296571 (RPL)' FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a I
J I F I M A M J J A S O N D
PERMIT No.
296
OWNER
DATE MST I OFFICE
,i�4%} ��
COUNTY OF RIVERSIDE
77
COMMUNITY
VALU OrN�
$ fL�+�►
1ST
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
$
NO. PLUMBING FEES
USE OF PERMIT
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
j A
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ pr URINAL
VALUATION $ WATER PIPING
r�r lle
NOTE: Not to be used as property tax valuation
J.SWIM POOL, PVT
FLOOR DRAIN
C!
MICROFILM FEE
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
LEGAL DESCRIPTION
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
I
MECHANICAL FEE
APPLIANCE ❑ DRYER
$
GARBAGE DISPOSAL
ZONE
SET BACK LOT SIZE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
TYPEZ-5.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
_
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
BOND AMT.
COMPRESSOR HP
POLE, TEMP/PERM
FINAL DATE
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
JINSPECTOR
,37 ? ' ~�.w�
BOILER B.T.U.
SQ.FT. @ a
DBL
BATH TUB
NAME OF CONST. LENDER
BRANCH OFFICE
SQ. FT. @ a
WATER HEATER
SQ.FT.RESID @ 11/4a
SEWAGE DISPOSAL
DBL
$
SQ.FT.GAR @ 3/4a
CITY
HOUSE SEWER
Jero
GAS PIPING
STRONG MOTION
PERMIT FEE
PERMIT FEE
Qd,
PERMIT FEE
t90
DBL.
TOTAL FE��E((S
�2 do
IMOB.HM.FEEI
MICRO FEE
MEC H. FEE PL. CK. FEE
-
CONST. FEE
�� 2
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
400
J I F I M A M J J A S O N D
JOB ADDRESS I SP NO
I
OWNER
DATE MST I OFFICE
,i�4%} ��
76
77
COMMUNITY
VALU OrN�
$ fL�+�►
78-4f
M H PERMIT FEE
$
USE OF PERMIT
F.C.
supP. 10 PERMIT
PE MIT NO
j A
r�r lle
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
I
MECHANICAL FEE
DBL
$
USE IqO.
ZONE
SET BACK LOT SIZE
GRP
TYPEZ-5.
_
�}
I S / S �} R/C.
PLAN CHECK FEE
$
BOND AMT.
PLAN NO,
PLAN CHECKER
FINAL DATE
JINSPECTOR
,37 ? ' ~�.w�
t.
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
Jero
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CON
INSTRUMENTATION FEE
1,411vt
, I
AV . 4110. ed1G 1
'SPECIAL INSP
$
ADDRESS
ADDRESS
DEMOLITION-
FEE
„y f
REGISTRATION
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
60
FEES $
AlyTOTAL
TEL. NO. AREA
CODE
TEL. NO.
AREA CODE
LICENSE tt
CASH❑.too
CHEC O.❑❑N.C.
�
—V
RECEIVED BY TREES REQUIRED(-V,HIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
2>1WITH
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEMI
HEREBY AGREE THAT All WORK IN CONNECTION WITHTHIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
L.UNU'tINJA IIUN INSUKANCt 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 HAS DONE
FORM 284-206 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.