268933 (SFD) FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING&SAFETY IIIIIIIIIIIIIII
COUNTY OF RIVERSIDEIIIIIIIIII gg
0 IE
DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING S` //
I$T FL. a a SQ.FT. 011' UNITS
2ND FL. SQ.FT. @ YARD SPKLR SYSTEM
POR. �"� SO.FT. ex
MOBILEHOME SVC. BAR SINK
GAR, SO.FT. @f2 +% POWER OUTLET ROOF DRAINS
CAR P. SOFT. @ DRAINAGE PIPING
WALLSO.FT. @ DRINKING FOUNTAIN
___dSQ.FT. @ URINAL
ESTIMATED CONSTRUCTION VALUATION $ a ^^*^ �/ WATER PIPING
NOTE:Not to be used as property tax voluation SWIM POOL,PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL,COMM WATER SOFTENER
VENT SYSTEO?t FAN O EVA P. COOL HOOD 4D SIGN WASHER IAUTU#TDISHI o f~?
APPLIANCE 11V GARBAGE DISPOSAL
FURNACE Cl UNIT ❑WALL O FLO O SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK (�
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE,TEMP/PERM LAVATORY C�
HEATING SYSTEM FORCED ❑ GRAVITY OV,,"a0l AMPERES SERV ENT v a% SHOWER
BOILER� B.T.U. SQ FT @ a BATH TUB
SQ FT @ ¢ WATER HEATER
t/�f SQ FT RESID @ SEWAGE DISPOSAL f Fj
�. —SQ FT GARAGE @ V,¢ HOUSE SEWER
PERMIT FEE U GAS PIPING
MOBILE HOME PERMIT FEE Is I , PERMIT FEE • PERMIT FEE G7
ER IT O. ` � FEFf$f MOB.HM.FEE MICRO FEE r + CH.,EEk DBL. .CK.FES ST.FEE DBL T.F15 BL. �SM� FEE PLU B.FEE DBL.
2 3 (��h `ski
*sal' J"YC
JOB ADDRESS SP NO OWNER
J F M A M J J A S O N D
74
75 USE OF PERMIT F.C. DATE PE2'808
IT O.
76 � . - - , 8933
M H PERMIT FEE $ COMMUNITY DST f UNITS I ROOMS VALUATION ISUPP.TOIERMIT OFFICE
MICROFILM FEE COPIES $ LEGAL DESCRIPTION
-
MECHANICAL FEE DBL $ SETBACK �^7 LOT SIZE �ZONE USE NO. GRP TYPE CK.BY
—4 ffBONDAMT.
4 A ?�S•i-
PLAN CHECK FEE $ PLAN NO. PLAN CHECKER FINAL DATE OR
� c' o /(9-/9jr7� _0W
CONSTRUCTION FEE DBL $ NAME OF CONST.LENDER BRANCH OFFICE NO LENDER INVOLVED
f d a
ELECTRICAL FEE DBL $ ADDRESS CITY STATE
STRONG MOTION $ OWNER/AGENT'S SIGNATURE CON RACTA l�
y
INSTRUMENTATION FEE
�+. ✓ 1�L.�J�?7O /f7/f'� ..✓-•�` if
$ ADDRESS ADDRESS -�
FEE
PLUMBING FEE DBL $ CITY ZIP CODE CITY ZIP CODE
f _ r+
z-) 0-7fad (,• ��
f TEL.NO. TEL.NO... LICENSE
TOTAL FEES (G , ��•/
CASH ❑ CHECK M.O. O N.C. O J/ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.CESSA-
RECEIVED B .s TREES REQUIRED 0 / TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
kvuI HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC-
SEWAGE SYSTEM CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
T LL P AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74)OL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.