354110 (BLCK)P . "« • : ,t NN - +f!� NOTICE TO APPLICANT f
1( In conformity with therovisions'of State of Calrf6rnia Labor Code Section 3800, the applicant shall'fidve on file i r file with,the'Riv rside Court
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Department of Building and Safety d certificyyatye as designated in Items I or II below,•or shall indicate Item III, IV or V, whichever,is applicable:,as
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I .i ,, CERTIFICATE -OF APPLICANT •r ~ ..• � .air:- i .ra`a r ,'K.i �v, »�,++� +i
Please mark the appr nate, block: j ..
( ❑ I. Certificate, of Consent to self -insure issued by the Director of Industrial Relations. •'
C3 Co
ontfile' + ❑ Copy submitted
' r ❑r �• �`
II. Certificate of Workers' Compensation Insurance issued by an admitted insurer.
�:Y�-fi'1Sts, rj w , .r..., # ,r=rw+�i".r, ., ' 2'r."•�` W`Lr..'1'a "+"+„v,�v, , +r"'' Yl.. R �",::+6i+!.•: • R..tyn.»v.
:i% ❑ Copy';on file �i''❑ Cody submittedPL
IJQi ; ❑III. The cost of.the,woik to be performed it $100 or less.
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'!❑ IV. I certify that in the performance of the,ovork�for which this permit is issued .'I shall nut mploy, any'.rson i ny, manner so as to.becomes:,-,-
of
ecome s:, -,-
subject to the Workers' Compensation laws oftCalifornia. I further certify that, in the;event.l.beco a sy6'ecI to the Workers Compensa
tion provisions of the Labor Code that l will cornply forthwith with the provisions of,Mabor}odeec`tio �3Dd0; et aeq.,•and understand •, ',
that, if I do' not'comply, the permits hall be,Oeemed revoked.
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t +fd, •F •.'�6 `fir �' �+� � •. �:
❑jV. I certify as 'theownei (or'tlie agent •of
the owner) that.' in the �performanc of`ther brkr for which'this permit i; issued �" •ti'':
t (b L I have engaged" 6f ti.
(% f> contractor. .(Contractor must have on file or" bruit certificate requireddby 1 or 11 bo'
f `rrl Applicant's Signature ?( t t' x '!1 : •S :' �yi .!"=� # .,^. ;
it i! Date t° i •'A , Ir % Permit NO.
Address and location where work is to be performed
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C f+; N Ji .FIT; 241 Rev. 6/77 .f; ,Fr j y,.t
�`._. I !JILDING-PERMIT.✓' f'-, � -� �y+�.�.,�w. r 'f .�. w� - r j r .c . , q rk. f «�.._ .^st ;. ... t� : s•-
PERMIT NO. ~'° i t c DEPARTMENT OF BUILDING 8 SAFETY ' "
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X54110; , i it
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CONSTRUCTION
ESTIMATE.: J . f
Owner
Oer
NO.
ELECTRICAL FEES-'
NO. PLUMBING FEES
`s" :•
(NITS
MIST FL.
1
SQ. FT .@, i ' v�
Valuatio�'n t 1
§
Date -.
U
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SQ. FT. @ 1 i
fee § - Z�
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YARDYSPKLR SYSTEM
/2ND. FL.
SQ. FT. •� !/'.
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arl.'
MOBILEHOMESt%C (i ✓xhi rr.aS... !r,� BARTSINK A0 rr,v.i
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tGAR.
#•✓_`-h�/ :-l •• •:
'L�e„'
SQ. FT. @ t' r, Iia
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POWER OUTLET" P L 3'r'".
ROOF DRAINS
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SQ. FT. @ i� M �t•:
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f Descri ti'Construction Vf.%f�l�. • J
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DRAINAGE PIPING '
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CAR P.
Group
SQ. FT. @.'_' r r '�J-
SMI Fee §
Plumbing Fee Dbl §
Btiindmt.
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FOUNTAIN.
Plan Checker i
JWALDRINKING
L
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Unit * '
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SQ. FT. j>j�f f
@
Demol. Fee § ., . �. r
Const✓ Lende[r� "r • :y Branch ' r
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,
URINAL
Mileage Fee $ 7.i
VALUATION' f ��`y l'
-✓� F�
Reinsp. Fee § �.
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WATER PIPING _
ESTIMATED CONSTRUCTION
Y NOTE: Not to be used as property tax valu6ilon'./,`• 'r+
: _C�' Zip - :r
City. _„ -i. ;:"7
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M.O. N.C. Cash Chec
SWIM POOL, PVT'
FLOOR DRAIN
Tel. - _
License# '
MECHANICAL,FffS1,,; . i f'
testi
'Addres4
SWIM POOL, COMM
WATER SOFTENER
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'DENT SYSTEM
FAN EVAP. COOL,` J !{HOODy • is•
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SIGN
r WASHER,(AUTO)(DISH)
APPLIANCE
.•_..i•DRY !"'";i+}�r+s.`
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GARBAGE'DISPOSALIr
FURNACE
UNIT WALL FLOOR l'JSPENDED`t
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f LAUNDRY TRAY
AIR HANDLING UNIT p '+Z''�!' ' CFM:},
IDLE METER
i KITCHEN SINK
ABSORPTION SYSTEM • �y� fIX B. T:, :Y.r
tk� . ,�
TEMP USE PERMIT SVC "
WATER CLOSET
COMPRESSOR HF,�'�I� •• ' t
AR..'
P LE,TEMP/PERM.
LAVATORY
HEATING SYSTEM FORCED GRAVJ Y rr ; U*
MPERES SERV ENT !
SHOWER
BOILER t
B.T.U. °Ike.}..
tJ
SQ. FT. @ . c.
�- BATH TUB
7"1{%�1ft�,";^t` #� , i, r..`..
J .jar .•, SQ. FT. .(@ .t : r• ,:. >,.5 WATER, HEATER,,,-.
er•I.'
SQ. FT. RESID @1'/.c
SEWAGE DISPOSAL
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SQ. FT. GAR @ ''/. c
HOUSE SEWER
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4
*
GAS PIPING
t
PERMIT FEE
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PERMIT FEE
PERMIT FEE
1FEE
DBL.
TOTAL FEES
I MOB. HM. FEE
/�. MICRO FEE
..MECH. PtE '' PC. CK. FEE
CONST. -FEE _ -ELECT. FEE -
_ ` Y SMI FEE' ,.
"• -.'"FEE PLUMB.
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t� PERMIT NO.
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Job Address ti� , - Space Zip
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35411
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Valuatio�'n t 1
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Date -.
Dish
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F.C.C. ..
1MH.Permit
fee § - Z�
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Micro Film Fee Cop § • -
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Parcel No.. �. wwr}' t +
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Use/Case No. •
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Dbl E
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Fee Dbl § yI
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Electrical Fee Dial §
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Zone Restrictions
Group
Type
SMI Fee §
Plumbing Fee Dbl §
Btiindmt.
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Pla ' No.4 ;- :
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Plan Checker i
final Dote '� "
Inspector- • f
Unit * '
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Sp. Insp. fee §
Demol. Fee § ., . �. r
Const✓ Lende[r� "r • :y Branch ' r
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Supplimentol Permit Numb
r;i•.'�'.. s '•-�. .„+•i n a►'.•'.ar a,.�•;w . �' • yw.»
Registr. Fee § {,,« 1 'i.
Mileage Fee $ 7.i
Adydress r ; - t. City Zip
Witness Fee §
Reinsp. Fee § �.
Owner/Agent t /. �inr t 1''1 ...a.r �. S
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v" i1yf''-f�J•s� 'rM4+�+NNr N.4,y,+..
Tel. ;. 1• - Zip
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Total Fees Is i
Address •,...-� , ..-,..•.� ..-...--.�. . -..� » v >.
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M.O. N.C. Cash Chec
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Received by J - -
,'Contro'ftor'' - ,
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Tel. - _
License# '
Trees required
Sewage System r
'Addres4
City . . .i Zip
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TLL P iC 1'�, THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verifib
ely:
Sewer District }' y/ FOR 120 DAYS SHALLALSO t PER TO BECOME VOID. 't.
HEREBY AGREE TH A L WOR N CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
�;
t �HE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
• c k (.: +..►-w w..r, - �...-...>`. _ p • �-+_ ' � .d•Y wa't• sw's v.-fa'„e•v •w`:.=..e.,yl..r„iaf.,�,ut r.. . .
r I HEREBY CERTIF-Y THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
r ACCORDANCE WITH SECTION 5541 OF THE BUSINM AND PROFESSIONS_ CODE OF THE STATE OF CALIFORNIA.
Form 284-208 (Rev.8/78) 1' F i v �- - '
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NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE 7INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Figs & Frms
2-7-3-2,9
>;;�Va e,-
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
_ _
36
Inlets & Outlets
4
Grout Blocks
— _ %QQV
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
10A
Fireplace
T. 0. C]
oo
'A'�
ADDITIONAL INFORMATION
FOOT/it/('rS Oss
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B 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
25
Final
Tank Pit L.Line 4
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
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26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
�., DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
s
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner�Mm V C" Architect — _ Contractor_—:- _
ddress
Addresn Address___— Address—
,-���5'h��
City -Lyvi �S�' City__ — _ City -
City
Phone 36& —4 13 Q Phone _ Phone— -..-
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 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 is agreed that I (we) will not occupy said property and will not cause said property to be occupied until I (we) have
complied lawsofthe County of Riverside and the State of California governing said property.
�with �all
DATE {__. SIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
a_tI4 SPACE NO.
USE OF STRUCTURE
JOB ADDRESS —/ _Zai �/v"r-�= �" CA �� - SINGLE FAMILY DUPLEX
F
LEG D SCRIPTION OF PROPERTY —/� APARTMENTS' �J AGRIC.
Z W
/ / 3%0
0 Q
-' COMMERCIAL INDUSTRIAL ❑
COMMUNITY . ALTERATIONS n
e
Z
NO. OF SUBMITTED PLANS USE OF PERMIT A9:1—A9:1—/P44=UA
V Q
CASE NO.
---
� c7
Z
NO. OF PARKING SPACES REQUIRED' NO. OF BUILDINGS NOW EXISTING
Q 0
ZONE., SETBACfKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK OR INA CE # OF FEET REQUIRED ON STREET
DATES/C SIGNATURE OF LAND USE OFFICIAL /��✓/� C�.�
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET --
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
i
t -
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
'
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
CIMPROVEMENT?
YES ❑ NO ❑
of
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
I
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
—
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
AA FLOOD CONTROL
F-
W AIR POLLUTION
_
I tDIV OF HWY
—
c a — YOUR PROPERTY MAY BE SUBJECT- TO
o.
c FLOOD. RIVERSIDE COUNTY ASSUMES N
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT