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417944 (PLBG)YY�VrVv s nr+i• PERMIT NO. ` DEPARTMENT OF BUILDING & SAFETY 413 (� 4 4 COUNTY OF RIVERSIDE FIELD CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. 2ND. FL. POR. GAR. CAR P. WALL ESTIMATED CONSTRUCT1ONl SQ. FT. @ SQ. FT. @ SQ. FT. @ UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. POWER OUTLET BAR SINK ROOF DRAINS SQ. FT. @ SQ, FT. @ SQ. FT. @ SQ. FT. @ VALUATION DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ WATER PIPING NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP, COOL HOOD SIGN WASHER (AUTO)(DISH) .APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY ,AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.0 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. @ t BATH TUB SQ. FT. @ t WATER HEATER SQ. FT. RESID @ 1 /, C SEWAGE DISPOSAL SQ. FT. GAR @ IN C HOUSE SEWER ffMECH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE srl DEL TOTAL FEES MOB HM FEE MICRO FEE PL CK FEE I CONST. FEE ELECT. FEE SMI FEE FEE PLL1 B. FEE PERMIT NO_ 417944 Job Add.ess� f _ ` — - -- --- — — — --. � `pace Zip Owner — -- - Community Valuation $ Date :Dial. /T Off. F C.0 MH Permit Fee $ Micro Film Fee Cop $ Use of Permit Parrel NI . Use/Case No Ck, By Mech- Fee Dbl $ Pl. Ck. Fee $ Set Backs Lot Size Canstructron Fee Dbl ;$ Legal Description y� r 4 f -/ .",I eF "'• � F S S R Electrical Fee Dbl $ Zone Restrictions _ Group Type SMI Fee $ Plumbing Fee Dbl $ Bond Amt. S Plan No. Plan Checker F��'le ✓� '3nspe clq�f Unit Sp- Insp, Fee Demol- Fee '6 Consl, Lender Branch Suppllmenlol Permit Numbers / Registr Fee ;5 fl Mlltroge Fee $ Address City Zip Witness Fee ;6 Reirnp. Fee ;$ Owner/Agent Tel. Zip Total Fees $ Address Gty Zip M-O. C3 N.C- Cash '=l, r•.-. Received by Contractor Tel. _ License# Trees required Sewage System Address W' Oily ZIP T LL P, r THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK Sewer District FOR 120 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 EI LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. " J IFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284-208 (Rev.8/78) ©s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. verified by: /d lid lould ZE aDIA10S IE Sajnlx!j OE 6u!Pu09 96Z anM 6uipunoj0 V6Z 6u'JIM 6Z aDuoJlu3 aD!AA@S 87 1!npuo:) LZ clod JaIAOd 96 S1VAOaddV IV:)Iai:)313 3NI1 A183d08d d0 8V3a au!l� lid • C 7 lould sa NOUV701 T 321S MISAS 30VM3S NOUVWHOINI IVNOI11aaV N Nn %d C 17 lsal SUE) hl a:)!AI@S Ja10M EZ Jaual4oS JalOM ZZ Ja10aH J010M LZ jarnaS OZ _ losods!O aboMaS 6I Sluan Ol qwnld y6nod LI 6wd!d JaloM 9I gwnld punoig SI _ SIVAOnddd T I -- - DNlewnld lould (uonolg) 6uiliaJ hl DZI (sllos) 6u!liaJ 9ZI (silos) slloM VL an o b A 1:)!yl NOIlVI(1SNI apoie ys!u!j £I IlomAj(i VZI ylol louwalul ZI y401 jo!ja4x3 I I 01 aDolda!j VOL lould £V El I'd a:)olda!j OI POOH 1o!3laww0] Zy lloM aa! j abojoO 6 ao!naO uO!pala0 9� OwS Iy sluan g jadwod aj! j Op 6u!woj j L aouojoalJ 'IddV 6£ j:)a0 pod 9 jossajdwOD 8£ swoag Puog S nV uo!ysngwoD LE slpolg 1noi0 y slalln0 g slalul 9£ aalS E -podwo' mown j SE apoje golS VZ spnd g swnuald t'£ swj j g s6lj Z walsAS uO!lol!luM EE 'pOg tas SIVAOaddV IVDINVH33W SIVAOBddV ONimin9 2101 NOIlVd3dO ON ZlO1J3dSNl 31V4 NOI1Vd3dO ON DEPARTMENT OF BUILDING AND SAFETY . COUNTY OF RIVERSIDE OFFICE DATE TIME ERMIT NUMBER/,O' % �" ✓v J �/ /-7 / INSPECTION FORUESTED ADDRESS / 2 ` 1SPACE NO. 1 OWNER COMMUNITY BUILDING I PLUMBING I ELECTRICAL REMARKS: t 1�1� '-p fv OWNER/CONTRACTOR TEL.NO A.M. MECHANICAL Ir1DI1 a WED `I THUR ®fRI 29446 11/75. r. P" NOTICE: THIS IS NOT A BUILDING PERMIT �+ DISTRICT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY Permit No COUNTY OF RIVERSIDE 284 199 9/74 CANARY—FILE, PINK—APPLICANT Owner Architect Contractor - r "`fABdiess / Addres t Address_ City City City_ dp�� G' I�7I Phone-- Phone Phone41 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 O without an encroachment permit. NOW, therefore, it is agreed that 1 (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. DATEr� ^lL SIGNATURE OF OWNER AND/OR AGENT Q Approval by Signature from the Following Departments Listed Below. Must Be Obtained Prior to the Issuing of a Construction Permit. SPACE NO. USE OF STRUCTURE � � srfa.' "Cot"K ,, JOB ADDRESS SINGLE FAMILY [_'Q, DUPLEX Z W L GAL DESCRIPTION OF PROPERTY �, Y fJ APARTMENTS [�"'1 AGRIC. �] N < /` Y ! COMMERCIAL INDUSTRIAL n 'A COMMUNITY. 6a ALTERATIONS n WQ OF SUBMITTED PLANS — USE OF PERMITr"��J ! _ NO. �+ CASE NO. - G Z NO. OF PAM�NG S//PACES REQUIRED NO. OF BUILDINGS Nk3�V• ES(ISTING Q -1 ZONE _/ SETBACKS: FRONT SIDE C/ REAR J m •• A GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE SETBACK 0,RDINANCE # _— OF FEET REQUIRED ON STREET DATE SIGNATURE OF LAND USE OFFICIAL DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -- — z CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET t- i CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ W HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET O IMPROVEMENT? YES ❑ NO ❑ - °L FFICIAL DATE _ SIGNATURE OF ROAD DEPT. OFFICIAL— SWIMMING SWIMMING POOLS PUBLIC ._ WSEWAGE DISPOSAL = Q FOOD ESTABLISHMENT WATER POLLUTION REMARKS �e FLOOD CONTROL— z AIR POLLUTION _ DIV OF HWY I- a — YOUR PROPERTY MAY BE SUBJECT TO ,., ._ d 1 c FLOOD. RIVERSIDE COUNTY ASSUMES NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199 9/74 CANARY—FILE, PINK—APPLICANT DEPARTMENT OF BUILDING AND SAFETY APPLICATION CERTIFICATE COUNTY'OF RIVERSIDE PERMIT N Effective July 'l 1980, Chapter 1301, Section 19825•of the Hilth 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:- M 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 fo ce and effect. se LicenC ass License �C/ Date Contractor [� OWNER -BUILDER DECLARATION I hereby affirm 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; B.&P.C.). [� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B.&P.C.). [� I am exempt under Section , B-.&P.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 ec. 3800, Lab. Code). Policy No. 4aE -oa zs�l Insurance 0 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. 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 0 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 id 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.) [� 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. 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 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- pety for which I have pplied for this permit for the purpose of makin'g/ins/pections. '�` `lam —�/ ignature of p scant/Agent Date -- Prfnt Applicant/Agent Name 284-2000 7/80 rte BUILDING PERMIT PERMIT NO. 417944 DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE DST COUNTY OF RIVERSIDE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. 2ND. FL. POR. GAR. CAR P. WALL ESTIMATED CONSTRUCTION SQ. FT. @ `P UNITS %Draatee rri * y T , SQ. FT. @ YARD SPKLR SYSTEM MOBILEHOME SVC. SQ. FT. @ BAR SINK POWER OUTLET SQ. FT. @ ROOF DRAINS SQ. FT. @ DRAINAGE PIPING SQ. FT. @ DRINKING FOUNTAIN SQ. FT. @ URINAL VALUATION $ WATER PIPING NOTE: Not to be used as property fox valuation SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER Plan Checker GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Unit 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 Received by f SQ. FT. @ c WATER HEATER LicenseA SQ. FT. RESID @Iv,c SEWAGE DISPOSAL (' SQ. FT. GAR @ s/. c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. 1 TOTAL FEES 14 ,,fir 1rj✓r! MOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE I CONST. FEE ELECT. FEE SMI FEE FEE PLU'LAB,/fE j PERMIT NO. 417944 Job Address C" .� Space ' -�� -1) Zip Y Owner c r©SS- 44,ks . _ Community // ,�+'/� ( / L/ i �7 Valuation $ %Draatee rri * y T , Dist. Off. F.C.C. MH Permit Fee $ Micro Film Fee Cop $ Use of Permit Parcel No. Use/Cole No. Ck, By Mech. Fee Dbl $ PI. Ck. Fee $ Set Backs Lot Size Construction Fee Dbl $ Legal Description L. / / 3 �y /J F 5 5 R Electrical Fee Dbl $ Zone Restrictions Group Type SMI Fee $ Plumbing Fee Dbl $ Bond Amt. $ Plan No. Plan Checker Fi�n� lllpole / 7 In Unit Sp. Insp. Fee $ Demol. Fee $ Const. Lender Branch Supplimental Permit Numbers Regisir. Fee $ Mileage Fee $ Address City Zip Witness Fee $ Reinsp. Fee $ Owner/Agent Tel. Zip Total Fees y Address City Zip M.O.0 N.C. Cash Check Received by f Contractor . !!.,/....;. 1 , Tel. r� LicenseA Trees required Sewage System/dddrrreessss (' city./4 /1 �C Zip T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: Sewer District FOR 120 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 k E LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. II&IIICERTIFY THAT'THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN Form 284-208 (Rev.8/78) @s ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.