
43
Final
10A
Fireplace T. 0.
0
°O.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
.12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final
4. _ .PLUMBIPLG.AP_P_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 10 100
25
Final�O_
��
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/l
p
q
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B �onding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATIDN TO CONSTRUCT Permit No
DEPARTMENT 0- BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
,ice
Owne RS ja. Architect— _. _ Contracto —_— _
AddressJJJe7 + J� Q�_ Address___ AddresA 4 --ii F "'� �_4
Ci tyL4_ (%i^tfA�_C� City-- - C i tylkiD_t O—sL—�- -- —
Phone KL00 Phone _ Phone_t7�7_�L1—.—_._
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I (we) the undersigned, hereby certify and acknowledge 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
3
shall not make a Final Inspection until said requirement=_ 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 I (we) will not occupy said property and will not cause said property to be occupied until 1 (we) have
complied with all laws of the County of Riverside and the State of California governing said property.
4
DATE -�-�— SIGNATURE OF OWNER AND/OR AGENT - -
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Frior to the Issuing of a Construction Permit.
a :2 SPACE NO.
USE OF STRUCTURE
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JOB ADDRESS 7� �,'
D SCRIPTION OF PROPERTY 712-3 77��� / G/�-L L� a SINGLE FAMILY DUPLEX
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LEG / ! APARTMENTS AGRIC.
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— __- —C� COMMERCIAL INDUSTRIAL •
COMMUNITY r
ALTERATIONS ❑
_
ONO.
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OF SUBMITTED PLANS USE OF PEFSMIT —
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CASE NO.
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NO. OF PARKING SPACES REQUIRED _— — NO. OF BUILDINGS NOW EXISTING -
Q 0
ZONE4 �',�_SETBA(�KS: FRONT SIDE REAR
J D
GRADING PERMIT REQUIRED? YES ❑ NO :D LOT SIZE
SETBACK ORDINANC }Y -- OF FEET REQUIRED ON STREET
DATE SIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: YES ❑ NO ❑ NCI. OF FEET—
F-
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CURB AND GUTTER REQUIRED: YES ❑ NO ❑ -STREET
i
cc
cc
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? 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 ❑
O
ce
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
vt FLOOD CONTROL
f. •
W AIR POLLUTION
W DIV OF HWY
c a 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 N
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 Cod? and my license is in full force and effect.
License Class C- 3 License No.Q-7-3p 09
Date 16 0,10 Contractor V 141.4 pt4 LtIU.t i'/,A) CO -
M OWNER -BUILDER DECLARATION
I hereby affirm that I amexempt from the Contractor's License Law for the following reasons:
[� 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;'8.&P.C.).
�] I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B _&P.C.).
Q I am exempt under Section , B.&P.C. for this reason:
Date �12�^ Owner
—r
Q WORKERS' COMPc_NSATION DECLARATION
I hereby affirm that I have a certificate of coisent to self -insure, or a Certificate of Workers'
Compensation Insurance, or a certified copy the-eof'(Sec. 3800, Lab. Code).
Policy No. 5,Ql;Z84- gD Insuran:e 51A-fe �JN_P
Certified copy is hereby furnished.
Certified copy is filed with the County of Riverside, -Department of Building and Safety.
rr
Date (D f,� Applicant V a m4 )I nX
Q CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed -f permit valuation is for $100.00 or less.)
I certify that ,in the performance of the work fcr 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 labcr 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. Codi').
Lender's Name
Lender's Address
DIVISION OF INDUSTRIAL-SIFETY PERMIT CERTIFICATION
Q I hereby certify that no excavation five (i) or more feet in depth into which a person is re-
quired to descend, will be made i6 connection with work authorized by this permit, and that no
building, structure, scaffolding, falsewor;, or demolition or dismantling thereof, will be
more than thirty-six (36) feet high. (Cha) 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.)
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.
�] 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-
pe,;rtyffor whicV have applie& for this permit fcr the purpose of making inspect'ons.
</�'V� 1 �. `r A I R 10 [ �f C Fa
i9hAtu"re —0y
Y `pp cantJA eh Date
Print Applicant/ gent Name
284-2000 7/80
DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE
OF FI ,E DATE TIME PERMIT NUMBER
�N& INSPECTICN
REQUESTED
ADDRESS ',SPACE N0. FOR:
A.M.
OWNER COMMUN Y
i0 ❑ PJA.
BUILDING PLUMBING ELECTRICAL MECHANICAL
yv�
PON
2 TIES
a WED
REMARKS: � � � -
��THUR
FRI
OWNER/CONTRACTOR TEL.NO.
2fl1�► N/�!
BUILDING PERMIT
PERMIT NO.
4.03.694
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE usr
COUNTY OF RIVERSIDE ,
CONSTRUCTION ESTIMATE
No.. ELECTRICAL FEES
'NO. PLUMBING FEES
1ST.FL. r--SQ.•FT..@
2ND. FL.','—'
POR.
GAR.
'CAR P.
• WALL -
•
ESTIMATED CONSTRUCTION
$
UNITS
• ..
-
50. FT. •@� -
YARD SPKLR SYSTEM
SO. FT. @ •-• MOBILEHOME SVC.
BAR SINK
50. FT. @ POWER OUTLET
ROOF DRAINS',
SQ. 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
WASHER (AUTO(DISH) '
APPLIANCE DRYER
$MI Fee S
GARBAGE'DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED.
Bond Amt.
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 "
SQ. FT. @,. a
WATER HEATER
Demol. Fee $
`SO. FT. RESID @I %c
SEWAGE DISPOSAL
Branch
S0. FT. GAR @ 3/4c
HOUSE SEWER
-
Regisir. Fee ,. $
•-
GAS PIPING' vf:
PERMIT FEE' •
°MECH.
PERMIT FEE
PERMIT FEE
DBL
TOTAL F.F�iK
MOB. HM: FEE
MICRO*FEE
FEE 1L. CK. FEE
CONST. FEE ELECT: FEE
SMI FEE
FEE P 61MB
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PERNO_Job
.403 N[r�(`• -
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Address `.'_"'
Community
`n
vo
- Space' i Zip- - -' Owner-
to
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-
ati
S - •.
l -
l
MH Permit Fee - S
Micro Film Fee Cop S
Use of Permit
- \ -•
r or
Parcel No. se/Case No:
Set Ba s Lot Size
Ck. By
Mech. Fee Dbl - $
PI, Ck. Foe $
Construction Fee Obl S
J./
Lega escrip ion
- •
/
F. S 5 R
Zone Restrictio Group Type
.
Electrical Fee Dbl S
$MI Fee S
Plumbing Fee Obl ,$
Bond Amt.
n'No.,
Ron Checker
Final Date9. l(x1•'
I ector�-
Unit
Sp. Insp. Fee S S
•
,t
".' V
Demol. Fee $
Const. Lender •
Branch
Supplimental Permit Numbers'
-
-
Regisir. Fee ,. $
Mileage Fee. $, -
Address - City Zip
Witness Fee $
Reinsp. Fee $
-
Owner/Agent. -
-
Tel.
-Zip,
Total Fees - S
Address y
City
Zip
M.O Q N.C. Co,ED Che<
'Received by
em
s
Tel. - '
License#
Trees required
Cr
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Sewage System `�,,,
1`
Addres
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City .tip -
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T LL P v . 'THIS PIT"IT SHALL BECOME VOIDSAF WORK IS NOT COMMENCED WITHIN'120 DAYS P CESSATION- OF WORK I 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
THELAWS .OF RIVERSIDE COUNTY�OND THE STATE OF CALIFORNIA." •.
I ER CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS•AND SPECIFICATIONS HAS DONE SO IN
AC C NCE WITH SECTION 5541 DF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. '
Form 484.208 (Rev. 1/80) «,