413167 (ELEC)BUILDING PERMIT
"1413167
PERMIT NO.
Job Address .. / (� C+•.�p 1 - , - Sjp�ace
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DEPARTMENT OF BUILDING 8 SAFETY
COUNTY OF RIVERSIDE
FIELD !/f
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CONSTRUCTION ESTIMATE
NO. - ELECTR AL FEES
NO. PLUMBING FEES
' 1ST FL.
2ND. FL.
I? POR.
GAR?
CAR P.
WALL
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ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
F.C.C.
MH Permit Fee $
YARD SPKLR SYSTEM
SQ. FT. @
Cop $
SO. FT. @ MOBILEHOME SVC. BAR SINK
Use of Permit
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SQ. FT. @ POWER OUTLET ROOF DRAINS
Use/Case No.
SQ. FT. @ •" DRAINAGE PIPING
Mech. Fee Dbl $
SQ. FT. @ DRINKING FOUNTAIN
Set Backs
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
Construction Fee Dbl 8
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER'
Group '
VENT SYSTEM FAN EVAP. COOL HOOD
SIGN
WASHER (AUTO)(DISH)
I
APPLIANCE DRYER
Dbl $
GARBAGE DISPOSAL".
Bond Amt.
$
FURNACE UNIT WALL FLOOR SUSPENDED
i
Plan Checker
LAUNDRY TRAY r.
Inspector
1-
' AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
'Demol. Fee
• ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
Supplimental Permit Numbers
COMPRESSOR HP
POLE, TEMP/PERM.
LAVATORY
`Mileage Fee $
HEATING SYSTEM FORCED GRAVITY
L. AMPERES SERV ENT
SHOWER
$
BOILER B.T.U.
SO. FT. @ a
BATH TUB
Zip
SO. FT. @ e
WATER HEATER
$
S0. FT. RESID @I %a
SEWAGE DISPOSAL
1:
Zip
S0. FT. GAR @ s/4a
HOUSE SEWER
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GAS PIPING
PERMITIFEE.
'Sewage System
PERMIT FEE
PERMIT FEE
Address ..
00 /
DBL.
TOTAL FE51'A_1 MOB. HM. fEEMICROfEE
MECH. FEE PL. CN. FEE
CONST. FEE E ECL fEf n
SMI FEE
FEE PLUMB. FEE
PERMIT N .
41316 7
Job Address .. / (� C+•.�p 1 - , - Sjp�ace
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Zip
Owne
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Voluotion
$•
Date
c� •`�
Dist.{
`
Off.
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F.C.C.
MH Permit Fee $
Micro Film Fee
Cop $
Use of Permit
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Parcel No.
s V I ,I
Use/Case No.
Ck. By
Mech. Fee Dbl $
PI. Ck. Fee $
Set Backs
Lot Size
Construction Fee Dbl 8
Lege Description
`' \ •� C..,_
F
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R
_
Electrical Fee Obl S
Zone Res)f'�)tions (L
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Group '
Type
SMI Fee $�
Plumbing Fee
Dbl $
Bond Amt.
$
Plan No.
Plan Checker
Final Date
Inspector
1-
Unit
,
Sp; Insp. Fee $
'Demol. Fee
$
Const. Lender - Branch
-
Supplimental Permit Numbers
Regior. Fee $
`Mileage Fee $
Address City Zip
.Witness Fee $ +
Reinsp. Fee •
$
Owner/Agent •
Tel.
Zip
Total Fees
$
AddressGty
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Zip
• M.O. XN.C. ❑ Cash 'Check
Received by
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License?
Trees required
'Sewage System
Address ..
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City Zip
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I—T LL 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
6 THE LAWS OF RIVERSIDE' COUNTY AND THE STATE OF CALIFORNIA.
1 REBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
Form 284208 (Res•. I/80) CORDANCE• 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 8 Frms
34
Plenums 8 Ducts
2A
Slob Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 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.0.
°o
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
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
28 Service Entrance
29 Wiring.
29A Grounding Wire 1 _ 1-(it5,��
29B Bonding
30 Fixtures
31 Service
32 Final
'S
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DEPARTMENT OF BUILDING AND SAFETY �y APPLICATION CERTIFICATE
COUNTY OF RIVERSIDE' PERMIT #
Effective July1, 1980, Chapter 1301- Section-19825-of,the HeSith'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. x! 2_5)_;3
Date Contractor 1 7Z v�-
Q OWNER-BUILIER DECLARATION
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 bf completion, I understand I will have the burden of proving I did not build or
improve for.the purpose of sale (Sec. 7031.5;'6.&P.C.).
�] I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 1044,,.6_.&P.C. )b�KN I /
[� I am exempt under -Section- �`,� \ V IN. K &P.Q. for
Date Owner
�] WORKE(RS' COMPENSATION(DECLARATION r,,
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. P z2-81(. Insurance ?A Is r e-
Q Certified copy is hereby furnished.
C Certified copy is filed with the County of Riverside, Department ppof Building and Safety.
Date—1 2 i ' 80 Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE U
(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 F
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). ' Jr
.'
Lender's Name n a
Lender's- Address
DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION
Q 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.)
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.
[] 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-
perty for,whi" h I have -pplied-for this permit for the purpose of making inspections.
Signature,/ofpp scant/Ag n Date
r nt App scant/Agent Name
284-2000 7/80 ,
' NOTICE: THIS IS NOT A' BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
DISTRICT
Permit No
284 199A 9/74
CANARY—FILE, PINK—APPLICANT
Y RLL -EY E1J7gtip9%f*tIArchitect_— Contractor_LVA 7-e--C`E_Ci/BtL
Owner�—. --_
Address �S900 (%aSEO Co"PAD41Address___ Address-- ----
niDlAly voGLLS, City-- Qp YefCO-?
City _ City_l�� ,-
i Phone _ Phone) 7e�0 G �i-----.--
Phone ° qL_7D Z 2
I (we) 'the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutters, and
W
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- Paving, and/or Dedication of right of way isorequired 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 o`f Riverside and the State of California governing said property.
17
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.
SPACE NO.
a�S 3
I USE OF STRUCTURE
5 0 5--Z-'
JOB ADDRESS SINGLE FAMILY. DUPLEX
H
LEGALDESCRIPTION OF PRROPERTY/ %�J �—�� � � APARTMENTS Q AGRIC.
Z
N Q
3-, --- COMMERCIAL INDUSTRIAL C,
COMMUNITY .
LTERATIONS
C
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NO. OF SUBMITTED PLANS — USE OF PERMIT
jCASE
NO.
-
C Z
NO. OF P IRKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING —
Q
ZONE r TBA(fKS: FRONT SIDE REAR
J m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK # OF FEET REQUIRED ON STREET
ORDINANCE
DATE-) —�� SIGNATURE OF LAND USE OFFICIA / - 203--
03 -t-
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET -_—
t-
W
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
t"
-
a
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
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DATE SIGNATURE OF ROAD DEPT. OFFICIAI
=
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SWIMMING POOLS PUBLIC
H I..:
SEWAGE DISPOSAL
Q
= C
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
HFLOOD CONTROL
f„ '
W AIR POLLUTION
W DIV OF HWY
c a YOUR PROPERTY MAY BE SUBJECT TO
—
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74
CANARY—FILE, PINK—APPLICANT