SFD (272656)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
Ashk COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
Ci � "MOBILEHOME SVC.
'3 U POWER OUTLET
SWIM POOL, PVT
SWIM Pnni (Y1MM
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
%A/GTFR Ch FTFNFD
DST
VENT SYSTEM ❑ FAN
CONSTRUCTION ESTIMATE '
I ST FL. 1,12--,161
SQ.FT. @4/2
2ND FL.
SO. FT. @
POR. &rv"O
'•.
SQ. FT. @ c✓ �- `
GAR.
SQ. SQ. FT. @
CARP.
SOFT. @
WALLSO.
FT. @
SQ. FT. @ '
2656
ESTIMATED CONSTRUCTION
VALUATION $�
NOTE: Not to be used CIS property tox valuotion
MF("HANI('AI FF'FC
NO. ELECTRICAL FEES
UNITS
Ci � "MOBILEHOME SVC.
'3 U POWER OUTLET
SWIM POOL, PVT
SWIM Pnni (Y1MM
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
%A/GTFR Ch FTFNFD
DST
VENT SYSTEM ❑ FAN
❑ EVAP. COOL Z HOOD
z0
u
SIGN
iii" f 1�1 S� �rJ f
WASHER (AUTO) (&M M
APPLIANCE
0,
•,,77✓J'
k�f/n�)'.'7 �Cf
JDATE�r^�'"�
2656
M H PERMIT FEE
GARBAGE DISPOSAL
$
FURNACE ❑ UNIT ❑ WALL ❑ FLOORj0 SUSPENDED
DST
UN Is
ROOMS
VALUATION
SUPP. TO PER
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
i,-,
11
IDLE METER
I
0
KITCHEN SINK
t
ABSORPTION SYSTEM
B.T.U.
LEGAL DESCRIPTION74
TEMP USE PERM SVC
WATER CLOSET
MECHANICAL FEE
COMPRESSOR
HP
%tj
POLE, TEMP/PERM
- C
LAVATORY
TYPE
CK BY
HEATING SYSTEM E]. FORCED ❑ GRAVITY
�,i
I)o
AMPERES SERV ENT
a-;
SHOWER
!J
BOILER B.T.U.
PLAN CHECK FEE
SQ FT @ ¢
BOND AMT.
BATH TUB
PLAN CHECKERFINAL
J
SQ FT C@ / a
/
WATER HEATER
CONSTRUCTION FEE
DBL
$
SQ FT RESID I(y }FrA
OFFICE
NO LENDER INVOLVED
SEWAGE DISPOSAL
SQ FT GARAGE 'q;oc
�� (j
$
HOUSE SEWER
ADDRESS CITY
PERMIT FEE
')
r; 41
3r�
/
qv 1 .f t
GAS PIPING
STRONG MOTION
MOBILE HOME PERMIT FEE Is I I % PERMIT FEE' j PERMIT FEE
_URIT NO. TOTAL FEES 'JMOB. HM.FEE MICRq.FEE MECH. FEE DBL. PL. CK. FEE CONST. FEE I DBL. ELECT. FEE DBL. SMI FEE _ FEE PLUMB. 36.0
27265d/75;'
J I F I M I A I M I J J A 1 $ 1 O N I D
LOB ADDRESS SP NO
OWNER
74512-`12-/
,4,' F%
iii" f 1�1 S� �rJ f
PERMITSE OF
u���I
PEI`
76
•,,77✓J'
k�f/n�)'.'7 �Cf
JDATE�r^�'"�
2656
M H PERMIT FEE
$
COMMUNITY !
DST
UN Is
ROOMS
VALUATION
SUPP. TO PER
OFFICE
i,-,
11
I
I ?l X6
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION74
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONEUSE
1p-/
NO.
l
GRP
TYPE
CK BY
"7015 - -
,7
0
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKERFINAL
DATE IINSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE/
')
r; 41
3r�
/
qv 1 .f t
'/
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONfR L..�',-*�
Yk--
INSTRUMENTATION FEE
C
%1
CoL
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
TEL. NO.
TEL. NO. LICENSE
CASH ❑ 5HECK;8 M.O. ❑ N.C. ❑"If
,rS THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 1120 DAYS. CESSA
�!' TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY 1
TREES REQUIRED f
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
SEWAGE SYSTEM
n �' n
/ %! 1
F/
Ll
P"
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (ReY. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE .
1 OF THE STATE OF CALIFORNIA.