286461 (SFD)DEPARTMENT OF BUILDING & SAFETY -
FIELD 'OFFICE
BUILDING PERMIT
1 F I M A M J J A S O N
PERMIT NO,
6
76 FDg
COUN1 T Ui K!YCK3IUC
�I
DATE - /
”
'/D/T
DST
CONSTRUCTION ESTIMATE
M H PERMIT FEE
NO. ELECTRICAL FEES
$
NO. PLUMBING FEES
USE PERMIT
1ST FL.Z4M
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ gl $
UNITS
MICROFILM FEE
COPIES
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
dt,
SQ. FT. @ 'gip, POWER OUTLET ROOF DRAINS
DBL
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
ZONE
J.
SQ. FT. @ URINAL
LOT SIZEGR
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
PLAN CHECK FEE$
FLOOR DRAIN
MECHANICAL FEES
BOND AMT.
SWIM POOL, COMM
FINAL DATE IN
I -A ! 7.1
WATER 'SOFTENER
CONSTRUCTION FEE.
VENT SYSTEM FAN ❑ EVAP. COOL HOODSIGN
$
NAME OF CONST. LENDER BRANCH
WASHER (AUTO SH)
NO LENDER INVOLVED
APPLIANCE-RYER
a
$
31
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
STRONG MOTION
'INSTRUMENTATION FEE
$
LAUNDRY TRAY
OWNER/AGE. TS SI' Nf4 URE CONTRACTOR
�j
1
AIR HANDLING UNIT CFM
'SPECIAL INSP
DEMOLITION
REGISTRATION
IDLE METER '
FEE
KITCHEN SINK
00
ABSORPTION SYSTEM B.T.U.
0"NESS ADDRESS
R® I( / y3
♦ 6,y
TEMP USE PERM SVC
WATER CLOSET
PLUMBING FEE
COMPRESSOR . ® HP
$
POLE, TEMP/PERM
CITY ZIP CODE CITY
LAVATORY
C7Q
HEATING SYSTEM„,OkFORCED ❑ GRAVITY
0
AMPERES SERV ENTSHOWER
NO.
AREA CODE
�¢
BOILER B.T.U.
q PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME. VOID.
EREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
ITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
SQ.FT. @ a
LL
BATH TUB
SO. FT. @ ¢
WATER HEATER
Q.
y Q.FT.RESM @ 11/4a
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a
+
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
C�f�
PERMIT FEE
r%✓
DBL.
TOTAL FEES
A. _aj
MOB.H M.FEE
MICRO FEE
J
MECH. FEE
PL. EE`
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE6.
1 F I M A M J J A S O N
JOB ADDRESS SP NO
I
! e y
OWNER
�-
76 FDg
77
C MMUNITY VALUATION
�"6t3
DATE - /
”
'/D/T
OFFICE
78
M H PERMIT FEE
$
USE PERMIT
F.C.
SUP . TO ERMIT
PE MIT NQ
6
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRiF1hON a� n
�17
MECHANICAL FEE
DBL
$
USE NO.
ZONE
J.
SET BACK
LOT SIZEGR
TYPE CK BYY
PLAN CHECK FEE$
BOND AMT.
PLAN NO. PLAN -CHECKER
FINAL DATE IN
I -A ! 7.1
CTOR
CONSTRUCTION FEE.
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
31
ADDRESS CITY
�..
STATE
STRONG MOTION
'INSTRUMENTATION FEE
$
OWNER/AGE. TS SI' Nf4 URE CONTRACTOR
�j
1
'SPECIAL INSP
DEMOLITION
REGISTRATION
FEE
$
0"NESS ADDRESS
R® I( / y3
♦ 6,y
•
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
CASH❑CHECK O.❑N.C.❑ e0°+ y
+^ ''
TEL. NO. �AREACOOE.,
� /.-.z
TEL.
F
NO.
AREA CODE
LICENSE a
RECEIVED BY x, TREES REQUIRED
q PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME. VOID.
EREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
ITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
ISEWAGE SYSTEM p�
S
LL
P J
X
•. + COMPENSA I ION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THEINDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-78) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.