404014 (RER)BUILDING PERMIT e
PERMIT NO. DEPARTMENT OF BUILDING 8L SAFETY FIELD FSI
04014 COUNTY OF RIVERSIDE
JJ
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. Fl.
POR.
GAR.
CAR P:
WALL
. t#O,tnv
ESTIMATED CONSTRUCTION
SQ. FT. .@ $
UNITS
SQ. FT. @
YARD SPKLR SYSTEM '
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
URINAL
VALUATION $ !ilr
WATER PIPING i{
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM v }
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
�,� WASHER (AUTO)(DISH)
APPLIANCE . DRYER
AA
n / f N f-eL• % r/{.�A,
�AG.G� r /
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. @ a
BATH TUB `
Zone Restrictions
SQ. FT. @ a
WATER HEATER
SMI Fee
SO. FT. RESID @ 1 /ae
SEWAGE DISPOSAL
S0. FT. GAR @ 1/4c
HOUSE SEWER
Plumbing Fee
Dbl S
GAS PIPING
PERMIT FEE
e- f
�/
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
SCS
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
404014
'
C munity '. Valuation isf.
Off. F.C.C.
+ r
0C,
ID6'fe
k" !
,MH Permit Fee
S
Micro Film Fee
Cop $
Us'e-o PeriM
Parcel No. J
j'U,./Cd`se`N..
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C
"$i,•;y�,
Mesh. Fee
Dbl S
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n / f N f-eL• % r/{.�A,
�AG.G� r /
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r'�SRt`
PI. Ck. Fee
$
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_
r'1
• Set Bd s
Lot Size
'fir
=re' +•'
Cr.
Construction Fee
Dbl $
i
Ld68I ` e32ripti
.
IS 11
Electrical Fee
Dbl $ 'i
l % %�%�U {y'�i
Zone Restrictions
Group
Type '
SMI Fee
S
,
Plumbing Fee
Dbl S
Pla dam•
-Pion ecke'r
e- f
�/
In e, or
Unit
Sp. Insp. Fee
$
$41
v
1
t
Demol. Fee
$
Const. Lender Branch
Supplimental Permit Numbers
Regist, Fee
S
Mileage Fee
$
Address City Zip
Witness Fee
$
I
Reinsp. Fee
$
OwnerA en /�+
Tel.
Zip ;
l'
Total Fees
$
ddie'ss""^r %''s•'" %, ""•"r*s• _ �"
City
Zip
M.O. ❑ N.C.Ej Cash Check
I
Received by,.
f, i
Contractor -
Tel.
Licenses) -
Trees a it
' �j •_ r'l
Address
CTY Zip
j00
/^
a
T
LL 1 J P
THIS PERMIT SHALL BECOME VOID F GJORK IS NOT COMME
CED''\ 1 0 DKYS. 'CESSATION OF WORK
verified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Sewer District
�.
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
I
,1
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
.s,
�jII REBB CERTIFY THAT THE INDP'IDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
u y
S
[Form 284 208 (Rev.
I/801
--'R•�•d'cv�+NCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
'j�
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATEINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS '
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 6 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
Comm erciol� Hood..
10
Fireplace P. L.
a
43
Final
10A
Fireplace T. 0.
E]
°o
_.a_._s_
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior lath
12 Internal lath
12A Drywall y ,,_ ,/L
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts) f/
12B Ceiling (Batts) /r 1
v
12C Ceiling (Blown)
14 Final /
.-PLUMBING-.. PPROVALS___. _.._ ..
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
i
T
P/L P/
"
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
q
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 should 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, you 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 contributions.
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.or.at 1020 N.Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you arer.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
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATION
Owner
Address
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)` T
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. J
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 T -
Address City .--
Contractors Cicense 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
284-2002 7/80
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301 Section 19825 -of the Neilth 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:
0 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
! OWNER -BUILDER DECLARATION
YI he-e�ffirm 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;•6.&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:
v �] 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
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 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. !f y _ le- Z A n
Date eLgl?�/w Applicant
N W
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 i6 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 (366)�feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, 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 u+ — -- — -
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 �o ente, upon the pro-
perty?for which I have appl% ed or this permit for the purpose of making ins ections e.
'rgna' ure of Applicant/Agent Date
PrintApplicant/Agent Name
284-2000 7/80
NOTICE: THIS IS NOT A BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Architect __ —_—_ Contractor_. _
Owner -01�j
�—�
Addres/O7a.s C�+�Ftfllr�YEless___— Address_—_—_—
City 1A &Z City--_ _ City___--_
Phone— Phone Phone _ Phone—
WI
(we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
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_%�/�kiZ'
Approval by Signature from the Following Departments Listed' Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
I SPACE NO.
I USE OF STRUCTURE
JOB ADDRESS u I�A I
SINGLE FAMILY DUPLEX
Z F
O LL
LEGAL -DESCRIPTION
'�x�r L� �jOFFPPROPERTY �y%F_� /1i�F/p—%� pARTMENTS AGRIC.
N
`q���J—1 ——��� — COMA�(ERCIAL INDUSTRIAL n
COMMUNITY ..17
ALTER S ❑
C C
Z
NO. OF SUBMITTED PLANS USE OF PER T
H
CASE NO.
p Z
NO. OF PARKING SPACES REQUIRED — -- NO. OF BUILDINGS NOW EXISTI
Q
ZONE y—�.--z SETBACKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK.ORDINA CE -- OF FEET REQUIRED ON STREET
DATEZOO SIGNATURE OF LAND USE OFFICIAL
F
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET --
z
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ _ —STREET
i
- •
H
a
W
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
IMPROVEMENT? YES ❑ NO ❑
°L
DATE SIGNATURE OF ROAD DEPT. OFFICIAL—
S
SWIMMING POOLS PUBLIC
Q W
SEWAGE DISPOSAL
FOOD ESTABLISHMENT
_
WATER POLLUTION — REMARKS
FLOOD CONTROL
f H
W AIR POLLUTION
W DIV OF HWY
a � _
a — YOUR PROPERTY MAY BE SUBJECT TO
a
' c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
GlI
.46Ad44 1,10e6 -44P12
, � , a el& rx
fe
COUNTY OF RIVERSIDE
DEPARTMENT OF
BUILDING & SAFETY
APIP ROV
Approval of these plans shall no ATE
o• permit for, or an approval of, anybv of tion o,
f revisions of the state or eoun
must kept lob laws. I
wail opmpk
j--
BUILDING PERMIT
PERMIT NO.
04014
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE 7/1
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR. •
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. .@ I$
UNITS
Zip-
SQ. FT. @
YARD SPKLR SYSTEM
MOBILEHOME SVC.
SQ. FT. @
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
MH Permit Fee S
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT 4
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM `
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
•� WASHER (AUTO)(DISH)
APPLIANCE DRYER
B A f. �+
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
MKer
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
Owner/A nt
SQ. FT. @ c
WATER HEATER
'
S0. FT. RESID @ 1 t/<c
SEWAGE DISPOSAL
heck E]
S0. FT. GAR @ 3/<c
HOUSE SEWER
City Zip
Received b
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
S�
HM. FEE
MICRO FEE
MECH. FEE PL. CK. FEE
s -o
CONST. FEE ELECT. FEE
,a
SMI FEE
- FEE PLUMB. FEE
V
PERMIT NO.
404014
Job Address
-Ta V4
Space
Zip-
Owner
,Co .unity
Voluotion
S
Dote
AJA '.
W.
Off.
F.C.C.
MH Permit Fee S
Micro Film Fee Cop S
wM—o .'mit
/
Legol Descripti
/�7- ` / /1G /C'
Af' V ��4..+++����///
- S'
O7�J
Porcel No. Use/Case No. Ck. y
-
Set Bac s Lot Size
F S $ R
Mech. Fee Dbl S9
PI. Ck. FeeS
Construction Fee Dbl S
Electrical Fee Dbl $
Zone Restrictions
Group
Type
SMI Fee $
Plumbing Fee Dbl g
B A f. �+
$
rIcm o.
Pan
MKer
Dole
j'�---'� /'
Inspector
Unit
Sp. Insp. Fee S
Demol. Fee $
Const. Lender
8ronch
Supplimentol Permit Numbers
Regisir. Fee $
Mileage Fee S
Address City Zip
Witness Fee $
Reinsp. Fee g
Owner/A nt
Tel. Zip
Total Fees s
M.O. N.C.0 Cash
heck E]
ddress
City Zip
Received b
Contractor
Tel.
�../
License#
Tre$K=14,
ys
Address
City
T LL 7u P THIS PERMIT SHALL BECOME VOIDIF WORK IS NOT COMMENCED WAN 120 DAYS. CESSATION OF WORK
Sewer District , FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
,1 HEREBY AGREE THAT ALLWORKIN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
IRE ERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284.208 (Rev. 1/80( ANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
verified by:
7