426599 (PLBG)PERMIT NO. r DEPARTMENT OF BUILDING & SAFETY FIELD DST f
1426599 COUNTY OF RIVERSIDE F//
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
V� �+
! �'
UNITS
_
1
IST FL. $Q. FT. @
Zip
r J
Owner ,�
,
Community
/ r
YARD SPKLR SYSTEM
2ND. FL. SQ. FT. @
Valuation
E
Date
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. @
I F.C.C.
MH.Permit Fee E
Micro Film Fee
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. @
y .tr %,
`� t�
Parcel No.
DRAINAGE PIPING
CAR P. SQ. FT. @
Ck. By
Mech. Fee Dbl E
Pl. Ck. Fee E
' -Set Backs
DRINKING FOUNTAIN
WALL SQ. FT. @
Construction Fee Dbl E
qaf Descript on /
//"n1 7
/'/ r1
L
URINAL
SQ. FT. @
S
R
ESTIMATED CONSTRUCTION VALUATION $
Electrical Fee Dbl E
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN F:
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
APPLIANCE DRYER
'LV/
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.
SQ. FT. @ c
BATH TUB
Address City Zip
SQ. FT. @ c
WATER HEATER
E
SQ. FT. RESID @1'Ac
SEWAGE DISPOSAL �
SQ. FT. GAR @ '/. c
HOUSE SEWER
Tel.
GAS PIPING
PERMIT FEE
Total Fees
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
M. 0. N.C. Cash Check
Received bye.
Contractor
QN r
r `
PERMIT NO.
426599
Job Address _
1-1- � -.
V� �+
! �'
(f�: ✓
_
1
_ Space
Zip
r J
Owner ,�
,
Community
/ r
Valuation
E
Date
/^
J /
DI.tJ
Off.
I F.C.C.
MH.Permit Fee E
Micro Film Fee
Cop E
Use o Permit
i
` n�
y .tr %,
`� t�
Parcel No.
Use/Case
No.
Ck. By
Mech. Fee Dbl E
Pl. Ck. Fee E
' -Set Backs
Lot Size
Construction Fee Dbl E
qaf Descript on /
//"n1 7
/'/ r1
L
�" F
S
S
R
Electrical Fee Dbl E
Zone Restrictions
Group
Type
SMI Fee E
Plumbing Fee
Dbl E
�„! , t
and Amt.
E
Plan No.
Plan Checker
'LV/
F ar, /
f'�/
Ins
Unit
Sp. Insp. Fee E
Demol. Fee
E
Const. Lender
Branch
Supplimental APermit Numbers
e9 — ` �
Fee E
Mileage Fee E
e
Mileage
Address City Zip
Witness Fee E
Reinsp. Fee
E
Owner/Agent
Tel.
Zip
Total Fees
E
4f ;,D
Address
j
City
Zip
M. 0. N.C. Cash Check
Received bye.
Contractor
QN r
r `
Tel. /
1F
License#
frees required
Sewage System
Address
City
Zi
't -, T LL P� TSO
Sewer District
Form 284-208 (Rev.8/78) @s
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. qj�A
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. 11
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
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
10A
Fireplace T.O.
P'
ADDITIONAL INFORMATION
- - - - - - -
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 ► V
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Vtg 1C Pit 06 L.Line
REAR OF PROPERTY LINE
jr
PL
PSL P/
�' O
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
+ STREET NAME Awti 7
NOT:CE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 " CANARY—FILE, PINK—APPLICANT
Owner v �'� �� `���/ Architect —. _ Contractor t!5"n I -
Addres _ r7� / �E!c����1 Address-__ uk_—
Address
City �� City_— City_A4
—
Phone _
- Phone _ Phone_J
ocs
W
'
1 (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 torbe donejwithin 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 occupiep until I (we) have
complied with all laws of the County of Riverside and the State of California governing said property.
A)l /19f ��—
DATE -J"
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.
a� , . �^,/ `��� /� /�' /�� v„IG` n i SPACE NO.
`f/�j `l ul r, ! r/
USE 0 STRUCTURE
JOB ADDRESS - I SINGLE FAMILY DUPLEX
ZH
L ESCRIPTION OF PROPERTY
�`AGRIC. El
0
.��� -��-Z��ATMENTS
MMERCIAL INDUSTRIAL [J
j C
Z
COMMUNITY JQL ALTERATIONS n
NO. OF SUBMITTED PLANS - USE OF PERWTn IT
CASE NO.
p Z
NO. OF W, KING SPACES REQUIRED _— — N0. F BUILDINGS NOW EXISTING _
Q CJ
ZONE SETBA(fKS: FRONT SIDE REAR
IF
J
m
f
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBAC ORDINANCE # OF FEET REQUIRED ON STREET
DATE 0SIGNATURE OF LAND USE OFFICIAL - •"
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_-
iCURB
AND GUTTER REQUIRED: YES ❑ NO ❑ -STREET
t-
oe
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
D
C
IMPROVEMENT? YES ❑ NO ❑
°C
DATE _ ^_ SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
SEWAGE DISPOSAL —3 y'ry4'•op t/y r / 0 o G T t T?"s %C i �I /.
FOOD ESTABLISHMENT
= C
WATER POLLUTION REMARKS
FLOOD CONTROL—
z AIR POLLUTION
� W
_
:1 h DIV OF HWY
0 Q — YOUR PROPERTY MAY BE SUBJECT TO
a
o FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 " CANARY—FILE, PINK—APPLICANT
DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
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;-
23
elow:[3 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 Glass L/ License o,. 12 (a 0 l
Date ontractor s r1I ?/ —C A ,
® OWNEj2j�8�1-ILDER DECLAARRATION
I hereby affirm that I am exempt from the/Contractor's License Law for the following reasons:
0 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;'B.&P.C.).
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, B.&P.C.).
[:1 I am exempt under Section , B.&P.C. for this reason:
Date
�] 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 c r.tified copy thereof'((Sc. `e 38 0,
Policy No. (/i� Insurance ( rC)l, Lab. Code)
��� ////���Y '►�-�vd��((
0 Certified copy is hereby furnished.
Certified copy is filed with the County o_ffRiverside „,`Department of Building and Safety.
Date /_ Applicant
[� 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.
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 ,� M '�;.
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 (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.)
0 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.
[� Div'sion of Industrial Safety Permit No. ./
Date 4o, Applicant 1
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 to enter upon the pro-
perty for which I have appl'dd f this perm•tjfor the purpose of makingmin pect oris.
(/ /�
_.I ature o pp tan / g,e t , 1 Date
.'�� ✓� IL( U/ilk r�d�
Print Applicant/Agent Name
284-2000 7/80