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427507 (MISC)oairvw riRl�r 1PERMIT NO. DEPARTMENT OF BUILDING & SAFETY MIT -427��,O 7 : ' COUNTY OF RIVERSIDE FIELD CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. 2ND. FL. POR. j SQ. FT. @ $ UNITS �. Valuation $ SQ. FT. @ YARD SPKLR SYSTEM SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. CAR P. SQ. FT. @ POWER OUTLET ROOF DRAINS SQ. FT. @ DRAINAGE PIPING WALL SQ. FT. @ Lot Size DRINKING FOUNTAIN SQ. FT. @ ESTIMATED CONSTRUCTION VALUATION $ F S S R URINAL WATER PIPING NOTE: Not to be used as 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 Unit GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Const. Lender Branch 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 BOILER B.T.U. SQ. FT. @ c BATH TUB Licensee r: SQ. FT. @ c WATER HEATER Address SO.. FT. RESID @lt/.c SEWAGE DISPOSAL SQ. FT. GAR @ : c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE -' PERMIT FEE DBL. TOTAL FEES MOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE SMI FEE FEE PLUMB. FEE T ` PERMIT NO. 427507 v — Job Address - �- _ -- Space �, - G Zip_ _ Owner - --- Community Valuation $ Date Dist. MH.Permit Fee$ Micro Film Fee Cop $ Use of,�e/rm/ilQ;Qy/4fA IS 4E A? 1Y' •yf Porcel No. se/Case No. Ck. By �•• Mech. Fee Dbl $ Pl. Ck. Fee $ SdfBdcks Lot Size Construction Fee Obl $ Legal Descri tion, y+^- J� GLS �� /y" �.F. F S S R Electrical Fee Dbl $ Zone Restrictions Group Type SMI Fee $ Plumbing Fee Dbl $ Bond Amt. $ Plcm No. Plan Checker Final Date / Insp ct r Unit Sp. Insp. Fee $ Demol. Fee $ Const. Lender Branch Supplimen I Permit Numbers 7.3 Regisir. Fee' $ .l Mileage Fee $ Address -• City Zip Witness Fee E Reinsp. Fee $ Owner/Agent Tel. !/ Zip Total Fees $1-j6- dd ess u I - City Zip ,y . M.O. N.C.n Coshn Check Received by Ctrac'tor,/ - - '_ Tel - Licensee r: Trees required • Sewage System Address City _ Zip T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. 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 THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284-208 (Rev.8/78) ©s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. verified by: NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade 35 Furnace Comport. 3 Steel 36 Inlets & 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 t0A Fireplace T. 0. oo ADDITIONAL INFORMATION �J Pgc OCA-rc- 57.Eku1ce- R.J5z2 T� %'Ravep� Rao le cD/�L.¢.e.4.v��s, SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING 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 P REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final t All, STREET NAME 74 DEPARTMENT OF BUILDING AND SAFETY APPLICATIOd CERTIFICATE tOUNTY'.OF RIVERSIDE' PERMIT # Effective July 1, 1980, Chipter 1301 Section 19825'of *the K"Ith and. Safety Code requires the execw-, tion of the followingapplicabledeclarations- prior to the,issuaincei,of a building permit. Please print'or type'.and sign,below.- LICENSED CONTRACTORS DECLARATION 9breby aifi'nn' 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 pffect.. License Class ef / d - - " License No. Da' -e,lC<;2 Contractor ,• C ✓ OWNER -BUILDER DECL—ARATIZN I hereby-affirm,that I am.exempt'from the Contractor's License Law for the following reasons:, 1, -as owner of the property, or my employeeswithwages 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.notbuild or improve for, the purpose of sale (Sec..7031.5,.'B.&P.C.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P C.). Y R-1 e /or this [:Q�I am exempt under Section reason: Date owner WORKER?' COMPENSATION DECLARATION I hereby affirm that I.have a certificateP of consent to self -insure, or a Certificate o- - Workers' Compensation Insurance, or a certified copy thereof.'(Sec. 3800, Lab. Code).. Policy No. Insurance is 0 Certified copy is hereby furnished. Cer 'tified copy is filed with the County of Riverside, Department'o'f-Building and Safety. Date Applicant CERTIFICATE OF EXEMPTIONFROMWORKERS' COMPENSATION INSURANCE- (This-section-nedd not be -completed`if'permi.t valuation: is for $100.00 or less.)� I certify that ,in the performance of the work for which this permit is issued, I sh'all not employ anylperson in any manner so as to become subject to the Workers' Compensation laws of California. I further- understand that if aftermakingthis Certificate of Exemption, I should become subject to the Workers' Compensatfon provisions of the labor code, I must forthwith comply with such provisions shall be• d. or this.,perinit deemed -revoke Date' ��_A p p 11 cant — CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the Lwolrk,for which this permit is Issued (Sec..3097, Civ. Code). Lender's Name oto Lender's Address DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION 'K 'in 'bycertify that' no excavation five (5) or more feet in - depth 6 wh'ich'. a Jerson ',is, re-, Ihere quired,to descend, will be made in connection with work authorized by -this permit., and ' that no- building;-structure,'scaffolding; Wsework-,',or demolitionordi.smantling,thereo., will -.6e' more than'thirty-six (36) feet'high;. p 3.2, Grp '2, Art,2, Sec 341;,,Title.�8, C.A.C,.) (Cha .". O As owner-builder,,I.will not'employ anyone'to.do work which would require ap errnit f;6m­the i Division of Industri al Safety,. as noted above,,� Unless. such' person has a permit tz) do sLcK, work from that division. Division of lndu's*trial Safety Permit No. 7 Date Applicant CERTIFICATE OF COMPLIANCE AND' AUTHORIZATION OF ENTRY! to I certify I have 'read this application'and state that the information given, is correcl.'. agree., 'comply with all -state construction,,,ard authodze'a laws and county building representative,of,the County of Riverside, Depirtmenti6f Building and Safety to efiter,up6n'the*o= perty,foed for this -.permit for the'purpose�of making pect .; , r_,which I have,appli Signature of,AVp7lscant' /Agen t Date Print Applicant/Agent 7.Name 284- 2000 k-7/80)' ? Jz t, 1�•_ ;Rls _;, �� , ;�; . : -2: BUILDING PERMIT PERMIT NO. DEPARTMENT OF BUILDING` & SAFETY 17", DST 427507 7 5 0 7 I COUNTY OF RIVERSIDE ,FIELD OFFICE. I .CONSTRUCTION ESTIMATE NO. ELECTRICAL'FEES NO. PLUMBING FEES IST FL. SQ. FT. @ $ UNITS - 2ND. FL. - SQ. FT. @ YARD SPKLR SYSTEM POR. SQr FT. @ MOBILEHOME SVC. BAR SINK GAR. 1 SQ. FT: @ POWER OUTLET ROOF DRAINS CAR P. SQ. FT. @ DRAINAGE PIPING r WALL SQ. FT. @ DRINKING FOUNTAIN SQ. FL'@ Community URINAL ESTIMATED CONSTRUCTION VALUATION $ Valuation $ WATER PIPING NOTE: Not4o be used as property tax valuation r SWIM POOL, PVT FLOOR DRAIN ` MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER Use of ermit j 6rfQ%• GARBAGE DISPOSAL FURNACE v ,UNIT WALL FLOOR SUSPENDED No. Ck. By Lot Size ! i LAUNDRY TRAY AIR•HANDLING UNITCFM IDLE METER _ KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET a COMPRESSOR HP POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ.'FT. @ C BATH TUB SQ. FT. @ t WATER HEATER * l SQ. FT. RESID @ 1114 c SEWAGE DISPOSAL Plu4bing Fee SQ. FT. GAR @ 'G c I " HOUSE SEWER xv=• Bond Amt.- .$ No. GAS PIPING ^ PERMIT FEE Final Date PERMIT FEE ' PERMIT FEE DBL. TOTAL FEES MOB.HM.FEE , MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE SMI FEE . FEE ,PLUMB. FEE t Demol. Fee $ PERMIT NO. Job Address - Space Zip Owner `- 427507 t f- Community Valuation $ Date Dist. Off. '�•F. C. C. MH.Permit Fee $ Micro Film Fee Cop $ Use of ermit j 6rfQ%• - Parcel No. ^ • se/Case t Backs F S S • , R No. Ck. By Lot Size ! i y Mech. Fee .Y•' Dl l $ PI. Ck. Fee $ Construction Fee Dbl $ Legal Descri tion • 4 4av,— f4 / � - - �G L�„//rJ j, Electrical Fee - D[il $ Zone Restrict! Group Type , SMI Fee $ ,Plan - Plu4bing Fee Dbl $ Bond Amt.- .$ No. Plan' Checker Final Date In p ctor , r ' Unit Sp. Insp. Fee $ t Demol. Fee $ Const. Lender Branch' Supplimentol Permit Numbers ' _ • - - Registr. Fee $ Mileage Fee $ AddressCity,-.- Zip Witness Fee $ Reinsp. Fee $ Owner Agent Tel. - ,Zip Total Fees $ O d ass - City-. Zip M.O: N.C. Cash Checkff/ ... '7..•� •' Received by nt. oc r , ' Tel. License# Trees required Sewdge System Address City Zip T LL P' ' THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. 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 PERMITtWILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284-208 (Rev.8/78) ©s ACCORDANCE. WITH. SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. verified by: s '