402749 (RPL)BUILDING PERMIT
PERMIT NO.
402749
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE S I
COUNTY OF RIVERSIDE II
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
Valuation
Dot
Dist.
SO. FT. @ YARD SPKLR SYSTEM
F•.C.C.
SO. FT. @ MOBILEHOME SVC. BAR SINK
Micro Film Fee Cop S
SO. FT. @ POWER OUTLET ROOF DRAINS
Parrc�ell•9NNoo... ••
G+ZO !/
SO. FT. @ DRAINAGE PIPING
Ck. B
SOFT. @ DRINKING FOUNTAIN
.
PI. Ck. Fee $
cj` URINAL
Lot Size
/
pe
VALUATION $ 04' WATER PIPING
Legal Description R
J
NOTE: Not to be used as property tax valuation
AV SWIM POOL, PVT
R
FLOOR DRAIN
Zone Restrictions
MECHANICAL FEES
SWIM POOL, COMM
SMI Fee S
WATER SOFTENER
Bond Amt.
g
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Final Dote14�if
WASHER (AUTO)(DISH)
Unit
APPLIANCE DRYER
Demol. Fee $
Const. Lender Branch
GARBAGE DISPOSAL
Registr, Fee $
FURNACE UNIT WALL FLOOR SUSPENDED
Address City Zip
Witness Fee §
LAUNDRY TRAY
Owner/Agent
AIR HANDLING UNIT CFM
IDLE METER
Total Fees $
KITCHEN SINK
City Zip
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
-
WATER CLOSET
License#
COMPRESSOR HP
POLE, TEMP/PERM
Address
LAVATORY
,
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT.
BATH TUB
SO. FT, @ a
-
WATER HEATER
S0. FT. RESID @lt/4a
SEWAGE DISPOSAL
S0. FT. GAR @ V44
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
a GU
DBL.�TOTALJ
f �i4„f'
>
MOB. HM. FEE
MICRO FEE MECH. FEE
PL. CK. �FEEEEs
CONST. FEr
LEC
SMILE
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e �J
FEE
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Job Address //j/J� /� �% Space Zip�7 �`
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pERMt
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Cam/muni,y
�N ��I'V
Valuation
Dot
Dist.
Off.
F•.C.C.
MH Permit Fee $
Micro Film Fee Cop S
Use of Permit2^���
/� 7,7 /
Parrc�ell•9NNoo... ••
G+ZO !/
Use/Case No.
i1ey,
Ck. B
Mech. Fee Dbl S
PI. Ck. Fee $
Set Backs
Lot Size
/
pe
Construction Fee Dbl § -
Legal Description R
J
F
§�26—
Is
R
Electrical Fee Diet S
Zone Restrictions
Group
SMI Fee S
Plumbing Fee Dot $
Bond Amt.
g
Plan No.
r
Plan Checker
Final Dote14�if
Inspector
Unit
Sp. Insp. Fee $
Demol. Fee $
Const. Lender Branch
Supptimentol Permit Nu s
Registr, Fee $
Mileage Fee $
Address City Zip
Witness Fee §
Reinsp. Fee §
Owner/Agent
Tel. Zip
Total Fees $
Add�reessss /�•"
City Zip
M.O. a N.C. s� Q Check X
Receive 47 r
• Contractor
_
"Tel.
License#
Trees
S. - Oe' System
Address
City Zip
,
T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 GAYS. CESSATION OF WORK
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
s THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
I kEBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
L Form 284208 (Rev. I/80) lf'CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
venf ied%y:
02749
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD r DST
//
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. @ $
UNITS
UlJ
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
Valuation
SO. FT. @ YARD SPKLR SYSTEM
Dist.
SO. FT. @ MOBILEHOME SVC. BAR SINK
F.C.C. �!
SO. FT. @ POWER OUTLET ROOF DRAINS
Micro Film Fee
SO. FT. @ DRAINAGE PIPING
SO. FT. @ DRINKING FOUNTAIN
URINAL
VALUATION $ Gl ✓ WATER PIPING
:2 f'
NOTE: Not to be used as property tax valuation
AV SWIM POOL, PVT
/� ✓�
FLOOR DRAIN
1 �: J
MECHANICAL FEES
SWIM POOL, COMM
+
WATER SOFTENER
S 5/2R
�
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
Zone Restrictions
WASHER (AUTO)(DISH)
e
APPLIANCE DRYER
Plumbing Fee
Dbl §/cif
GARBAGE DISPOSAL
Bond Ami.
S
FURNACE UNIT WALL FLOOR SUSPENDED
Plan Checker
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
Dental. Fee
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
Mileage Fee §
LAVATORY
Witness Fee §
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
i
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Total Fees
SO. FT. @ a
J
WATER HEATER
y
S0. FT. RESID @ 1144
SEWAGE DISPOSAL
M.O. N.C.[) Cash Q Check ®'
Received -by
S0. FT. GAR @ 3/44
HOUSE SEWER
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_ Tel. �('f
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GAS PIPING
Trees requ red •fX: '7w'- f. -_ .--.../
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PERMIT FEE
PERMIT FEE
•7
PERMIT FEE
/,.t r� ,
DBL.
TOTAL_FEMOB.
HM. FEE
MICRO FEE MECH. FEE
PL. CK. FEE
CONST. FEE
ELECT. FEE,:>
SMI EEE
FEE
PLUMB.fFE6 J '.
PERMIT NO.
4"0'27
I
Job Address
/'// Alf4�14 2
.
Space Zip
17 2 5'
Ow
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t
Community
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
Valuation
Dote///'''���
Dist.
Off.
F.C.C. �!
MH Permit Fee EA
Micro Film Fee
Cop S
Use of Permit -+�
ParcelNo.No..Use/Case
No.
Ck. By
Mech. Fee Dbl §-
PI. Ck. Fee § :Lv
Set Sacks
lot Sire
Construction Fee Dbl § 'e 4 %�
Legal Description
/J-�h/6-I"//]
/fjJ .-�
�}� '"
+
F
S 5/2R
�
Electrical Fee Dist § / �% ✓'/
Zone Restrictions
Group
e
SMI Fee §
Plumbing Fee
Dbl §/cif
Bond Ami.
S
Plan No.
Plan Checker
Fin t s e<t
Unil}
Sp. Insp. Fee §
Dental. Fee
§
Const. Lender
Branch
Supplimental Permit Numbers
s�
Regisir. Fee §
Mileage Fee §
Address City Zip
Witness Fee §
Reinsp. Fee
§
Owner/Agent
Tel.
Zip •!
Total Fees
§
J
Address
City
Zip
M.O. N.C.[) Cash Q Check ®'
Received -by
x%
Contractor,
`[./ i
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_ Tel. �('f
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Licensell
Trees requ red •fX: '7w'- f. -_ .--.../
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Sewage System
.�.E�
Address
r%3/
/,.t r� ,
City
{�
�iL,
Zip
-•
T LL
THIS PERMIT SHALL BECOME VOID IF. WORK IS NOT COMMENCED WITHIN 120 BAYS. CESSATION OF WORK
p
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Sewer District
�y,-�
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.
• /�J
I EBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284208 (Rev. 1/80) ,n
CORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified,'¢y:
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING 'APPROVALS
MECHANICAL APPROVALS
I
Set Bock
33
Ventilation System
2
Ftgs 8 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
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.O.
°o ADDITIONAL INFORMATION
_ _ � _ _ , _ _ -- - • _ ,. _ _ _ _ .. _-- - . _ . __ _ s _ _,._-,.-- x. _ _
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath '
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
---- _ _ _ .PII.IMBING_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
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
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NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
Owner Archijim __ _ Contractor —_-_ -
Addres� Address___— -- Address_ --
City R City --_—__-
Phone 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
W
Z
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 with all laws of the County of Riverside and the State of California governing said property.
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.
Ii SPACE NO.
- ! USE OF STRUCTURE
JOB ADDRESS SINGLE FAMILY DUPLEX
Z W
LEGAL DiSCRIPTION OF PROPERTY _ -----, APARTMENT AGRIC.
O v.
H Q
f COMMERCIAL INDUSTRIAL
j '^
COMMUNITY ALTERATIONS C�
O O
Z
NO. OF SUBMITTED PLANS USE OF PERMIT -
1
CASE NO.
Z
NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING - - -- -- `-
Q
ZONE 'SETBACKS: FRONT SIDE
J m
GRADING PERMIT REQUIRED? YES 7 NO ❑ LOT SIZE �-
SETBACK ORDINANCE # _-- OF FEET REQUIRED ON STREET
DATE SIGNATURE OF LAND USE OFFICIAL -
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET
H
_ r
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
i
H
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES ❑ NO ❑
O
°C
DATE __ SIGNATURE OF ROAD DEPT. OFFICIAL- —
=
SWIMMING POOLS PUBLIC
iW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
s;
WATER POLLUTION REMARKS
Pn FLOOD CONTROL
AIR POLLUTION
W
W
DIV OF HWY
F
o _ YOUR PROPERTY MeY BE SUBJECT TO
c FLOOD. RIVERSID& COUNTY ASSUMES
NO RESPONSIBILITY 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, 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.
Q 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
Q OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt 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, B.&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
Owner
71 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 copy is hereby furnished.
Certified copy is filed with the County of Riverside, Department of Building and Safety.
Date Applicant
a 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' Compensation 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
�] I hereby certify that no excavation five (5) or more feet in depth into which a person is re-
quired to descend, 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.)
Q 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.
r
d Division of Industrial Safety Permit No.
i
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-
perty for which I have applied for this permit for the purpose of making inspections.
gnature of Applicant/Agent ua
Print Applicant/Agent Name
284-2000 7/80