413738 (BLCK)PERMIT NO. DEPARTMENT OF BUILDING & SAFETY
13738 COUNTY OF RIVERSIDE FIELD MST,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND. FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. .@ $
UNITS
SO. FT. @
YARD SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BAR SINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SO. FT. @
DRAINAGE PIPING
SO. FT. @ -1 `.�
DRINKING FOUNTAIN
SO. FT. @ t 's'
URINAL
VALUATION $ •a
WATER PIPING
NOTE: Not to be used as property tax valuation
s SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH) I
APPLIANCE DRYER
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.
SO. FT. @ a
BATH TUB
Lot Sire
SO. FT. @ a
WATER HEATER
R
S0. FT. RESID @1144
SEWAGE DISPOSAL
S0. FT. GAR @ sWa
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEESMOB.
HM. FEE
MICRO'FEE
MECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
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PERMIT NO.
413738
Job Address
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Construction Fee Dbl S
L gI Description
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Electrical Fee Dbl S
Zone Restrictions
Group
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Demol. Fee $
Const. Lender
Branch
Supplimermit Numbers
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Registr. Fee §
Mileage Fee S
Address City Zip
Witness Fee §
Rainsp. Fee §
Owner/Agent
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Zip
Totol Fees $
Address/'(/
City
Zip
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T LL �t P THIS PERMITsSMAIL BECOQ(E VVIU 0V4ISNOT COMMENCE6'WITHIN-12Qlf"D S. "C'-AAhO CIF WORK
Sewer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
•1 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.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICAT79NS HAS DONE SO IN
Form 284-208 (Rev. 1/80) NCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE O&tALIFORNIA.
verified by:
ti y: I
a
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVA�LS
MECHANICAL APPROVALS
' 1
Set Back
,/�`�
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slob Grade
35
Furnace Comport.
3
Steel
I / .�f4y-
36
Inlets 8 Outlets
4
Grout Blocks
/ rj A /)�
37
Combustion Air
5
Bond Beams
%S '"'tel/
38
Compressor
R 6
RVol 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.
Ej
43
Final
loA
Fireplace T.O.
°ON
ADDITIONAL INFORMATION
e
,
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION
Thick R
Value
7A Walls (Botts)
12B Ceiling (Botts)
12C Ceiling (Blown)
14 Final ✓ /J
PLUMBING APPROVALS
15 Ground 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
)
P/
26 Power Pole
27 Conduit r
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
DEPARTMENT OF BUILDING AND SAFETY APPLIVTION 'CERTIFICATE
COUNTY OF RIVERSIDE PERMIT N
Effective July 1, 1980, Chapter 1301 Section 19825•of the H"I th 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:
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 Class - � License No. ?,/ &6, 3 5/
Date I�I ( Contractor _ AETj ill-2,okL ,d
[1 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 sate. 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.).
Q 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'(Sec. 3800, Lab. Code).
Policy No. Insurance
Q Certified copy is hereby furnished.
Kat
Certif ed opy is filed with the Co" of er d D r ent of Building and Safety.
1 / Applicant t
Q CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATI 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
d 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.
M 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 th ty of Riverside, Department of Building and Safety to enter upon the pro-
perty which I e a pl d for this permit for the purpose of making ins9ections.
i nature f pp scant gent Date
Print pp i t/Agent Name
284-2000 7/80