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A009629 (SFD)FIELD DEPARTMENT OF BUILDING & SAFETY PERMIT NO. PERMITTYPE COUNTY OF RIVERSIDE t f/ A 0 0 9 6 2 ionol Information: ACTORY BUILT HOUSING MOBILE HOME INSTALLATION ~ onufocturer „- MH Monuf. New ❑ odel Designation f,�t0 } Size Relocated ❑ 1 nit Serial No. _ ,-i I Total Fees $ .Ian Approval No. nsig. Seriol No. Moving Sewage System'1 ` T 1 1 p , Permission is hereby granted to move the structure, described below, in Width Length Height otol Fees $�rU f RADING lut #1 Number of #2 Sections #3 Fill otal Fees $ Present Location Community County RELOCATION INSPECTION Destination resent location community "' County" Total Fees Total Fees $ _ Permit Na. _ Job Address �. _$ SP # Zip wner Plan Check Com `unity ✓�. ��,e -�-CA Valuation is Date Dist Off P.C. !�,einspection Use of Permit / � }I,¢-ft.�� ' arcel No. t Size _ ,— - tJ J ;-o ni,-% Factory- Built �j �' Set backs Use Permit p Legal Des( iption �� ...CC�tY'=i�- %}p —C C�' Gradin g Bond ,,� Zane $ 1 Grp Type Unit yk_by Mobile home Engineer License # Final ate Inspector Env. Assmt. Requirement Relocations r Escrow Company Bronc Tota I Fees $ 1 .11' Address City Zip Cash I Check Mo r1c Owner/Agent Tel. IX Received by Date �! . � , y, ' Related Permit(s) %r., Contractor/ Mover Tel. workers' comp. ..r yes ❑ no ❑ Address City Zip 'certify that in the performance of the work for which this permit is This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days ued I shall not employ any person in any moaner so as to become b, shall also cause permit to become void. Iect to the workers' compensation lawspf California. /' I hereby agree that all work in connection with this permit will be done in accordance with the laws of �ff erside County and the State of California. I hereby certify that the individual who prepared the plans and Owner Signature ////�„% icohons has docile so in accordance with Section 5541 of the Business and Professions Code of the Builder Signature State of Coljfornia. FORM 284-208A 5-77 OM n NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Bock 33 Ventilation System 2 Ftgs & Frms Q . '1 34 Plenums &Ducts 2A Slob 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 Detention Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P.L, Ej 43 Final _7-412 ani 10A Fireplace T.O. 0 NON ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Loth 12 Internal Loth 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 Q� 20 Sewer 21 Water Heater / 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank r7,5-0 Pit ( L. Line PSL REAR OF PROPERTY LINE ELECTRICAL APPROVALS 7l - Q j I ` > .t Pi 26 Power Pole 27-- Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures _ 31 Service 32 Final STREET NAME n DEPARTMENT OF BUILDING AND SAFETY • -.x COUNTY OF RIVERSIDE NOTICE TO APPLICANT In conformity with the provisions of State of California Labor Code Section 3800, the applicant shall have on file or file with the Riverside County Department of Building and Safety a certificate as designated in Items I or II below, or shall indicate Item III, IV or V, whichever is applicable. CERTIFICATE OF APPLICANT Please mark the appropriate block: (� I. Certificate of Consent to self -insure issued by the Director of Industrial Relations. a Copy on file F-1 Copy submitted II. Certificate of Workers' Compensation Insurance issued by an admitted insurer. Copy on file = Copy submitted III. The cost of the work to be performed is $100 or less. IV. 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 certify that, in the event I become subject to the Workers' Compensation provisions of the Labor Code that I will comply forthwith with the provisions of Labor Code Section 3700, et seq., and understand that, if I do not comply, the permit shall be deemed revoked. n V. I certify as the owner (or the agent.of the owner) that in the performance of the work for which this permit is issued I have engaged , contractor. (Contractor must have on file, or submit certificate required by I or II above.) Applicant's Signature Date 4.1_ 71_ Permit No. 1�Crj) Address and location where work is to be performed Y 8�, 9 7% d-t,� 284-141 Rev. 6/77 i p f NOTICE: THIS IS NOT A BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE d I" P C.c M / DISTRICT # R Permit No 284 199 9/74 CANARY—FILE, PINK—APPLICANT Owner rchitect Contractor $'_'—L Address ' �/ ' Address Address_ <S' U ? Cit y.,_, City City_ Phone Phone Phone of W I (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 without an encroachment permit. NOW, therefore, it ig(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 df the of Riverside and the State of California governing said property. %County DATE SIGNATURE OF OWNER AND/OR AGENT Approval by Signature from the Following Departments Listed Below Must Be Obtained Prior to the Issuing of a Construction Permit. I SPA E NO. 1 USE OF STRUCTURE JOB ADDRESSF%7/All" SINGLE FAMILY ;g DUPLEX O >_ 16 LEGAL DESCRIPTION OF IP P RTY 1 A// � + e' - W EE NN TS /G�R/I/C. �i7T Lel' / dAM O T� B, < _ I CfO{MMEIFC(ALV IW -TRIAL CJ COMMUNITY L- CG _ ALTERATIONS n Z NO, OF SUBMITTED PLANS --. USE OF PE — _ ul 4 < CASE NO. •^ Z NO. OF PARKING SPACES REQUIRED — NO. OF BUIL1 GS NOW EXISTING jJ i SIDE a RE r�d ZONE SETBACKS: FRONT m �% GRADING PERMIT REQUIRED? YES 0 NO)< LOT SIZE S 40 f s SETBACK ORDINANCE # —L OF FEET REQUIRED ON STREET DATE SIGNATURE OF LAND USE OFFICIAL F, DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__ CURB AND GUTTER. REQUIRED: YES ❑ NO ❑ —STREET t- oe 4 CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ W HAS AN ACCEPTABLE AP CATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET IMPROVEMEN ? YES NO ❑ °C r' ! DATE ' SIGNATURE OF ROAD DEPT. OFFICIA I SWIMMING POOLS PUBLIC WSEWAGE DISPOSAL FOOD ESTABLISHMENT _ �� WATER POLLUTION REMARKS �n FLOOD CONTROL— z AIR POLLUTION at i _ DIV OF HWY I.- a — YOUR PROPERTY MAY BE SUBJECT TO a WA FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199 9/74 CANARY—FILE, PINK—APPLICANT i' RIVERSIDE COUNTY DEPARTMENT OF PMOLIC 14EAL714 DIVISION OF ENV IRON MtNTAL'HEALTH Food Establishment Sewage Disposal Trailer Park Z—V Gal. Septic Tank t4wel, Apt., Hotel Sq. Ft. of Leach Line Dwelling x 'L Seepage I — Commercial Building Connection to Selivey, - Swimming Pool'. No on-site regenerating water softening devices may bi dischiro2d in,:) the individual Sewage dispow 'herewith approved %Y',hcut -----system clearance fro c2 QJ4ti*7 Czntral. Board. ._Water supply servi ' r%g this instv!�aticn must be f� ').-n an s-u-ce. sewage, disposal installation must conform w'.n r-qu:r,mants of cu:curtUrawran Pttgnbiriq CbdoA '740 Any cutting, grading, or filling in cx,,;c-ss of f.,u � (4) f, c.t will nul::fy svkvLV-_ e1sposali appvmvat. he Approval has been obtained from the regional Wchardanr Quality ContrcJ chard for of t sew* age disposal system. This is to certify that the Riverside County Departmen' 40fP bDI*IC Health approves far, aec:uprancyn, constr4i:OMI or installation the item(. ) checked above. 72 DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE A009629 itional Information: FIELD OFFICE FACTORY BUILT HOUSING MOBILE HOME INSTALLATION ,'Manufacturer Com. MH Manuf. New ❑ Model Designation /! Size Relocated ❑ Unit Serial No. �„ Total Fees $ i.Ian Approval No. .. insig. Serial No. Jtr { ♦. (i"� .. sr Moving Sewoge System— (� =�ii, Permission is hereby granted to move the structure, described below, in T �?'� 1 1 p * otaI Fees $ Width Length Height GRADING # 1 Number ' Cut of #2 Fill Sections Total Fees $ #3 Present Location .LRELOCATION INSPECTION Community County 's Destination r Present location Commun.ity County- Total Feesotal Fees-�.-t ermit No.. 1.1�T Job Address i SP # Zip 'canerA009629 r ,r v Com unit Valuation Date Dist #f P.Plan Check - Use of Permit arc No. t Size 5V YAW Reinspection .- - ,'Factory- Set backs Use Permit # Legal pti ` O /O :Built / Bond �zo ne Grp Type Unit Grading $ 1 Engineer License Final DateInspecto Env. Assmt. Mobile home #&�% Requirement Escrow Company Branch Relocations E, Address City Zip ,Total Fees $ '0 Cash I Check Mo rvC Owner/Agent Tel. Rece'iv d by Dot - ` A r e s s ®, 0 7 q / A N �A, v SA N7 City Zip F, �r Lt 12 U 6,7 Related Permit(s) Contractor/Mover Tel. ti workers' comp. Address City Zip :r. yes ❑ no ❑ i I certify that in the performance of the work for which this permit is This permit shall become void if work is not commenced within 120 days. Cessation of work for 120 days 'issued I shall not employ any person in any mwner so as to become sub- shall also cause permit to become void. `eject to the workers' compensation lows f CoI forn I hereby agree that all work in connection with this permit will be done in accordance with the lows of � / verside County and the State of California. I hereby certify that the individual who prepared the plans and Owner Signature Z ��ns has done so in accordance with Section 5541 of the Business and Professions Code of the Builder SignotState of California. — FORM 284-208A 5-77 OQ M