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OF BUILDING & SAFETY
It. Amr Pion No
Plan Chader i.rol Dat t/7 S
ISG
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FEW NM
DEPARTMENT
COUNTY OF RIVERSIDE
FIELD.
%--426327
s
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tkunclr Svpp6manial Po,mn Nvmberc
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NO. ELECTRICAL FEES
NO. PLUMBING FEES
Re11tw. F«
CONSTRUCTION ESTIMATE
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$
UNITS
IST FL:
SO- FT. ®
2#1"Ifs. foe
YARD SPKLR SYSTEM
0-na,/Ages
2ND. FL
SM FT- ®
MOBILEHOME SVC:
BAR SINK
=`P
Total F0",s
T
-POiIL
SO. FT. Q
POWER OUTLET
ROOF DRAINS
f
GAR'
$0. FT. ®
NL
DRAINAGE PIPING
1.1
lrceacer
Rowkwed by
CAR P.
SO. FT. 0.
CenirOPor
; 1-
DRINKING FOUNTAIN
LeN le"llod
WALL
50. FT. ®
URINAL
'
50-011”, System
S0• FT, ®
WATER PIPING
'ref
(�yy
ESTIMATED RUCTION VALUATION $�
� FLOOR GRAIN
$
T
NOTE: No to b0 Used as property, ton S.luctTon
SWIM POOL. PVT
THIS PERMIT SHALL BECOME -VOID IF WORK IS NOT COMMS 410 WITHIN 140 I)p Yf CESSATION WORK
c
•
MECHAN ICAL' FEES
:~SIGN
SWIM POOL. COMM
WATER SOFTENER
t
5",-w Obbld
-
WASHER (AVTO)(DISH)
+
—
YEW :: • FAN EVAP. COOL HOOD
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GARBAGE DISPOSAL
APPUAN(i DRYER
LAUNDRY TRAY
'
a FURf*CE= . • UNIT WALL. FLOOR SUSPENDED
ACCORDANCE WITH
KITCHEN SINK
. t :
a
A1R HANpUNG UNIT CFM
?WATER
IDLE METER
.
CLOSET
r
'
ABWRF"ION SYSTEM B.T.U.
TEAM 135E PERMIT SVC
_
His
POLE TEMP/PERM
LAVATORY
+
HEATING SYSTEhA FORCED GRAVITY
AMPERES SERV ENT
SHOWER
B.LU:
SO. FT. ® c
BATH TUB
50, FT 0 c
WATER HEATER
SO. FT RISID QL1 .t
SEWAGE DISPOSAL
SO fT GAR ® L. c
JHOUSE SEWER
GAS PIPING
L
PERMIT FEE '7
PERMIT FEE
•`t2T. -1`� , - ••TOTAL THS'
/AOB.IIM,ftE
MKRO FEE
MICH. FEE R. CK. RE
CONST. FIE t7
FEE FEE PL
SMt��
FEE
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It
0-na,/Ages
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Total F0",s
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Add,„s
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NL
fi CMc\
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lrceacer
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CenirOPor
; 1-
LeN le"llod
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50-011”, System
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U
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THIS PERMIT SHALL BECOME -VOID IF WORK IS NOT COMMS 410 WITHIN 140 I)p Yf CESSATION WORK
y",++ild bf
'
•
FOR 170 DAYS 514ALL ALSO CAUSE PERM;T 10 BECO VOID.
5",-w Obbld
-
• C Li•''
I HEREBY AGREE THAT ALL WORK IN CONNECT104' IS PERMIT WILL BE DONE IN ACCORDANCE WITH
NIA
+
—
AK
THE LAWS OF RIVERSIDE COUNTY AND THF STATE r.
I HEREBY CERTIFYTHAT THE INDIVIDUAL WHO , RED TH<<jlANS AND SpEC1FICATIONS HAS DONE SOIFORN IN
A.
SECTION SUI OF THE BUSINE AND PRG •E5510N5 CODE OF THE STATE OF CALIFORNIA.
I
1 Form 4642W (Rey.") Os
ACCORDANCE WITH
'
- - rr,r' 1-` --.++rr,r�r..�r.r++.rrnr•'�•w....•1•�++ve.rreerr..�r..�.....rt�
OPERATION I DATE
"t BUILDING APPROVALS
Ser Sock.
%~r'q'.: ;2;.`• r �lgi:d• hint
Slab Gristle
w 'i' r 3 . :Sterol 37 -a
'Bond Beams
'4Ra f.Oetk
%' .�7��:; • framing'•
Vents,
+.Garage Fire Wall'
:;10 firep►cco P.L
_``Fueplate i.0..
�'�`••11-:, ?Exteriorli5lh::• '
:12A.; ,Orywa I-'
66cl
INSUlAt10N• Thick
>, Volvo
Lf6wYa' ;t
t'�- �la9M�f�i/�
!fie.•• �
•
INSPECTOR NO.
OPERATION DATE
INSPECTOR
■
MECHANICAL APPROVALS
'
" 33
Ventilation System
? .
34
Plenums 8 Ducts
35
Furnace Comport.
v^;
36
Inlets d Outlets
37
Combustion Air
i:.
38
Compreisor
39
Appi. Cleoonce
dD
Fire Damper
41
Smcke Detection Device
r
42
Commercial Hood
43
Flnol
:'••
1?Cyf:eilleig(81own)
,
PLUMBING APPROVALS
.1GlopndPl'utn6
.36: 1No4r Piping
17-*-' 'Rough Plumb
TB Veno'
�.y;�,:
. `•: 19 Sewctgo Disposal
—
70. Sewer
`i'y;�
;:' `�
."ZL Water Hearer
•
22 Water Solienut
23 Water Service
.24 Gas 7011
SEWAGE SYSTEM SIZE & LOCATION
25 Flnat
Took Pit 1. Sine
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
1
�
ti
26 Power Pole
27 Conduti
.
29 Service EMtanca
+r(
:9 Wifing
/
I•.
PA
P I
29A GroundingWou
29B Bonding
}'
30 Futures
31 Servku
!'
32 Flrse)i>
;o
SIREEI NAME
�•������R�i'�`'r'�.'.t!��,�r��•pr'iLiii.IMrr �,,. ;-,',.•lr ri�1•.:.•�� .�y� 'j..:N� .r .,•_ �,1) ... .:. .•.. .... :�......•.��i
� h ' \. �Yt'••••� �,r.�•!sj,y4.i.D�pi�, ��,+tMhN':Pe•�;�4.Ss+•��tr'pR�„•,•v::'IJ�IYI(itgl�y,�jl.1R••' • • A�
ps ,��;' DEKPARTNEIIT 0> 0.
-BUILDIN6'AND-SAFETY t i' j
�'COlM4T�iR`•OF RIVERSIDE APPLICATION CERTIFICATE
.. '` PERMIT #
- 5y: •.� Etfoeifri"July 1. '1980; Chapter 1301 Section 19829*Of the Ntilth. and SafetyCode
s s,f::•;•;;;,t1on'10f be•following applicable declarations pricfAto the issuance permit. the execu-
of a building e
• '•�;:':f�• •:;pi�iit;o'r �YPe';and sign'Oelowr 9 p rm1t. PleaseMOW
�
,,3;•,,C':; LICENSED CONTRACTORS DECLARATION
heriDy''atfine_that I as licensed under provisions of Chapter 9 (commencing with Section 7000) of
;Dtirision:,3 of -the Busi ass and Professions Code .and my license is in full force and effect.
W. is�s N 33/• 4� c
%•c`?GJ�'. Date on rac r G (-tiy
_ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reasons:
_ Q 1. as owner of the property. or my employees with wages as their sole compensation, will r
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 th6 burden of proving.I did not build or
Improve for the purpose of .sal.e (Sec. 7031.5,:'64P.C.).
[� I, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. B.3P.C.).
p 1 aro exempt under Section , B.bP.C. for this reason:
Date Owner —
f,:?;y;r= :. ; • L�l WORKERS' COMPENSATION DECLARATION
-'I -hereby Affirm that I•have a certificate of consent _to self -insure, or a Certificate of Workers'
mpe
Consation InsuranCce, or a certified copy thereof'(5ec. 3800, Lab. Code).
Policy No.y��G -
insurance
..Cy
• Certified copy is hereby furnished.
Certified copy is filed with the Count of Riverside.-Departalent of Building and Safety.
,.'Date S iS1 Applicant emlll P r
'• �1' ,Q CERTIFICATE OF EXEMPTION FROMARKERS' C09PENSATIDif INSURANCE
(This section need not be completed omp if permit valuation is for 5100.00 or less.)
*- Icertify'that,in the performance of the work for which this permit is issued. I shall not employ
y•person in any manner so as to become subject to the Workers Compensation laws f California. o
I,further•understand that if after making this Certificate of Exemption, I should become subject to
the.Wbfters' Compensatfon provisions of the labor code. I must forthwith comply with such provisions
'or this',pemit .shall be deemed revoked,
Date` Applicant
i{;;:'•';. 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 S •k.
Lender's Addres—�� ,
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 B. C.A.C.)
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.
M 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 Riverside, Department of Building and Safety to enter upon the pro-
perty for I have app ied f this'permit for the purpose of making inspections.
g ure p p can nt Fate
r ntpp cant/Agent amen'
284-2000 7/80
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