417968 (GRES),hr �: 6VIs.OsseV-e•.w..ls r� ) ... ,
CFPARTMEN?
r [�
/j 'j `]
BV ILOING Q SAFETY
Q
`t ! . 1 J U B
•: COUNTY OF RIVERSIDE
FIS
i CONSTRUCTION ESTIMATE
f
NO: ELECTRICAL FEES
NO.
PLUMBING FEES
ISTSO. FT. QD $
J UNITS
SO. F7,' ®
ti
�
• '
'
YARD SPKIR SYSTEM
PORSO. FT. ®
MOBILEHOME SVC.
BAR SINK
SO. FT, @�
POWER OUTLET..
ROOF BRAINS
SO. FT.
OIL.
DRAINAGE PIPING
SO, FT, ®
• (
DRINKING FOUNTAIN
SO. FT.
URINAL
ESTIMATED CONSTRUCTION VALUATION
.
NOTE: Not robe used as.,..
FuoperFy tart valuation
Cop S
WATER PIPING
MECHANICAL FEES
SWIM POOL, PVT'
FLOOR DAMN
VFRr 3rstfw FAN EVAP. COOL HOOD
SWIM Ism, COMM
WATER SOFTENER
APPLIANCE DRYER
SIGN -
WASHER (AUTOJ(DISH)
FURNACE UNIT WALL FLOOR • SUSPENDED
GARBAGE DISPOSAL
AIR HANDLING UNIJ CFM
LAUNDRY TRAY
ABSORPTION SYSTEM
IDLE METER
KITCHEN SIN%
B.T.U.
COMPRESSOR
TEMP USE PERMIT SVC
WATER CLOSET
HP
HEATING SYSTEM FORCED GRAVITY
POLE; TEMP/PERM '
LAVATORY
,
BOILER B.T.U..
I F AMPERES SERV ENi
SHOWER
` SO. FT. Q c
BATH 7US
,�,, -. _
_ .-^...
�• �• c
WATER HEATER
.
- 50. FT. RESIO QPI'•.c ►
SEWAGE DISPOSAL
2
S0. f1. GAR 0, y c *
HOUSE SEWER
r+
PERMIT FEE
t
GAS PIPING
�F• tOTA! fFES fAOB.MM EEE MICrrO fLt
PERMIT FEE
MICH. FEE R Q.a2_,/_3C1EfFEf
PERMIT FEE
a
� 3 j
31
. SM) FFE FEE RUMe. FEE
RfbwI NO:
- lob Address --•
Spoee.
- »�...�.� r... ....^.••-••---�-�.,
f
l
It P owner
+•
M)1 Permll Fedcr
Communny ._ -.. -
>�
Ve)uoepn `_`^--T•..�. Dere
..3� •
C sl.
OIL.
P.0 C.
• (
.
Mtpe Alm fee
Cop S
Use of pasmrr
Mack Tae
Dill f
. •,
'---' -
orce No.' Usetco a o. Ce. By
-„.���
PI CS. Fee
S
•
,
• .i Conslroa.aa Tee
Dbl S
. ' % �
egol De�c•rpnpn
L. pl Elotl/
F
Fel $rte
,�,, -. _
_ .-^...
S 3 R -
.
' Flednaol Fee
Obl f
2
T
�”
•.
r+
Zone R�yrt��n
Ciro p
)ypr
IMI fee.
S
1'.
/
.
• plYmbing Tee
Dbf ( �
'Bond ATI.
Pren No
plpn Chet\er r
..._. . \r
e• -
f,not Dol�
, Sip Insp. Fee
_ .�.
+.•
Im ca
! 2
un p
Deraol. Fee
3
Cantt. lender �, Bronch -I
J /
SYpphmerr P6rm.f NYmbe»,
Rcg.,lr. fee
S.
�
� .. ,�,
ALr ' e Fes
S
Mdress _ Cey 1,P
i-. •.
W.mess fee
S
/
Remtp fee
S
+
01«ner/Agent .,
.
let
.
t IP
• Tao) Fees
3
Addmss •. -
p
Cash
Ch
tiS cam: Y
Cos i
Zip
:�
omr• f r
'frees r pwro
-
�
lel.
trcente•
' Sewagn'S)vem
Add+eN
I
r
Car
bp
e
•
FF
p
Sewer D:sh 1,t
�
('
t THIS PERAW SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 110 DAYS. CESSATION OF WORK +014104 vy:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT 10 BECOME VOID.
+
'
.1 HEREBY AGREE THAT All WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH 7
•THE LAWS, OF RIVERSIDE COUNTY AND TKI STATE
OF CALIFORNIA.
fy.THE INDIVIDUAL WHOBUST
'THE
790 LOB law e;`9) Ops
50eg��yLTH SECTION 3561 OF DONE
PREPARED TME PLAESSI i$ ANDDE O FTHE
IIH E*C BUSINESS AND PROFESSIONS CODE OF THE
A
�r
ST THAS
STATE OF CALIFORNIA.RN!<
C�.;
.r^�' NO. OPERATION DATE II,S7ECTOR' s . N0. OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
BUILDING. APPROVALS.
t,; 1 Sal Bock 33 Ventilation System
2 figs 6 Frms 2�g 3d Plenums @ puclt j
• 1
•4 2A Slob Grade 3S Funtoco Compere t
3 Steel 36 Inlets 8 Ow1
91
5
r
4 Greui Blacks 37 Combwtron An
cS Bond Roams 38 Compressor j
6 Root Deck - -- 39 Appl. Clearance
( 7 Framing ( 40 fire .Damper —_
8 Vents
-- - _ —d1 Snrtsv Derecnon Davao 1
9 Gorage fan Wall d2 Cotnrnorc.ol Hood
to Firanlace P.L 0, 43 Fine)/ i
IDA Ftreptnce 1.0. O OP'N ADDITIONAL 1 FOR ATION
}1 Exterior Lath k;i( _
SS 12 Internal tolh 1
1 12A Drywall ���
t _
1 11 Finials Grdd9 r
1 /.
INSULATION Thick ••R•. —� j
Value t
7A walls (Bans) i
128 ' Cc.hng (Sails) i —— F CY�C.i ►rte
12C Ceiling Ialownl h-
I
W Final
` PLUMBING APPROVALS !
}5 Gr9vnd Plumb
16 Water Piping
17 Rough Plunb '
18 vents —
1 r19 Fwwogo Dispaal �—
Si 20 Sewer
21 Water 14eaie, I ,
i 22 Wafer Solurner_-
J
23 Water Service• . __ l
24 0 -is Im._ SEWAGE SYSTEM SIZE d. LOCATION ,
2S Fina
—--------i `� —
tank Pn
1 REAR OF PROPERTY LINE
ELECTRICAL APPROVALS,I.,
26 Power Pole
t 27. ct,nds..t _
28 Se":(v Ent•ance - t
V ��1 77 'Nrnrq P/L Ar
29A Grcv.nrirnit lV..e J9
296
34 fotwus 'J9�:�
31 t Swvic!•
.;. 37 j Final
r
STREET NMIE
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT /'
Effective July 1. 1980. Chapter 1301 Section 19825•of the Ikslth and Safety Code requires the eicecu-
�.` tion of the following applicable declarations prior to the issuance of a building permit. Please.
print or type .and sign -below: -
LICENSED CONTRACTORS DECLARATION
FLIhare!byy affirm that 1 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. '
Licente Class 1 License No, 91 7A
Date. Contractor
OWNER -BUILDER DECLARATION 1
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 1 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. 7031.5,13P.C.).
[� 1, 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.SP.C. for this reason:
bete ` 7C9/ Owner
WORKERS' COMPENSATION DECLARATION
4 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
�] Certified copy is hereby furnished.
. Certified copy is filed with the County of Riverside. Department of Building and Safety.
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed.if permit.valuation is for 5100.00 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 sub:ect to
the Workers' Compensation provisions of the labor code, 1 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 t
i
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. 1 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.
Q Division of Industrial Safety Permit No. i
Date Applicant
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY
\f -I certify l 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-
f Lent for which I have appligd for thisermit for the purpose of making i7ections..
:4•-,a:: is . P V, j0
Signature of Applicant/Agent Uate /
r n pp can / gent Name
284-4000 7/80
_...._._._....._..�...... ............ .._�__,.. ..__ ...L_.__..._,_, ...._�...._._...... __.,...z.