427400 (ELEC)BUILDING PERMIT
PERMIT Na, ;DEPARTMENT OF BUILDING &S'AFETY T
4 411 COU..NTY OF RIVERSIDE FIELD OFFICE
CONSTRUCTION
ESTIMATE,
- • NO. ELECTRICAL FEES _
NO:', PLUMBING FEES
IST FL: SQ. FT. G;. $
. 2ND. fl. _ SQ. FT.:@
POR. 5Q.
GAR: Sq, FT. G
CAR p. SQ. FT. G.
- ®
WALL SQ. FT.
SQ,FT, ®.
ESTIMATED, CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC:
POWER OUTLET
'
YARDSSPKLR SYSTEM
BAR SINk
ROOF DRAINS
`DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL _
WATER PIPING
NOTE: Not to.be used as property tax voluotion
SWIM POOL, PVT
Dlst.
FLOOR DRAIN
MECHANICAL .FEES
sWIM POOL, COMM
Cop, S
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL • HOOD
SIGN
C By
WASHER (AUTO)(DISH)
APPLIANCE DRYER'
Sel Bo_ rks
Lot Size
-
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED-
F S S R
LAUNDRY TRAY
AIR HANDLING -UNIT GFM
IDLE.METER
Type
KITCHEN SINK,
ABSORPTION SYSTEM B..T.:Ur
TEMP USE'PERMIT SVC
Bond Amt.
$
WATER CLOSET -
COMPRESSOR HP
'POLE,TEMP/PERM
Fi. Da� •' `' :
LAVATORY
HEATING SYSTEM. FORCED GRAVITY
00AMPERESSERVENT
$
SHOWERJr
BOILER B. T. U:
SQ. FT. @ t.
Re
BATH TUB
.Address - City - ZIP
_
SQ, FT. Q t.
Reln&A Fee
WATER HEATER
Owner(A
SQ, FT, RESID @1"14t
Tel. Zip
SEWAGE DISPOSAL
Total Fees
SQ, FT. GAR @ 'At
Address. _
HOUSE SEWER
City Zip.
M.O. Cash 171thec
Received•.by
GAS PIPING
PERMIT FEE 1
Tel,: ` If
.,'�. •�+ V
.PERMIT FEEI
Trees repaired
PERMIT FEE
DBL,
< FEESMOB:HM.FEE
MICRO FEE
MECH. FEE; PL, CK. FEE,
CONST. FEE
ELFG �
SMI FEE
FEE ;PLUMB. FfECS
PERMIT NO.
2 O O
.Job Address- -- _
" e
SC1.
Zip
7NIA
Community
j�p.,.+
volilat16ri
_
Date{} I `y
1
Dlst.
Off. F.C.C.
MH,Fermii.',Fee =
Micro Film Fee
Cop, S
Use of' Permit j,0 Av-1 j� 050:- Ap fj
Parcel No.
!GAF -� '� �jO o4
Use/Case No,
C By
M_ ech. 'Fee _Dbl' ;
PI: Ck. Fee
Sel Bo_ rks
Lot Size
-
Constrtiction Fee .Dbl §
Legal Description -
0
F S S R
'El9chiEal Fee Dbl S
Zone, Res on; 'Growrp
Type
Plumbing Fee
'Dbl S
Bond Amt.
$
Plan No.
Plan, Checker
Fi. Da� •' `' :
In cror :U611
Sp. Insp' Fee - S _
Demol.'Fee
$
Const. Leader Brokh
Suppfimental Perihit Nuaibei's
r
Re
Mileage Fee $
.Address - City - ZIP
_
Witness fee $
Reln&A Fee
i.
Owner(A
Tel. Zip
Total Fees
Address. _
City Zip.
M.O. Cash 171thec
Received•.by
Contract
L J ';.0
sr„ -r
Tel,: ` If
.,'�. •�+ V
License`#
'
Trees repaired
Sewage System
_ /J }L,Addres
-.,
-7 4- Li
cityAq
T U. P
Sewer"DiitricC
i
I
form 2841/" (Rey:OM. ) ®s.
i_.
THIS PERMIT SHALL BECOME'VOID IF WORK,, IS NOeCOMMENCED WIT14-IN I20:DAYs. CESSATION OF WORK
FOR 1;20 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' RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
I HEREBY CERTIFY THAT THE INDNIDIJAI WHO PREPARED THE PLANS ANDSPECIFICATtONS HAS DONESO IN
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE
STATE OF CALIFORNIA.
verlfled'by:
NOTME: THIS IS NOT A BUILDING PERMIT
Ct _ APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING .AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
28.4 1:99A 9/74CANARY-FILE, PINK -APPLICANT
Owner �IGP r"� Architect _ —_ Contractor 4
Address -_-_ Address_.- A'ddress�.y S�
City ; City - Cllty__14_
�-
Phone Phone _ Phone ? _
�.
1 ,(wej the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
.W
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/O'R
Approval by Signature from the Following Departments Listed Below
lt1lust Be Obtained Prior to the Issuing of a Consfruttion. Permit.
1.SPACE NO.
•C 1 OF STRUCTURE
_ _ 4 r USE
�.
JOB ADDRESS _ 1 - "yINFAMILY ❑ DUPLEX ❑
_
LEGAL DESCRIPTION OF PROP.ER,TY I Z� �ti - /1 !=➢
-crr �- APARTMENTS ❑
Z W
AGRIC. ❑
N Q
L — tiq -►
�'COMMERCIAL ❑ INDUSTRIAL
CC
COMMUNIT
ALTER TIONS ❑
Z
_
NO. OF SUBMITTED PLANS - USE OF PtRMIT
d
W Q
CASE NO.
-
p Z
NO. OF'PARKING SPACES REQUIRED — NO. OF .BUILDINGS NOW EXIST1 G
J10
ZON.E SE"TB'A(`kS: FRONT SIDE REAR
m
740,
GRADING PERMIT RERUIR.ED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE OF FEET REQUIRED ON STREET
DATE ! r2 - SIGNATURE. OF LAND USE OF.FI:CIAL -
EETiH, DEDICATION REQUIRED: YES ❑. NO '❑ NO. OF FEET—
z:
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
t-
ot
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
HAS AN ACCEPTABLE APPLICATION BEEN, MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
CIMPROVEMENT?
YES ElNO El
O0
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
SWIMMING POOLS PUBLIC"
H
Q W
SEWAGE' DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
FLOOD CONTROL -
F
z AIR POLLUTION
W ": DIV OF HWY
c — YOUR PROPERTY MAY BE SUBJECT TO
d
c FLOOD. RIVERSIDE COUNTY ASSUMES
N0, RESPONSIBILITY IN EVENT OF FLOOb.
28.4 1:99A 9/74CANARY-FILE, PINK -APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CER7IF3CATE
COUNTY OF RIVERSIDE PERMIT if
Effective July .1. 1980, Chapter 1301:Section 19825 of the. Health 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.
Q LICENSED CONTRACTORS DECLARATION
I hereby affirm that I air licensed under provisions of Chapter 9' (commencing with Section 7000) of-
Division
fDivision 3 of the Business and Professions Code. and my license is An, full force. and effect.
-License Class - /U License No.
.1. Date/di%jti' ontractorr-
0 r-77 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the fo.11,owing reasons'::
[� I, as owner of the property, or my employees withwages 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 1 will have the burden of proving I did not build or
improve for the purpose of sale (Sec. 7031.5, B.bP.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 exemptunder section , B.BP.C,. for this reason:
Date Owner
_ 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
® Certified copy' is hereby furnished.
Certified copy is filed with the County afIR- erside., Department of Buildf g and Safety.
.� Applicant
0 ! CERTIFICATE OF EXEMPT40N 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 maki.ng,,this Certificate of Exemption, I should become.subject to.
the Workers' Compensation.provisions of the labor code, I must forthwith comply with such provis',ions
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
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,author zed by this permit, and that no
building, structure:, scaffolding, fa.lsework, or demolition or dismantling thereof, will be
more than thirty-six (3 6) 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
Oivis;ion.of Industrial Safety, as noted above,. unless such person has a permit to do such work'
from that division.
0 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 inforination given is correct. I agree to
comply with al'l 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-,
_pg_rty4o=Whd 1 I have applied for thi ermit for the purpose .of makingGipspections...
`X1,9ftJire of A
pp cant gent FaRte
/.���w r
PrrIVM- p cant/ gent Name.
2844000 7/80;