PMT15-02552 i
City of Menifee Permit No.: PMT15-02552
29714 HAUN RD.' Type: Residential Addition `
CCCF—I. MENIFEE, CA 92586
MENIFEE Date Issued: 08/20/2015
1
PERMIT
Site Address: 25275 BRIGGS RD, MENIFEE, CA 92585 Parcel Number: 327-420-008I�
Construction Cost: $0.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of HOURLY INSPECTION TO FINALIZE ACCESSORY STRUCTURE, ORIGINALLY PERMITTED WITH
Work: RIVERSIDE COUNTY PERMIT#409298
Owner Contractor
FRANK&LETICIA COTTO
25275 BRIGGS ROAD
MENIFEE, CA 92585
Applicant License Number:
FRANK&LETICIA COTTO
25275 BRIGGS ROAD
MENIFEE, CA 92585
Phone: 9513994790
Fee Description Qtv Amount
Inspections not specified 129 129.07
$156.07
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee. Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permil_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirely by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'1/www.Ieginfo.ca.agv1caIawhtmI.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read "
(This section need not be completed if the permit is for application and the information I have provided is correct. I aa•-, -„0101y
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws iwdring to building
constru 11autprize representatives of this 'ty or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I d i pfor the inspection pu o as.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become o v
subject to the workers'compensation provisions of Section 3700 of the Labor r perty Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES El NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
- FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law(Chapter 9 (commencing with HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IkEPOR�ING.
compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
r Wenifee
DATE O S PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL C:) MULTI-FAMILY ll> MOBILE HOME C:? POOL/SPA O SIGN
SUBTYPE: Cl ADDITION C%ALTERATION C, DEMOLITION ELECTRICAL 0 MECHANICAL
C NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
City of enife
PROJECT ADDRESS q p Suildin & a
ASSESSOR'S PARCEL NUMBER ,?jZ)- yZO LOT TRACT )'
OWNER NAME koAtt4 !iOOTT-U/
ADDRESS S27S SA�445 REP /10�L16� o� Ca. `7dS449ceived
PHONE 43/ 3917- �/79a EMAIL clor-To 6e 7 (Q ci ,.•r,,, /. c*"
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 4e4'ES C, NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP i
INVOICE PAIDAMOUNT Q,
AMOUNT ' 5� C,CASH O CHECK N '.i CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT C,CASH 0 CHECK 9 ''CREDITCARD VISA/MC
OWNER BUILDER VERIFIED -'YES ') NO DL NUMBER NOTARIZED LETTER " YES NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
a 5 iy,
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TIDING PERMIT
�F "-� -y rERAur•No _ DEPARTMENT. OF BUILDING & SAFETY b
COUNTY OF RIVERSIDH' FIELD °51•
LO 9 2 9 8 .�•:
CONSTRUCTION.-ESTIMATE f NO., ELECTRICAL FEES.'' NO. PLUMBING FEES '^
isT SO.Fr. YARD
r..._--.L�'�� n,:PGAOsA Rl1.P,•,'�-P'--".�..t..w--�^ ..•J - so:Fr @@ ' i�. ,
f M nite r$ UNITS CitL Bw o
MOBILEHOME SVC BAR SISNK' ' 50.FT. .RF DRAINS_POVER OUAf7.: _
50.FT. DRAINAGE P
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Ile-_-_�ESTPIATED CONSiRUCTN2N VALUATION - -.$- s,= WATER PIPING
'•a' t+iNOTE'.�Not tebe-Vial ai Propirly tix wluodon �.`� _ SWIM POOL. PVT FLOOR DRAIN
,.MECHANICAC'•FEES -" SWIM POOL, COMM WATER SOFTENER
��' •"-jDh SYSTEM �y'rry_:,.FAN _ !�EVAP.:000L;:.-`HOOD,- SIGN _ WASHER(Al/TORDISHI.
: F3
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e -50.:FT.RESL @ I%c SEWAGE DISPOSAL
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-
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; N_'r"fi?� �I �OTAL,H,IyES� ,;-- MOE.NAI.fYE ; iAIC11O fEE mmm- M OL_FEE.. CON31.FEE DECF. $W FEE Z {EF Flt)-E.-FEE
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T ll P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK ...,Iwa by,
_ .So—,WAN FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
1c J HEREBY AGREE THAI ALL WORK IN CONNECI ION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH I'
THE LAWS OF RNERSV; Cii)UNTY AND THE STALE OF CALIFORNIA.
I NER CR it THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPEOFICAHONi HAS DONE SOW '
1!Eol _ -- ACCORDANCEANGE With SECTION 55+1 OF THE BUSIN(.SS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA, `
:aid;_ �.,. - .. - -• -. - . . - _
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to No GPERA1
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BUILDING APPROV
ALS MECHANICAL APPROVALS
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ADDITIONAL IWRMATION
City of ManKeel,
Safety Dept-.-'AUG '2 1 2015
........ ...........
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LulAlIqG.-APPROVAL
...........
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FWAGE SYSTEM SIZE & LOCATION
P" I- Lin.
REAR-6F PROPERTY LINE
::ELECTRICAL APPROVALS
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PILI
270. �'U'quad;no Wl'n P/L
29.8 1
—30
STREET NAW
NOUCE 10 APPLICANT
In<onfownhy With the Pro-ont of Stare at CotifoMa Iahar Cade SSNian TOM.The appleom%hall hews an file at Ills wish the Riverside County
Geparlmem of Building and 5o1my D on5lkam of dmipnaled in VamE I or 11 below,ar,hall indicate Item III,IV,or V.Whichever i,applicable.
SEPI ATE OF APfANT
Ms.,-moA the aP,rsl block:
❑ k Certililene el Cannel m lelhinwre k..el by the Praa,ar al bid onrul U.N.,
❑ r-spy on INa ❑ C,trill '
❑ 11. CscNIic,'.d Worbn'Campenatian W-1.itwed by as admitted inwrer.
❑ Copy oa No ❑ Copy tubmined
❑ Ill. Th.cost of the wort 1.6 parlormed i,SIM or let,.
xw. I cndly shot in dip Poch mvne of the work]or which$his puma it hand.I shall tat employ any person in any home,w in w baceme
wbind 1.the Worker,'CempenpNan,leyn of Cnblarnla,1 line,eenpy Mal,in the weal I Is....wbiw to the workenr Cemp.Itw- Jclty of Menifee
Nnn prcwi im,al IM Who,Cede that I will comply Iorthwilh wilh the prwhlam of Labor Cade Section 3no.CI ant.,and undanmrel Building & SafetyDept.
The,.if I do no mmph.the pmmh shall be deemed revoked. Y
f. ❑ Y. I onily al the ownu to, tho .,an, 01 the owner) than in the psdamenn of the wmk for which this permit it awed
hate na.(C AUG 2 0 2015
v Co-6 Eisner,
ICmrba�m. hiw}rUie,F ubmll regd.ed by I o•N abo+e.)
= Appl¢anyt l5iynewr.fiy A.S ;r qL gyS_q—era
Ease /n-.30 -'13c) IlNo. 4n929�
Addis„and location where work is so be perlarmad ArI2 174" !3p?IG-.S /QDF Received
BVILOING PIRAW - ✓ -
w..ar rw DEPARTMENT OF BUILDING & SAFETY HEADQUARTERS cis
9298 COUNTY OF RIVERSIDE G
C STRUCTION ESTIMATE NO. ELECTRICAL FEES I NO.1 PLUMBING FEES
ISI IL 60.Fl.@ S UNITS
]ND.R. SG.FL @ nPO SN(1P srsrem
P09. 50.R. ® M moe"a E SVC I.SIN.
GAst, M.Fl. ® `5EE' Al 4m4DWwE9 GMft ROOF pP.WS
CM P. 50 Pi. I§ OPMNAG£PMNG
WMl dO.R. adncn GoW,deIN
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ES awl CGNSINCIIdE VAWAIYSI 5 wAIIR PIPING -
- NOT(: Nq to or oW at P."aaa wawfan SWIM KOI:Ni PLOOR OMIN
MECHANICAL FEES ..Pool.Co. w.rz.SONENu
yBR5151£M FaN Wo.COOL HXe, SWN ."HER IAUrONaVy -
A"Ehat F pNYER GA9eaGE DIiZ,
NAN.S"X UNR WAIL„ L= SUSHEN0£D UVNdy IR.LY
[AIN N,WOUNG VNp CM AnE wife, AIICNFN SINC
m CN SYSTEN '" L.Lu, TLm[NE F£RMII Sw[ ,.E.aostr,..5W. NP PEE.IE.11H.'s5y51FM MPCEG GRAVIN MFE.LS SEPV ENI Shown
HJR RI.V. $O f1 p BAIN IUS
Al£R N!A£FRse EI PWp h"' SEWAGE ORPOSAIIre Q Home SMER vwn me �- - W PI.INe p "Awe Pu Ipµ RfE NM xCrO TEE ✓.Ep 1E %p rFE COxSr sal F cl !FF IL alv,N
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r..-rer,ev.•.. �y -"_^'.. ..'Irr sECln�n S).x UI IN[9uSVlL55 irvn evOtfSLON:CODEM INF SInIF CI CnIITCL+Ia
y ` � ° 4"x^=1 at P�i..s Z - e _<�� ''.�n>iyr•.��\ti5�._ yµt >r •, i�p _�,�:�.�n> hb°a.ki�..LLJ,•pn.Ff�*5i
a ' DEPARTMENT F BUILDING-AND SAFETY
is y�q ai pp - City of Meni
n_ r COUN hl OF RIYERSiDE y Building & Safet kept.
OWNER-BUILDER VERIFMATION " AUG Z O .€J
/y:[;-,_ . �l�. 7/� .. -fie c 1 FJ
} �� �+t$Y•�s�ri,i:5w�Jv -/._l -/.�LG�%7a /�" ' ,4��,�'/f A.ull" C r� /�✓ y� }'
` ^ Y�Anr!'yowner bUi.I erl bullaing permit has been, applied for in your name and bearing
Yourignatur'e .V -
Xrr
� ease comple'te�andureturn this Information in the envelope provided at your
ryearflies�topporturiltyrto avoid unnece deTay. 9n,pracessing•and issuing your, {.
��buildinglper ,I; ,, No building-. permit ssary:w.ill,.U.a issue'd•6- .il.•this verification, s.. t
personally,plan .to provide the major labor and materials for con-.
1• C oDw{.y 'sCtnruction(fofl�the "proposed"'-property •improvement (ys.or no)
T p v \1�il�.S '��\���kli•F�i'J`Y( l r Y _ i- • \. ' r •. _ - J. -
" not) signed an application for building permit
-
a
_ *3I Have tracted;wlth the;followi.ng person (firm) to provide the pre-
"� u'VIV
+o"sedcansNaMtructzon:
"� r Addre 5 Yr2^ City ne
J L •`Ven:+ •ry 43+
µ r�Gohtr£aetors "L,icense' No. l
' t § �� fsun Say ,
4 I� lan toprovide 'portions of the Work,' but.I have hired the following
��pw2 �'pePson to coordinate; "'supervise, and provide the;major,work:
e— ,
- Phone,_._
ni. �C• K t M1JC +�NainMk /Y7�/ -
Y•. •• - L
„- -�•a `�v;n ---7; `,':Contrac ors - tense No.
-
L
. L°��'•,;2 �,�, i , 5 ,I 'will: rpr•ovide. sosrle of the work but.I have contracted (hired) the fnl-
1"dwing" persons. to"provide the work indicated:
rF, 8 " Ndme Address phone. . Type of work
_ ,J ,� I.e,_ 1/•�i��i' � �Gf/uf�..4'{.-� �(J `�� i(G ,i
S gnature Property Owner
oc al Security Number - f
284-2002 7/80
fit•.._ _.�_...... -- ._—____._.�.�—.........._._._._._.._�_<_,...�.._..._._
` ;4 4 r ce ast � u ty
4 'KlWi1 ICY�r+b -1
fee
PuNciing& SaSe Dept.
,
' Y M4! flr �4i DEPARTMENT OF BUILDING"AND SAfE1,Y AUG 2 0 2015
kr ' u COUNTY OF RIVERSIDEry
OWNER=BUILDER INFORMATION
N� Fecerved
F r r Dear. Property Owaerrr_l' s
r'An epplication.for a_6ui•ldinq permit has been submitted-in your nacre listing_Yourself as are builder
of_the . -•specifed.propertYim ravemnt "
..
.
,..; owners unless
protection.:you should,be_aware. that .as owner-builder.,you are the, responsible,party of re-
r cordon such a permit Building .perm its are not required to be signed_erformedrby someone other
is r�..'�.they=are personally per,:forming their own work, If your work is being per lies for the pro-
if..yourself, you may protect yourself from possible liability if that person app
per permit in his or her name, _
4s `Contractors are required,by law:to be licensed and bonded by the State of California and, where
'i" �reguired, fo ti�ave a business 'license from4£he city or county. 7hey.•are•also required,tij-1'aw to put
1 45 ;their`licensenurnber on all permits far which they apply.
ntl''YC'I + J, Cry - }f t.�::.'h:?.`•�'
ra 'Ifyou plan ,to doayour own work„ fitndd prbtection.
with the exception of various•trade that you plan to subcontract,
f you should be aware of the' following information for your bene a i
'.t"'r si. 't - •, 7if p-t. °+ tS:2 {i -FED%. } - i
r -�If you, employe otherwise_en gagefany persons other than your immedlate'family• and the work
(including'materals and other costs) is $200 or more for the entire protect, and such persons are . . i
'not licensed aspcontractors or subcontractors then you may bean employer
c,l ......... e eo.W-- al�obligaregister wi , M,fate andnfederalaincomertaxnw thholding, federal
�t Youyare su t
x ti 's1` son al security taxes, workers' compensation insurance, disability rns,urance costs, and.unemploy
u y merit compensation contributions'
be',financial:risks.'for-you if you do 'not.carry out these..obligations';'and these'risks
e i «There maY
�.,. " especially serious with respect. to workers' compensation insurance; )s Servicee,(and��ifcyouf`wishtitheaU�St' rnal
Smalt�Bu'sgnes4nAdministrateon) - Forcmore�speciftict the tinformationue
under -state. - i
s' _ about-your obligations, law, contact the Department of benefit Payments and the Division
of industrial°Accidents
property owners who are not licensed contractors are-allowed,
If the structure is intended for sale, prop Y,
to,:perform'their work"personally or through their own employees, without anlicensed contractor or i
,ubcontractor; oply:+underxlimi:ted conditions. j
er
that`the property owner; is providing his or her own
A frequent practice-of unlicensed persons professing to be contractors is to secure an "or her
builder',',ibuilding permit, rroneously imple'"9ts are not required .to..be, signd by property owners
I and material personally.,': Building p
unless theyLare performing,heir own work personally
Infonnation,abaut licensed contractors may be obtained by. contacting the Contractors' State License .4
Board[I -11 ;;yoOr'community or:at 1020 N Street, Sacramento, California 95814.
confirm
can
Please complete and return the enclosed owner-bdrwillinot be issued untilI so tion fornatheeverification ;Sat
youvarevaware, of.these matters,. The building permit
returned:
Sincerely,
DEPARTMENT OF, BUILDING AND SAFETY
r
eopo o Rojo, ar. „
Director i
284-2001 7/80
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CIVY of fee
Code-requires.. Idirid& Dipt.
permit.
AUG 20 015r�sI hereby` affirm that I am ticensed under prvasions of-LhapEer 9 (commencing 1
T, I
with Section 7000) of
1 s. i Division 3 of the.Business and Professions Code and my license is in full force and effect.
License
Class
License No.
Date on ra t.or
OWNER-BOLDER DECLARATION
lowing reasons,.
f the-fol
�.1 ' the Contractor's License Law forrhereby:affirm--that I am exempt ran
property,of the employees with wages as
as cwner� or my their sole compensation, will
for sale.* If I sell within one
i- .,'do:.the work-,46d the struEture is.not.intended oi:offered
proving I did not build or
completion, I understand I will have the burden of proV
Iyear.R.:comp -7031;5; B.&P-C.).
��,2 improve;farthe
Purpose of,sale,(5ec.
I as property,
-owner of-the pperty;.am exclusively contracting with
licenied contractors to
construct the projec t-(Sec: 7D44, 0:&P.C.).
B.&P.C. for this reason.:
1.am exempt uncer ec ion
Datel
"killbV'COM-PENSATION DECLARATION
have a Cer7tifiCite of consent to self-insure, or a Certificate of Workers'
,z ,- ,�.Compensaticn, nsurance or alcertif0d copy thereof"(Sn' 3800. Lab.-.Code).
-,�z .,
Insurance
-7777777��
by fUniShed.
r Ified copy.Is nere
rtment of Building and Safety.
Certified-copy is filed with the County of Riverside. Depa
Applicant
CERTIFICATE OF.EXEMPTION-FROM WORKERS' COMPENSATION INSURANCE
section need not be completeO t permit emit valuation is for $100.00 Or less
is issued, I shall_not employ
-performance:of-the work for which this permit
r.-so"as-to-become subject to the Workers' Compensation laws of California.
�ne Eand that Tf after making this:Certificate of Exemption, I should become subject to
tion provisions of the labcir code, I must forthwith comply with such provisions
I'be deemed revoked.
L Applicant
CONSTRUCTION LENDING AGENCY
-by affirm that there is a construction lending agency for the performance Of.the work for
l which this pbmit is issue&(Sec. 3097, Civ. Code).
ir's Name
Lender's Address--
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
.... ... hich-A person is
-excavation five-(S) or more feet-in depth-into I o
descend, will be made In connection with work authorized by this p6mit, and that no
r* q,i red.*to dedismantling
h building, structure, scaffolding,' falsNork, or demolition or dismantl inig thereof, will be
than thirty-six. (Chap 3.2, Grp 2, Art 2, See 341, Title 8, C.A.C.)
more (36) feet high.
anyone co work which would require a
not employ permit from the
As ownerwbuilder,.I will person has a permit to do such work
E Division of Industrial Safety, as noted above, unless such
from that division.
M. -Divtslon'of Ind
agree to.
- r• .I certify I Dave read this application and state that Lhe information given is.correct. 1
' -�'•• comply xith ell state laws and county ordinances relating to bui)dlrg construction, and authorize a
•' - representative of the County Of Riverside, Department of Building and Safety to enter upon e pro'
�: ' / p'er�y for, hich I%h�e�pplj��f�this permit for the purpose of making inspections.
Si
gilia ure 0 PP canV, gent ate
IAR41 J) 41
print Appli cant/mgent "011M
284-2000 7180
-
,dl,., L3Uildmg & a e y p8.
fin r�Avt4'-r��' _?�a✓ / Y I /\'_� .; I '' a � AUC� �>� �Q '
NOTICE THIS IS NOT.r..A�.. �gaILDING.PERMIT ` DISTRICT �f 7
APPLICATION'FO_CO STRUCT. _ -
iTi ��j � ,.� � :DEPARTMENT OF BUILDING AHD,:SAFETY - —Peml .'�o
'COUNTY OF RIYERSICJE
Oyrner� r Chltect Contractor_
Addre Address_ Address
r >
City .. CIIy..
1{s, q. It Phorie on
r
�(wel the and kgned hereby tel ly and x4 o Icdpe that I (we) hare.rcad the tw3untlicin and agree t,it if Curb and Gurley, and
ti t
r fi . C I Zh+t Pa hq end/o7 Oeo Cal on o/ rght of way s cR it d by the iCou�ytoeri ne R rn r the Rvchat County Odparlme t I hin g unty lets
I y S 3 shall not make a Fwl Inspca on until said reeuymen6 bout-bcrn r 1 am nl aware-Ihat work rs to be done thin Ih County R/W
- r F.�Oa ° Ihot!t an Ton M t" .- ._S: .•;-, ;
.c
INOW Ifterefq C,d s aq q d INaI I ( cl II not xcupy fa d Present and w111 n ! ca sa d properly to bo peeup ed:unl I I ( ch hu.c
tS` i I tempi ed rh all,is4 s of the CouMv of R c sdc`and the.Stole 61 CAlornla 9o5 crmnq said property. i'z -
sq Sa 1I t DATE 'U 7 �c' SIGNATURE OF OWNER AND/OR AGENT {�C�{,cLG1fJ " j
t ..
Ap
{tom �-.v.5ryt, S proval by m Sr9natum ( m menh the Following Depart -Ln}ed Befori
-.Must Be Obtained Pnoa to'.the Isswng of a Cortahu<tipn Permit
a (SPACE NO
1 j Nc, ,�y •„_ ° r yy1/: I 4USE OF STRUCTURE
v 708-ADDRESS l -7; �1 I aI
xaF'�'4' ll u„Ts a:• s 1 SINGLE FAMILY-�j,�—DUPLEX
-q>~ Y t S• LE DFSCRIPT ON OF RO ERTY o -a Jri - ,2.Y�
r'Xy` MOM
rc�r APAR TM EN 75.:.:�1 AGRIC
Ir A Y a t COMMERCIAL INDUSTRIAL r 4
iCOMMUNI CY ALTERATIONS
t .Sr NO' OP SUBMITTED PLANS t USEOF PERMIT. _
9T0 rZ - e NO OMP
N G: PACES REO!' - NO OF,BUILDINGS NOW E%(STING a
F�• y zna^isi'.�+ '.4 - ZONE _ _ SETSk". RONT... {L L .SIDE,-7/1 -SA-) REAR — -
;, A P'AZ m'T Y 5s GRADING PERMt,T REQUIRED?.`, , ,, so NO.Q LOT SIZE - f -
tr • p��''e rr rrs fl SETBACK`ORDINANCE 9 OF - FEET,REQUIRED ON _. STREE
yaws a Ir } DATE - SIGNATURE OF-LAND USE OFFICIAL�s—_c '
F '" DEDICATIOCJ- REQUIRED:_ YES ❑ NO C ,'NO. OF FEEL.
AND GUTTER-.REQUIRED: YES ❑ NO ❑ - STREET as
CURB AAD.GU7TER FEASIBLY BE. INSTALLED? 'YES ❑ NO ❑ - -
- _'HAS`AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
"xr '`[:' IMPROVEMENT>', YES.❑ NO.❑ - - - - - - -
DATE— - SIGNATURE OF ROAD' DEP.T: OFFICIAL -
r` i
_ '.SWIMMING-POOCS PUBLIC -
t .` 'S EWAGE DISPOSAL
Fui per'. - - _
S FOOD ESTABLISHMENT -
.. . . ..
WATER'POLLUTION - REMARKS
I FLOOD CONTROL'
V40 -
w . AIR;POLLUTIOH- 5
IV
YOUR PROPERTY'MAY BE SUBJECT TO
FLOOD. RIVERSIDE COUNTY ASSUMES: I
N0.RESP0NS1BIL1TyN EVENT OF FLOOD
9/74 CANARY FILE _
PINK APPLICANT -
i
I