404248 (BLCK)BUILDING PERMIT
PERMIT NO.
0424,8
DEPARTMENT, OF BUILDING & SAFETY
COUNTY OF ,RIVERSIDE
FIELD '
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=CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
2ND. Fl:'
• POR. •
GAR r
--YAR P.
ra��
WALL 'S
•
.ESTIMATED CONSTRUCTION_
SO. FT. .@ $
UNITS.
S0. FT. @ YARD SPKLR SYSTEM ,
' MOBILEHOME SVC. BAR SINK
S0. FT. @
4
_
S0. FT. @ a POWER OUTLET ROO.F.'DRAINS
SO. FT. @ DRAINAGE PIPING
li
@ - DRINKING FOUNTAIN''
0. FT. - �- ..
• ci' . { URINAL
SO. FT. @ "
VALUATION .' $ WATER PIPING
-
NOTE: Not to be used os 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
-
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
COMPRESSOR HP
POLE,, TEMP/ PERM
LAVATORY
'
HEATING SYSTEM FORCED GRAVITY.
AMPERES SERV ENT
SHOWER
s
BOILER B.T.U.
SO. FT. @ a
BATH TUB
SO. FT. @ a
WATER HEATER
.
S0. FT. RESID @ 11/4c
SEWAGE DISPOSAL
{
S0. FT. GAR @ 3/a¢
HOUSE SEWER
- - -
-
GAS PIPING
PERMITTEE t
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEESM
OB. HM. FEE
MICRO FEE
s:
MECH. FEE PL. CK. FEE
r
CONST. FEE ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
29A
29B
30
31
32
Ground Plumb
Water Piping
Rough Plumb
Vents
Sewage Disposol
Sewer
Water Heater
Water Softener
Water Service
Gas Test
Final SEWAGE SYSTEM SIZE & LOCATION
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
Power Pole
Conduit
Service Entrance
Wiring
Grounding Wire P/L P/I
Bonding
Fixtures
Service
S
Final
STREET NAME
PERMIT NO.
Job Address Space
Zip,
y'
ate-
Owner
•"'Dist.—
ColfrM.rity—
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V luation
5 s~ �� s
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Oft.
n
F.C.C. -"
MH Permit Fee Et
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Micro Film Fee Cop $ /
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Us of Peity -
rm
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%!/- S�,/J✓/c'J ['�•re
P4.61 No.. `"
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'Use/Case No. —/s
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Ck. By '
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Mech. Fee D61 S•,'�
PI. Ck. Fee b -
- '•'` •'Set B66,-_ -
Lot Size '`.r•- "r^ -�i
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Construction Fee Dbl E �.(�
Legal Description
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F
S S R
,Electrical Fee Dbl 5
Zone Restrictions
Group '
Type �?
SMI Fee S
Plumbing Fee Dbl E
Bond Amt...
E
Plan No. � � `„
PI C eckei
oO'
1I -2I -8b `
Inspector
Unit .
_
t ,
Sp. Insp. Fee, $
Demol. Fee. $
Carist. Lender Branch
-
Supplimental Permit Numbers - •
T
Y,
_ J
^ �r
Registr. Fee $
Mileage Fee S -Address
Cit Zi
- Y P
' Ji '
Witness Fee ;
Reinsp. Fee $
Owner/Agent.
Tel. Zip t
Total Fees $
Address
• -
City Zip
;3
'M.O. ❑ N.C. q Cash ❑ C eck"
Received by Nf ,.
Contractor -
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Tel.
Licensen II
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a �3im
AOdre35el]
pity
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FOR 120 DAYS' SHALL ALSO CAUSE PERMIT TO BECOME -VOID.
Sewer_ District ' - ".«..•r' •
L:1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT. WILL BE' DONE IN ACCORDANCE WITH!'
r THE LAWS OF RIVERSIDE COUNTY AND THE'STATE OF CALIFORNIA.
'
~
I' REBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS'AND SPECIFICATIONS HAS DONE SO
CORDANCE(WITH SECTION 5541 OFTHE BUSINESS AND PROFESSIONS CODE OF,THE STATE OF CALIFORNIA.':#
'Form 284208 (Rev. -1/80) e e •t • - - r„ - • "`t5 ✓ ( •':\, ',4
NO.
OPERATION
DATE
INSPECTOR NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
/ 3 U
33
Ven•ilation System
2
Ftgs & Frms
1 l
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
—
36
Inlets & Outlets
4
Grout Blocks
, „'l %�
37
Combustion Air
5
Bond Beams
/ _ b
l
38
Compressor
6
Roof Deck
39
Ap?l. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
n
43
Final
10A
Fireplace T.O.
[)
No
ADDITIONAL INFORMATION
11
Exterior Lath
12
Internal Lath
12A
Drywall
13
Finish Grade
"
INSULATION
Thick R
Value
7A
Walls (Batts)
126
Ceiling (Batts)
12C
Ceiling (Blown)
14
Final
.+2 f,.
DIIIKADIIJd_ ADDDAVAIC
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner / fL OL - 7 5- Architect —. —_ Contractor.
Address�/����}��h ��A����f�Jdress___— Address "����/'3�5✓y
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<L i ! ! Yt G 0 1Y/ r �ert 1�.� a C+q(r
L+ _f_i1
Cityrd) y. City-- City^
Phone Phone _ Phone ✓ !ve"
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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 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 occupy said property and will not cause said property to be occupied until I (we) have
complied with all laws of the Countv of Riverside and the State of California governing said property.
SIGNATURE OONANNTQ�
D A T E OF AND/OR AGE
�-------
Approval by Signature from the Following Departments Listed Below _
Must Be Obtained Prior to the Issuing of a Construction Permit.
gJGGES PACE N0.
U�e r USE OF STRUCTURE
JOB ESS c / �414.
SINGLE FAMILY DUPLEX
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AL ES IPTI OF PROPERTY - APARTMENTS n AGRIC. El
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COMMERCIAL Ej INDUSTRIAL -
COMMUNITY ALTERATIONS ❑
C O
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NO. OF SUBMITTED PLANS - USE OF PERMIT
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CASE NO.
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NO. OF PARKING SPACES REQUIRED — NO. OF BUILDINGS NOW EXISTING
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ZONE4:�F — I/ ETBAeKS: FRONT SIDE REAR
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GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE# OF FEET REQUIRED ON STREET
DATE —42—��d SIGNA-TURE OF LAND USE OFFICIAL - -
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET --
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
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CAN CURB AND GUTTER• FEASIBLY BE INSTALLED? YES ❑ NO El
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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 - _ SIGNATURE OF ROAD DEPT. OFFICIAL
=
SWIMMING POOLS PUBLIC
JW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
rn FLOOD CONTROL
H -
W AIR POLLUTION
ix
W DIV OF HWY
YOUR PROPERTY MAY BE SUBJECT TO
a
g _
Lu 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 #
Effective July 1, 1980, Chapter 1301 Section 19825,of the Nealth 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 Code and my license is
ssrin full force and effect.
License Class 1- _ License No.
[� OWNER -BUILDER DECLAON
I.hereby affirm that I am -exempt from the Contractor's License Law for the following reasons:
0 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;'6.&P.C.).
�] I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B.&P.C.).
[� I am exempt under Section B:&P.C. for this reason:
Date Owner
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"(S 8 0, Lab. Code).
Policy No.'J /0-,-/:z—`aa Insurance
M--i:ert:-ified copy is hereby furnished.
Certified copy is f le)d with the County -Df Riverside, Department Building and Safety.
Date�f.(f`�j o_—County-Df
tiG 1%J
CERTIFICATE OF EXEMPTION 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 work for 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' Compensat"ion 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. Code).
Lender's Name
Lender's Address
DIVISION OF INDUSTRIAL`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 i6 connection with work authorized by this permit, and that no
building, structure, scaffolding, falsework, or demolition or dismantling thereof, will be
more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.)
CAs owner -builder, I will not employ anyone to do work which would require a permit from the
rvision of Industrial Safety, as noted above,.unless such person has a permit to do such work
from that division.
0 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$$Idver ', Department of Building and Safety to enter upon the pro -
which I have a plied fdr permit for the purpose of making inspections.
/ a - 'yo
S'i nature of ApT cant) gentDa e
Pi`I- Yt le
Print-Applican04 1�/Agenir Name -
284-2000 7/80