301838 (SFD)DEPARTMENT OF BUILDING,& SAFETY
BUILDING PERMIT a- SI
FIELD OFFICE -
J F M A M J J A S O N D
PERMIT
-30l
NO.
8381
11 -mum 1'1 Or RI V CRiIUC
R76
,77
DST
CONSTRUCTION ESTIMATE
78
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
,..
UNITS
t c
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @' POWER OUTLET ROOF DRAINS
SQ.'FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
MICROFILM FEE
SQ. FT. @ URINAL
$
VALUATION $ . 7a d? WATER PIPING
PAGE EL
NOTE: Not to be used as property tax valuation ✓
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
MECHANICAL FEE
VENT SYSTEM FAN ❑ EVAP. COOL HOOD
<1,00
. SIGN
USE 96.
WASHER(AUT.0)(
�y
TYPE
APPLIANCE DRY
GARBAGE DISPOSAL
113RP
�J
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
�.
i
LAUNDRY TRAY
AIR HANDLING UNIT CFM
S S
IDLE METER
KITCHEN SINK
-PLAN CHECK FEE
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
PLAN NO.PLAN
WATER CLOSET
lob
INS$E TOR '
COMPRESSOR :L. 0 HP
^`
POLE, TEMP/PERMj
ILAVATORY
HEATING SYSTEM FORCED ❑ GRAVITY
AMPERES SERV ENT -
DBL
SHOWER
NAME OF CONST. LENDER f
BOILER B.T.U.
NO LE ER INVOLVED
SQ.FT. @ a
BATH TUB
SQ.FT. @ a
DBL.
WATER HEATER
ADDRESS
CITY
STATE
.FT.RESID @ 11/aa
SEWAGE DISPOSAL
4010
SQ.FT.GAR @ 3/441
HOUSE SEWER
STRONG MOTION
GAS PIPING
OWNER/AGENTS SIGNATURE
PERMIT FEE
,INSTRUMENTATION FEE
PERMIT FEE
PERMIT FEE
DBL,
I TOTAL FEES
MOB.HM.FEE
MICRO FEE
ME H. FEE
PL. CK. FEE
I CONST. FEE
ELECT.FEE
SMI FEE
FEE
PL MB. FEEEE �y
J F M A M J J A S O N D
JOB ADDRESS SP NO
I
&
OWNER
R76
,77
COMMUNITY. VALUATI•
$
E "'�'"� DST OFFICE
l f f
SUPP. TO PERMIT PERMIT NO.
78
M H PERMIT FEE
$USE
OF PERMIT `
F.C.
•
t c
AIA 1.4'
301831
MICROFILM FEE
COPIES
$
PAGE EL
AL DESCRIPTION
MECHANICAL FEE
DBL
$
USE 96.
ZONESET BACK LOT SIZE
TYPE
CK BY
-'540I
113RP
�J
3j
�.
i
S S
i
-PLAN CHECK FEE
$
BOND AMT.
PLAN NO.PLAN
CHECKER
FINAL DATE
INS$E TOR '
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER f
BRANCH OFFICE
NO LE ER INVOLVED
ELECTRICAL FEE -
DBL.
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONTRACTOR
,INSTRUMENTATION FEE
SPECIALINSP
$
ADDRESS
ADDR SS
DEMOLITION
REGISTRATION
FEE
f
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
�
t y
i/y�
L ✓
TOTAL FEES $
TEL. NO.
AREA CODE
EL. O.
AREA COD
LICENSE a
CASH 0CHECK `.O.0N.C.- L.✓
�
00
;RECEIVED BY ' TREES REQUIRED
IS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
W DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
HE REE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WS OF "
SEWAGE SYSTEM
/
T.
LL
p
RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
DF"l z A TIllwl 1-C"BAll
��•'••�•'"••••�•��•+••���.-vr vl�IY,ILIY�IVILLJ.L-VIYIrLIH1Vl..0 YYIIfI IfIC•LHYVJ-Vf 4flC JIHIC Vr -
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-20e (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.