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FIELD
r•{DEPARTMENT OF BUILDING & SAFETY
Y
PE7iMIT NO:� PE M TTYPE- S COUNTY OF RIVERSIDE / ~ '' ..._ N
Additional Intormation: °" t
.ACTORY BUILT HOUSING
MOBILE HOME INSTALLATION
Manufacturer
MH Monuf.
New ❑
Model Designation
Size
Relocated ❑
Unit Serial No.
Total Fees $
Plan Approval No.
4nsig.
Serial No.
Moving
c ewage System
T 1 1
p
Permission is hereby granted to move the
structure, described below, in
Width Length Height
Total Fees $
GRADING
sx _.Ci
� _._--�.
#1 '
Number
of #2
#3
Cut
,Fill.,Sections
Total Fees $
(}
Present Location
Community County
RELOCATION INSPECTION
Destination
Present location
Community
County
Total Fees
$
Total Fees $
NO. er t .
A �' 10
Job Address
�- : _c� v .y 11) �� - r�
SP #
Zip
Owngr
,�"�� �i ��v ae�
Plan Check
Comm pity e�
aluation
Date
Dist
Off
A�
C.
s"
.Reinspection
Use o' er�m t .
1G� G����
������
Parcel �No.
Lot Size
Factory-
.Built
Set backs
Use Permit #
Leg I D cri •ti n
74
Bond zone
Grp
Type
Unit
ckby
Mobile home`c
Engineer License
r_ -X41
Final DateInspector
1 12A -`
Env. Assmt.
Requirement
Relocations
Escrow Company
Br Th
Tota I Fees
$ "12141
6�O
Address f
O Gd o� % r y 1-
City
Zip
x cash
Checke
MO rvc
Owner/Agent
Tel.
RecetfjQd by 4e
A d nC/Ylii1" I f�V
Address
Addrejsjs
���' �`t'...� ✓— �..�
City,,. Zip
� si .r7 (: tf P%' ��f `cn
,Related Permit(s)
Contractor/ Mover
Tel.
workers' comp.
* yes ❑ no ❑
Address
City
Zip
',t ertify that in the performanc f)in.n.ylim
he work for which this permit is This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days
+ssued I shall not employ any erson ann os to become sub -shall also rouse permit to become void.
ject to the workers' compens tion low Cfo i 4 I hereby agree that oil work in connection with this permit will be done in accordance with the laws of
Riverside County and the, State of California. I hereby certify that the individual who prepared the plans and
Owner Signature specifications has done so in accordance with Section 5541 of the Business and Professions Code of the
Builder Signoturq State of California.
FORM 284-208A 5.77 @m
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
plenums & Dues
2A
Slob Grade
35
Furnace Comport.
3
Steel
36
nlets & Outlets
4
Grout Blocks
37
Combustion Ai -
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detention Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O. 0
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE .& LOCATION
1 1 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts))
12B Ceiling (Botts)
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
REAR OF PROPERTY LINE
PSL Pi
ELECTRICAL APPROVALS
26 Power Pole
27- C6nduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
r
W
,,� STREET NAME —
4 .284 199 9/74 CANARY—FILE, PINK—APPLICANT -
Owner
Architect Contractor
AddreAddresAddr
City City. Ci ty_ r/ (. '} ✓ f`
.".Jy�"bJ 3 S
Phone Phone
'AOT
WIv(we)
i'
NOTICE: THIS IS A. UILDING PERMIT..
DISTRICT
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
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
Permit No
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be occupie it 1 (we)_.4a e;
complied with all 1 ws of the County of Riverside and the State of California governing said property.
1 -.• }
t`-� �r
DATE `� SIGNATURE OF OWNER
y
COUNTY OF RIVERSIDE
----
the Following Departments Listed Below C
_,yyr �4 11
.I SPACE NO. ,
��j"'�ab 441ZA1d I USE'OF STRUCTURE
h �`T j/y;I �t� ' r.
4 .284 199 9/74 CANARY—FILE, PINK—APPLICANT -
Owner
Architect Contractor
AddreAddresAddr
City City. Ci ty_ r/ (. '} ✓ f`
.".Jy�"bJ 3 S
Phone Phone
WIv(we)
the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
j
Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building' and Safetyw
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.
"un
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be occupie it 1 (we)_.4a e;
complied with all 1 ws of the County of Riverside and the State of California governing said property.
1 -.• }
t`-� �r
DATE `� SIGNATURE OF OWNER
AND/OP AG.ENT'�
Approval by Signature from
the Following Departments Listed Below C
Must Be Obtained Prior to the Issuing of a Construct?n Permit.
.I SPACE NO. ,
��j"'�ab 441ZA1d I USE'OF STRUCTURE
h �`T j/y;I �t� ' r.
z W
JOB ADDRESS- 1 11 ;
�g f •rfs+� —,0/4 — SINGLE'FAMILY � DUPLEX1. �
.,UEdL,SC.RI'TI0 F PROPE.RT! ''>•
— APARTMENTS AGRIC.
r Y'
O r`
W '"COMMERCIAL INDUSTRIAL CJ.
COMMUNITY/ALTERATIONS
Z '
J Ej
NO. OF SUBMITTED PLANS —U,S OF PERI�I¢T-�
us a
ICASE N0. P���cG'+ �.lG ^ . ✓fizGic.tf*ll-4y.
p Z
NO. OF PNG SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING --
j ?
ZONE SETBACKS: FRONT DAE< EAR
9r,
m
,' gey
GRADING PERMIT,REQUIRED? YES �NO ❑ LOT SIZE
SETBACJC O.DINA yC�ES OF +.r•+•..••- FEET REQUIRED ON .;T
e/
DATE SIGNATURE OF LAND USE OFFICIA _
F
DEDICATION "REQUIRED:/ YES ❑ NO ❑ NO. OF FEET ---
CURB AND GUTTER REQUIRED: YES*❑,;. NO ❑ STREET
H
of
_
s
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE- APPLICATION BEEN MADE FOR ENCROA MEN',TAPERMNtwQFU DRIVEWAY AND STREET
��+
CIMPROVEMENT?
YES ❑ NO ❑
°C
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL
SWIMMING POOLS PUBLIC
F
a W
SEWAGE DISPOSAL _
FOOD ESTABLISHMENT
_
WATER POLLUTION REMARKS
�n FLOOD CONTROL
of W AIR POLLUTION
_ DIV OF HWY f
o a YOUR PROPERTY MAY BE SUBJECT TO
o FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
4 .284 199 9/74 CANARY—FILE, PINK—APPLICANT -