SFD (290778)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT _ .__ _ __
'
J F M A M J J A S O N D
PERMIT NO.
OWNER
s.VUIVI T Or KIVtKblUt
_I
COMMUNITY
VALUATION
1
DST
CONSTRUCTION ESTIMATE
OFF
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CARP.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. 3,
26.7
UNITS
$
SQ. FT. @ YARD SPKLR SYSTEM
F.C.
SQ. FT. @ A� MOBILEHOME SVC. BAR SINK
PERMIT NO.
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ - WATER PIPING
e7>q
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
MECHANICAL FEE
FLOOR DRAIN
$
MECHANICAL FEES
ZONE
SWIM POOL, COMM
LOT SIZE
WATER SOFTENER
TYPE
CK BY
VENT SYSTEM ❑ FAN ❑ EVAP. COOLw
_ACOD
SIGN
WASHER (AUTO) ISH)
!a
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
S✓
S
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
xso
+'� '
LAUNDRY TRAY
1-10
r
AIR HANDLING UNIT CFM
IDLE METER
PLAN NO.
KITCHEN SINK
430
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
=WATER CLOSET
D
COMPRESSOR HP-
S
POLE, TEMP/PERM
DBL
2 LAVATORY
CJCJ
NAME OF CONST. LENDER BRANCH
HEATING SYSTEM RCED ❑ GRAVITY
dX�
MPERES SERV ENT
SHOWER
/ 0�
BOILER B.T.U.
SQ.FT. @ a
DBL
BATH TUB
og
ADDRESS CITY
STATE
SQ.FT. @ a
WATER HEATER
Q.FT.RESID @ 11/aa
V
SEWAGE DISPOSAL
OWNER/AGENTS SIGNATURE CONTRACTOh-
.�
INSTRUMENTATION FEE
W,KAQ.FT.GAR @ ¢/4¢
HOUSE SEWER
i•
SPECIALINSP
$
GAS PIPING
Dc!
PERMIT FEE
Gh'i
FEE
PERMIT FEE
PERMIT FEE
40.47
"> i 4�0
OBL.
TOTAL FEES
J1
MOB.HJ.I.FEE
MICRO FEE
MEC.. FEE
/j
P L. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE PLU14T3. FEE
'
J F M A M J J A S O N D
JOB ADDRESS I SP NO
-� t Avg 1p 6
OWNER
76
77
COMMUNITY
VALUATION
1
DATE
DST
OFF
78
M H PERMIT FEE
$
USE OF EERjM�Ij
F.C.
SUPP. O PERMIT
PERMIT NO.
1290778MICROFILM
FEE
COPIES
$
�BOOK PAGE PARCEL LEGAL DESCRIP��TIyON
MECHANICAL FEE
DBL
$
USE NO.
ZONE
ET BACK
LOT SIZE
GR/�P7
TYPE
CK BY
I !
I �
S✓
S
R
xso
+'� '
PLAN CHECK FEE
r
$
BOND AMT.
PLAN NO.
PLAN CHECKERFINAL
DATE INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NOLENDERINVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOh-
.�
INSTRUMENTATION FEE
i•
SPECIALINSP
$
ADDRESS ADDRESS
DEMOLITON
REGISTRATION
[�
FEE
"> i 4�0
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
}
/
' TOTAL FEES $
TEL. NO. AREA
CODE TEL.
NO.
AREA CODE
LICENSE 4
CASH ❑CHECK O❑
.N.C.❑
f
ZA4
'RECEIVED BY% TREES REQUIRED
'
P SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
OR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I h BY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
�k.EWAGE SYSTEM
&�I.neeocwlc4Tv
T
LL
P
I THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO.CARRY
.,c, ..-..-•^-'--- ATEO.. .___RNIA, - - . - -
w4cca. l- mru AFVt_c wnn ImE LAWS Ur Irit DIAIt Vr
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-761
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.