403065 (RPL)03065
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD FDTTJ
PERMIT NO.
403065
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
Dist
/
Off.
SQ. FT. @
YARD SPKLR SYSTEM
SO. FT. '@ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Zone Restrictions
FLOOR DRAIN
Typa
MECHANICAL FEES
SWIM POOL, COMM
Bond Amt.
WATER SOFTENER
VENT,SYSTEM
FAN EVAP. COOL HOOD
SIGN
Unit ,.
WASHER (AUTO)(DISH)
APPLIANCE
DRYER
Supplimental Permit Numbers
— �/���/,'[\ f
Registr. Fee f
GARBAGE DISPOSAL
FUR"rACE• UNIT
WALL FLOOR SUSPENDED
Reinsp. fee f
Owner/Agent
e
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
Gty Zip
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
License#.
) •� ,�;
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY'
HEATING, SYSTEM
FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER
B.T.U.
SQ. FT. @ a
BATH TUB
SO. FT. @ ¢
WATER HEATER
S0. FT. RESID @ 1 tAa
SEWAGE DISPOSAL
S0, FT: GAR @ 344
HOUSE SEWER
GAS PIPING
PERMIT FE
PERMIT FEV
^CONST.
J
PERMIT FEE i
DBL.
TOTAL FE -
M08. HM, FEE
MICRO'FEE
MECH, FEE PL. CK.
. EEE
^'MHLECT_Ufr,
SMI'FEE
FEE FLUMB,,F,E2'�
PERMIT NO.
403065
Space Zip
Community
Valuation
S
r
Dist
/
Off.
F.C.C.
MM Permit Fee f
Micro Film Fee Cap f
Use of �Perm/it.L,rl. /a•` -/• ./ (/%
F /e
(Y�
V�(/•%N///%Use/Case.
No.
Ck. By
�'•
Misch. Fee Dbl $
PI.. Ck. Fee S' �^-
Set Socks
Lot Size
Construction Fee D S �
Electrical Fee Db i
lope!Description
/ �/"),
% `fi Jr `-• iy%
F
Zone Restrictions
Croup
Typa
SMI Fee S
Plumbing Fee Dbl f.
Bond Amt.
Plan No.
Plan Checker
FinalData or
Inspector
Unit ,.
Sp. Insp. 'Fee j1 $
Denial. Fee f
Const. Lander Branch
Supplimental Permit Numbers
— �/���/,'[\ f
Registr. Fee f
Mileage Fee S
Address - City - Zip
Witness Fee f
Reinsp. fee f
Owner/Agent
e
Tel. Zip.
Too! FeesI47.7S '-�
Address. �'+wm," ''
Nrtiy
Gty Zip
M.O. ❑ N.C. ❑ Cosh Check Q
Contractor
ry✓IJ °x .��'!'~_
'Tet.
s.�/• r,��
License#.
) •� ,�;
T i °q9'f !.1
wage System .. _ •!
Ad renp .
City/` Zip. •
T LL THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Sewer District - .
I HEREBY AGREE THAT ALL. WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
Z q THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
I,REBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS. HAS DONE SO IN
Form 284'208 (Itev.' 1/80) RDANCE 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 Bock
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bdnd 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.
F-1
43
Final
10A
Fireplace T.O.
[j
°o
-------------------------------------
ADDITIONAL INFORMATION
n
%
--15
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lash
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
--
--P-WmlatNG-APPROVALS. ------ ----------------------------------------------
15Ground 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
4
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding.
30 Fixtures
31 Service
32 Final 1 2
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY .,:COUNTY OF RIVERSIDE
OFFICE
DATE
TIME,
PER Mlye
'INSPECTION
FOR:
-'REQUESTED
ADDRESS 'SPACENO.
AA - .
IT COMMUN
a_
BUILDING
_
PLUMBING
E .. LECTR - 1%1-
MECHANICAL:_
ITN
t
TUIES-
THUR
-REMARKS::
nol
OWNER/CONTRACTOR TELI.N.10.
w.
C.
Fk
. . . . . . . . ....
..........
71
TT
LATEST*I'NSPECTIO.N INITIALIZED ON FINALIZED' ON EXPIRED ON
01/02/80 01/02/80
INSPECTION DATES
nG
fi
Yt 5r
PROCESSING COMPLETE
4
MIN3
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 follow.fng'applicable declarations prior to, the issuance of a building perm,it.` Please
print or type and sign below.
�-i LICENSED CONTRACTORS DECLARATION
�I hereby affirm that I am, licensed under proxisions of Chapter 9 (commencing with Section 700.0) of
Division 3 of the Business and Professions Code and my license is i'n fu€11 force and effect.
License lass License
Date —3 Contractors
Q OWNER -BUILDER DECLARATION
�- Me a 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 isnot 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 7037.5, B &P C').
e I, as ,owner of the property, am exclusive:l'y contractingwi`.th licensed contractors to
construct the project (Sec. 7044, 6.&P.t j .
[:I I am exempt under Section , B,.`&P.C. for this reason::
I hereby affirm that I'have a certificate of consent to•sel,.f-insure, ori -Certificate of'Workers'
Compensation Insurance, or a certified copy, thereof (Sec.. 3800, Lab.. Code').
Policy No. Insurance
[] Certified copy is hereby furnished.
0 Certified copy is filed with the County of River-si:de, Department of'Bui`lding and Safety..
Date Applicant
CERTIFICATE OF EXEMPTION. FROM WORKERS' COMPENSATION INSURANCE
(This section need not 6e completed if ipermit valuation is for $100.00 or less.,)
I certify that in the performance of the work for which this permit is issued, I sha`11 not employ
any person in any manner so as to become subject to the Workers' Compensation l.aws of California.
I further understand that i' after making this Certificate of Exemption,, I should become subject:�to
the Workers' Compensation proyisi'ons of the labor codej'I must forthwith 'comply with such provisions
or this permit shall be deemed revoked.
Da) � i�� �� � ADPI'i,cant �-
ON LENDING AGENCY
y affirm that there is a construction lending agency for the performance of the work for
'his permit is issued (Sec, 3097, Civ.. Code).
s Name.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
[� I hereby certify that no-excavatiton 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, fals'ework, a 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.)
['] 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.-
[�] Division of Industrial Safety Permit No.
Date Applicant
CERTI!,FICATE OF COMPLIANCE AND.AUTHORIZATION OF ENTRY' F1.
I certify I. have read this application and state that thedinformation g,i;ven fs :correct. I agree to
com,'ply 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-
erty fQr w)7h I`ffia'we applied for this permit for the purpose of making inspections.
Si.gnat o App scar%A9 - - Date ( C
rrnt AonlicanV&ent Name
BUILDING . PERMIT
PERMIT NQ: �'• ;. DEPARTMENT- OF BUILDING A SAFETY
14-03,0-6 C . ;CO.UNTY &JRIVERSIDE'
FIELD OFFICEJ
P
CONSTRUCTION ESTIMATE
NO. ' .. y .. ELECTRICAL; FEES -
„NO. -PLUMBING. FEES
1ST FL
2ND FC.
POR.
GAR
CAR.P., :•
WALL _ - -.
ESTIMATED. CONSTFU,CT.ION'•
SQ:,,Fi.
' Owner
,[//�
'• .'. ,
PERMIT' NO:
S,Q:'FT: -@ YARD:SPKLR SYSTEM '
SCQ'.:FT.@-- _ AA081LEHOME SYC BAR'SINK '
SQ. -FT- @ FOVJER.OUTLET ROOF DRAINS,
"
S,Q:'FT.- •@ DRAINAGE PIPING
SQ. SFT.G�'-. - - - DRINKING FOUNTAIN
VoI gfien' -
ISI
r UR1NA}
-I
VALUATION, $., WATER; PTINfa'
-CHI.
NOTE:• Not to be used, cs', property tcxs valuation
SV✓IM. POOL, Pv
; FLOOR DRAIN.: '
MH.Pertnil .Fee.
MECHANICAL :F.EES ::._ " , :. _
- SWIM POOL,, coMM
WArEA�soF.iENER
Use of'Paimif- _
VENT'SYSIEM FAN E,"P,- CQ QL -HOOD - '
SIGN -,
WASHER (AUTO)(DISH)
APPLIANCE, ._ DRYER.
lDbI
GARBAGE- DISPOSAL
5,:
'FURNA_CN ._ s UNIT _, -WALL :. FLOOR. SUSPENDED '
/ !T .! :p.. /f` f!' -
YYY���"' -' •
.DescriplionR
LAUNDRY TRAY.
,�, • r•
AIR: HANDLING UNIT,
IDLE': METER
KITCHEN SINK q
;Pl. Q. Feey
,ABSORPTION ;SYSTEM. ; �, B;T:U.
TEMP UWPERMIT SVC
WATER CLOSET -
COMPRESSOR HP'
I'POLE-; TEMP/ PERM
LAVATORY .
HEATINGSYSTEM FORCED GRAVITY'
AMPERES SERV" ENT
SHOWER'
�•+•
BOILER, - i B:T v
SQ: FT. @' a.
BATHTUB
Zone1RedricMm:•
'Type
_.
SQ.. FT:'!@ a
,'WATER HEATERS
+, a/
- ..
rSMl.Fde _�• Sy-
$0', FT,- RFSID -@ 1;Vi47 •
!S EWAGE';DISPOSAL
'rood AmL. •
Plan 'No..
S0, FT: GAR @ ?ba
HOUSE .SEWER
Do„- (1�
.
Inspeetor,
_
CiA'S,PIPING' '
PERMIT FE _
f._
PERMR ;FE� .,
RERMIT FEE
Const lende-r Brbmch
•.Address ,City,
f DBL.
- "TOTAL ,FEE - •
MOB: HM FEE'.
MICRO. FEE'
MECH. FEE CK.. RFF�.,
C11�C��
CONST. FFi •�t6LECT_:jry
SMIFEE-
'FE .
PIUAAB, .
?_ _ LL _ _ IHib�F1:RMII SHALL BEEUME VUID•IF WORK 15 NO] EUMMENLED-WIIHIN-11U UATb. LtS,-,Al,lUN Ut WVRK • verified by(
Sew
FOR 120 DAYS,-5HALl A'LSOICAUSE PERMIT TO BECOME VOID..
Sr 'District . n - -
-1'.HEREBj” AGREE THAT' ALL WORK IN CONNECTION WITH THIS PERMIT WIM BE DONE IN ACCORDANCE -WITH
- THE `PAW, OF•.RIVERSIDE'€OUNTY'•AND THE, STATE OF CALIFORNIAS'
/� f HEREBY CERTIFY7TiAT THE INDIVIDUAL WHO PREPARED THE PLAA5 AND-fSPECIFIC'ATIONS .JAS DONE SORIN t
Form 28A 206 "(Rev. dy80) - Gam!/� - RDANCE WITH SECTION 3541 OF THE BUSINESS AND PROFESSIONS CDDE 06 THEBTATE OF ,C_:ALIFORNIA': --
-
.. ..
lob, Addreis - • - - .:
y/ -,
- r -:Spore li'p -
n
' Owner
,[//�
'• .'. ,
PERMIT' NO:
03
,o.
CA—unify -
s
' -
VoI gfien' -
ISI
Da
.
-I
D!sl
-CHI.
' T
MH.Pertnil .Fee.
Mt o filrrm Fee �.
Cop'S:'
- -
Use of'Paimif- _
,.
Porcel%;N,cy:/� -
�/ �S
UTe/Case Ne:.
Ck~ By
�.
lDbI
Mech..Fee
5,:
/ !T .! :p.. /f` f!' -
YYY���"' -' •
.DescriplionR
,�, • r•
-
;Pl. Q. Feey
Set 'BprJis
Lot :Size,
Conrrudieri Fee
Legol
�Q
�•+•
19
Zone1RedricMm:•
'Type
_.
Electrical --Fee DB
+, a/
- ..
rSMl.Fde _�• Sy-
'Plbmbing„Fee _
Ob( S-: " •
'rood AmL. •
Plan 'No..
, Plon•Checkpc •"- f:Flnoi'
Do„- (1�
.
Inspeetor,
_
unit.
Remol. Fee -
' "S,
Const lende-r Brbmch
•.Address ,City,
Supplimeiitol Permit Nsfmben•',
w��'• / �/ t•
!% -
Mileage• Fee S ', ''t
7 Zip
' - -.i1-
WYnesr Fee ,. S� - t
R
r- -
- -'-.
art
-761fi`
-.
•
..
�'
r ..
Total;Feei
E'
Addr- - i .. "='' -
City
hL:O: a No -C ❑, .Cgsb• heck-row
a '
z_ o_ c r: "_n -/ ' _
e_ F,7-1•+ -
.lf�ensaR+�7 .
wage System
- ✓
'Ad rens ' - / t - ,
Cit /J'l'sI : •
:Yip.
'
?_ _ LL _ _ IHib�F1:RMII SHALL BEEUME VUID•IF WORK 15 NO] EUMMENLED-WIIHIN-11U UATb. LtS,-,Al,lUN Ut WVRK • verified by(
Sew
FOR 120 DAYS,-5HALl A'LSOICAUSE PERMIT TO BECOME VOID..
Sr 'District . n - -
-1'.HEREBj” AGREE THAT' ALL WORK IN CONNECTION WITH THIS PERMIT WIM BE DONE IN ACCORDANCE -WITH
- THE `PAW, OF•.RIVERSIDE'€OUNTY'•AND THE, STATE OF CALIFORNIAS'
/� f HEREBY CERTIFY7TiAT THE INDIVIDUAL WHO PREPARED THE PLAA5 AND-fSPECIFIC'ATIONS .JAS DONE SORIN t
Form 28A 206 "(Rev. dy80) - Gam!/� - RDANCE WITH SECTION 3541 OF THE BUSINESS AND PROFESSIONS CDDE 06 THEBTATE OF ,C_:ALIFORNIA': --