Loading...
403199 (RC)r� PERMITNO^r• 403199 DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE FIELD M CONSIRUCTI&T Eff I AT IV NO. ELECTRICAL FEES NO. PLUMBING FEES, pace 1ST FL. 2ND. FL. POR. GAR. CAR P. WAIL f ESTIMATED CONSTRUCTION SO. FT. @ $ UNITS As -N A ,D SO. FT. @ YARD SPKLR SYSTEM SO. FT. @ MOBILEHOME SVC. BAR SINK SO. FT. @ POWER OUTLET ROOF DRAINS {. SO. FT. @' DRAINAGE PIPING SO. FT. @ DRINKING FOUNTAIN ` zs. SO. FT. @ r URINAL F.C.C. VALUATION $ WATER PIPING _ NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN r MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER 8' VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) P APPLIANCE DRYER +y ka Construction Fee Dbl $ GARBAGE DISPOSAL I FURNACE UNIT WALL FLOOR SUSPEN)ED LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK Electrical Fee Dist S ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET r 4 COMPRESSORf HP 0GRAVITY POLE, TEMP/PERM LAVATORY ` HEATING SYSTEM FORCED 13 Plumbing Fee Dist S AMPERES SERV ENT SHOWER Plan No.P BOILER B.T.U. Fina Date SO. FT. @ a BATH TUB $p. Insp. Fee $ SO. FT. @ a WATER HEATER i 1 J ^� O V / a v S0. FT. RESID @ 1'Aa SEWAGE DISPOSAL Daniel. Fee $ Const. lender SO. FT. GAR @ V4a HOUSE SEWER ' Registr. Fee S Mileage Fee Address City Zips $ GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. TOTAL FEESMOB.HM.FEE f W Zip MICRO FEE MEC �FJ PL. CK. FEE f9 CONST. FEE ELEC~ E ` SMI FEE FEE PLUM. E r PERMIT NO. JOo Address ".._780 "�� pace Zip ner 403199 -N A ,D Commun - r ; - Valuation S zs. Ofl. F.C.C. MH Permit Fee $ Micro Film Fee Cop S ze of Pe"mit '�" RE MOD IN„ EXISTING COM G a cai o`. "" W 9t692620 e/Case N.. +Ck. dy Mach. Fee Dbl S ir PI. Ck. Fee S WL h IVA kr--' Lot Sixe +y ka Construction Fee Dbl $ I F S S R ii n Goo f 00 Electrical Fee Dist S LOTS 21.22, 32 y 24 DC TR 2 e es rictians Grorx. w SMI Fee g } r, �Unnst Plumbing Fee Dist S n n -Amt. Plan No.P Ion Checker Fina Date Inspector ; $p. Insp. Fee $ g i 1 J ^� O V / a v Daniel. Fee $ Const. lender Branih �'' Supplimanto a Numbers v"� ' Registr. Fee S Mileage Fee Address City Zips $ Witness Fee S Reinsp. Fee $ Owner/Agent,�t, //� Tel. Zip WEISy ' Total Fees $ A rers _1 it t 78-025 . ly ”' ! 4 Zip . M.O. N.C. ❑ Cash Check Received by ✓ t Contractor - Te . " licenses Trees requir Sewage $ ,. 4 Address` City Zip ilyiti T LL 4 - THS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK 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 THE .AWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I RE CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO}IN Form 284.208 (Rev. 1/80) FCDANCE WITH SECTION 55i1 OF I�(�;,-JSINESS':,+ND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. .;r , f NO. OPERATION DATE INSPECTOR NO. OPERATION Di;TE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS , 1 Set Back 33 Ventilation System• ' 2 Ftgs & Frms 34 Plenums 8 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 t�% 77 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. E) 43 Final % 40 10A Fireplace T.0. NOADDITIONAL INFORMATION I. LN / C) C.T Sr�h / uP el�(hr �4ek C/ �/O Zai - -- ----- -----15 SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal lath ' 12A Drywalldr 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 128 Ceiling (Batts) 12C Ceiling (Blown) 14 Final _ PLUMBING -.APPROVALS.. _ 15Ground Plumb Qr/��`op 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 ELECTRICAL APPROVALS P/L . 1 P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME DEPARTMENT OF BUILDING AND SAFETY COUNTY*OF RIVERSIDE OWNER -BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you shDuld be aware that as owner -builder you are the responsible party of re- cord on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from,possible liability if that person applies for the pro- per permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and, where required, to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, ycu must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemploy- ment compensation,contribLtions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish. the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. - If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner - builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information: about licensed contractors may be obtained by contacting•the.Contractors' State License Board in your community o^ at 1020 N Street, Sacramento, California 95814. Please Jcomplete and returi the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Sincerely, DEPARTMENT OF BUILDING AND SAFETY Leopoldo Rojo, Jr. Director 284-2001 7/80 h F- DEPARTMENT OF BUILDING AND SAFETY COUNTY 'OF RIVERSIDE s OWNER -BUILDER VERIFICATION Owner Aaaress An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for con- struction of the proposed property improvement (yes or no) 2. I (have/have not) signed an application for building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the pro- posed construction: Name Phone Address City Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Phone Address , City r Contractors License No. 5. I will provide some of the work but I have contracted (hired) the fol- lowing persons to provide the work indicated: Name Address Phone Type of work Signature Property .Owner Date Social Security Number 284-2002 7/80 NOTICE: THIS IS NOT A BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OhBUILDING AND SAFETY COUNTY OF RIVERSIDE DISTRICT / I� Permit No 284 199 9/74 CANARY—FILE, PINK—APPLICANT Owner � 13 Architect Contractor AddressZP_S�v A by Addres7r Mb� U Address— Cod' li_4 A/City City City_ Phone Phone ✓ Phone WI Z (we) the undersigneo^ereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and Paving, and/or Nii P( of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety 3 shall not make a a nspection 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 encroach ent permit. 1 NOW, thereto e, it 's 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 aws of the Courcy of Riverside and the State of California governing said pro erty. .Q j 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. R ,,, I SPACE NO. USE OF STRUCTURE JOB ADDRESS ®p`�} J /_ / �� I _ / SINGLE FAMILY E] DUPLEX LEGAL DESCRIPTION OF PROPERTY -7/-f 9 "' Fj QOQO� f - r `):�, o -3 a u p(��A �r� �/ APARTMENTS GR C. �c(� �' - INDUSTRIAL H N COMMERCIAL d L` J Sr COMMUNITY + G Z — ALTERATIONS ❑ '' NO. OF SUBMITTED PLANS USE OF PERMIT Q N --__ t 1 CASE NO. r p Z d� NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS N EXISTING_ _ 9 Q ZONE (- — --SETBACKS: FRONT V �S �1� '- J _R,E �R Co GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE SETBACK` ORDI ANJCE # _— OF FEET REQUIRED ON _STREET '_ DATE U / SIGNATURE OF LAND USE OFFI F DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET___ _ USCURB AND GUTTER REQUIRED: YES ❑ NO ❑ _STREET of W , CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET O C IMPROVEMENT? YES ❑ NO C3 j °L DATE _ SIGNATURE OF 'ROAD DEPT. OFFICIAL_ �, . �r n w„✓° 3 A, e . i N . T0,0_., +S,-. 771,Vj� k/A_10-0.v (�"t - �O! +'o _ Q W SWfi17il0ii39S:R Ff 4cLa. Cu < j r yv 6YiS OISPOSAL�' = 4Q .SEWAGE //�+'tt.'GW Bi�iiF'�=-� •�'+4 FOOD ESTABLISHMEN�[�d cr!> r`,�r_�izi,, �ro C�SDdL�e, 4 57 ox 7-wo )r�yjrr `ate/�rT+�rrJ�WH/t /1 / WATER POLLUTION _ r mac. REMARKS n 4lr .c ( �n FLOOD CONTROL 11nttc•5- A -.in.; Pnlpu,e.y A64,10 1 rV f_ -e t dFt W AIR POLLUTION JFa Goth t A -/X OG = f DIV OF HWY o a^`'^"` - YOUR PROPERTY MAY BE SUBJECT TO o -.- FLOOD. RIVERSIDE COUNTY ASSUMES ESPONSIBILITY IN EVENT OF FLOOD. 284 199 9/74 CANARY—FILE, PINK—APPLICANT DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE COUNTY OF RIVERSIDE PERMIT # Effective July 1, 1980, Chap-er 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. C7 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 in full force and effect. License Class License No. Date Contractor 0 OWNER -BUILDER DECLARATION 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, B.&P.C.). I, as owner oithe property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). [� I am exempt under Section y/ B .&P.C. for this reason: Date Owner /,AP-Aw r] 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 (Sec. 3800, Lab. Code). Policy No. Insurance Q Certified dopy is hereby furnished. Certified copy is filed with the County of Riverside, Department of Building and Safety. Date Applicant Q„ 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 mainer 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 labor code, I must forthwith comply with such provisions or this permit shal be deemed revoked. /�� _ Date y ��-�% 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 Q I hereby certify that no excavation five (5) or more feet in depth into which a person is re- quired to cescend, will be made in 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.) r� As owner -builder, I will not employ anyone to do work which would require a permit from the Division cf Industrial Safety, as noted above, unless such person has a permit to do such work from that division. Q Division )f Industrial Safety Permit No. r1 r Date Q—a Applicant CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY I certify I hale 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- perty for which I ha-ve applied for this permit for the purpose of making inspections. Signature of Applicant/Agent Date Print Applicant/Agent Name 284-2000 7/80 v RIVERSIDE COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health # of Employees �� # of Food SFOOD ESTABLISHMENT FORM ervice 7j Cards � NAME OF ESTABLISHMENT n�G I ADDRESS NAME OF OWNER OR MGR. A% Ql UN � !EP INSPECTED THIS 6- DAY OF LWRJI.k-kms' 19 R. DISTRICT # PERMIT # RECEIVED TYPE OF ESTABLISHMENT SANITARIAN 31 FLOORS NOT CLEA WALLS & CEILINGS NOT CLEAN 1 DOORS, WINDOWS & SCREENS NOT CLEAN .L UTENSIL WASHING AND SANITIZING UTENSILS NOT THOROUGHLY WASHED 6 NOT SANITIZED 6 PROTECTION OF FOOD OPEN DISPLAY _4ANIMAL OR FOWLS —3— FOOD NOT PROPERLY STORED 1_. REFRIGERATION INADEQUATE TEMPERATURE 4 NOT CLEAN 2 UTENSILS & EQUIPMENT NOT CLEAN 2 TOILET FACILITIES NOT CLEAN 1 USED FOR ` STORAGE 1 RODENT & INSECT CONTROL EVIDENCE OF RODENTS HANDWASHING FACILITIES NOT CLEAN 1 GARBAGE & RUBBISH DISPOSAL CONTAINERS NOT CLEAN 2 CONTAINERS NOT COVERED 2 DIRTY SURROUNDINGS 2 . PERMIT NOT DISPLAYED 2 CURRENT -FOOD -HANDLER PERMIT NOT DISPLAY EDG. LIST OF EMPLOYEES NOT DISPLAYED 2 CLOTHING STORAGE CLOTHING NOT PROPERLY STORE[ LIVING QUARTERS LIVING QUARTERS NOT SEPARATED BY SOLID PARTITION 1 HOUSEKEEPING POOR HOUSEKEEPING- 2 TOTAL SCORE ' 1. FLOORS NOT SMOOTH 1 NOT IN GOOD REPAIR 1 13. NOT EASILY CLEANED 1 14. � 2. WALLS & CEILINGS NOT SMOOTH 1 NOT IN GOOD 15. REPAIR 1 r' 16. ` 3. DOORS & WINDOWS NOT -SCREENED 1 NO FANS 1 NOT IN GOOD REPAIR 1 17 4. UTENSIL WASHING FACILITIES IMPROPER SINK 2 IMPROPER DRAINBOARDS 2 5. UTENSILS, FURNITURE & EQUIPMENT NOT IN GOOD REPAIR 1 NOT EASILY CLEANABLE CONSTRUCTION 1 19. OPEN SEAMS 1 CORROSION 1 20 i 6. PLUMBING POSSIBLE CONTAMINATIONBY LEAKAGE 2 CROSS CONNECTION 2 SEWAGE DISPOSAL FAILURE 2 21 7. DRESSING ENCLOSURE NO DRESSING ENCLOSURE 1 22 I 8. TOILET FACILITIES NOT CONVENIENT ON PREMISES 1 23 DOORS NOT SELF CLOSING 1 NOT FLY PROOF 1 I NOT PROPERLY VENTED 1 INADEQUATE LIGHTING 1 9. HANDWASHING FACILITIES NO HOT AND COLD RUNNING 24 , -, WATER 1 SOAP_ 1-' NO'SINGLE SERVICE TOWELS 1 10. _NO GARBAGE & RUBBISH DISPOSAL CONTAINERS NOT 26. LEAKPROOF 2 CONTAINERS NOT FLY PROOF 2 INADEQUATE CONTAINER COVERS 2 27 11. PERSONNEL OUTER GARMENTS NOT CLEAN 1 HANDS 28• NOT CLEAN 3 TOBACCO USED AROUND FOOD 2 12. VENTILATION & LIGHT INADEQUATE 1 29• 31 FLOORS NOT CLEA WALLS & CEILINGS NOT CLEAN 1 DOORS, WINDOWS & SCREENS NOT CLEAN .L UTENSIL WASHING AND SANITIZING UTENSILS NOT THOROUGHLY WASHED 6 NOT SANITIZED 6 PROTECTION OF FOOD OPEN DISPLAY _4ANIMAL OR FOWLS —3— FOOD NOT PROPERLY STORED 1_. REFRIGERATION INADEQUATE TEMPERATURE 4 NOT CLEAN 2 UTENSILS & EQUIPMENT NOT CLEAN 2 TOILET FACILITIES NOT CLEAN 1 USED FOR ` STORAGE 1 RODENT & INSECT CONTROL EVIDENCE OF RODENTS HANDWASHING FACILITIES NOT CLEAN 1 GARBAGE & RUBBISH DISPOSAL CONTAINERS NOT CLEAN 2 CONTAINERS NOT COVERED 2 DIRTY SURROUNDINGS 2 . PERMIT NOT DISPLAYED 2 CURRENT -FOOD -HANDLER PERMIT NOT DISPLAY EDG. LIST OF EMPLOYEES NOT DISPLAYED 2 CLOTHING STORAGE CLOTHING NOT PROPERLY STORE[ LIVING QUARTERS LIVING QUARTERS NOT SEPARATED BY SOLID PARTITION 1 HOUSEKEEPING POOR HOUSEKEEPING- 2 TOTAL SCORE 40PERMIT NO.nt �i {I . DEPARTMENT OF BUILDING 8r. -3199 An r�t COUNTY OF RIVERSIDE to is s � FIELD OFFICE —wow— v0tv11 0SlM ICU I%Jfi PERMIT NO. CONSTRUCTI E A NO. . ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. 2ND. FL. POR. GAR. CAR P. WALL ESTIMATED CONSTRUCTION SO. FT. @ $ UNITS rt2 fA SQ. FT. @ YARD SPKLR SYSTEM SO. FT. @ MOBILEHOME SVC. BAR SINK SQ. FT. @ POWER OUTLET ROOF DRAINS 50. FT. @ ' DRAINAGE PIPING SQ. FT. @ DRINKING FOUNTAIN SO. FT. @ Q 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 ad VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (Al TO)(DISH) APPLIANCE DRYER Zone Restrictions Group1-type GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT Pion No. , CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMP/PERM LAVATORY HEATING SYSTEM 1300 FORCED GRAVITY - AMPERES SERV ENT SHOWER BOILER B.T.U. Address City Zip SQ. FT. @ a BATH TUB SQ. FT. @ c WATER HEATER Owner/ � e wzis Tel. y SO. FT. RESID @1144 SEWAGE DISPOSAL Total Fees 5 Ad ress SO. FT. GAR @ t/aa HOUSE SEWER M.O, N.C.C] Cash C] Check Received by Contractor Tel. GAS PIPING PERMIT FEE Trees requir Sewage S Address PERMIT FEE PERMIT FEE DBL. TOTAL FEESMOB. HM. FEE MICRO FEE , MEC PL. CK. FEE I CONST. FEE ELEC 01 SMI FEE FEE PLUM . nn —wow— v0tv11 0SlM ICU I%Jfi PERMIT NO. � Job Address 78025 Space Zip Owner 403199 Commune y Valuation S - Dist.Off. F.C.C. MH Permit Fee ET,A Micro Film Fee Cop, S se of P mitorce REMODEL EXISTING COMM BLDG o. se/Case No. v k. y Fee Dbl S Pl. Ckh. PL . Fee S - � t ck'Lot Size Construction Fee Dist S g tib � F S S R MA Electrical Fee Obl S LOTS 41 � 22' 32 24 DC TR Zone Restrictions Group1-type SMI Fee gam+ 14414 t A I _ Plumbing Fee Dbl S Norit Amt. Pion No. Pion Checker Fina Dote. Ins ector Unit Sp. Insp. Fee S S / Demol. Fee S Const. lander - Branch Supplimeentoll Permit Numbers RB040319 Regisir. Fee $ Address City Zip Mileage Fee S Witness Fee $ Reinsp. Fee S Owner/ � e wzis Tel. Zip Total Fees 5 Ad ress Gty h Zip M.O, N.C.C] Cash C] Check Received by Contractor Tel. Licenses , Trees requir Sewage S Address City Zip T LL THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK 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 THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I ER CERTIFY. THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284.208 (Rev. 1/80) %`/� DANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.