301842 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT e'nr lklTV ne oweoelnc I
F M A M A S Q N D
PERMIT NO.
30 1 84 21
-Now,vvvl—
1 yr ni v GnJIVG
77
COMMUNITY VALUATION
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
/TEE }} f./.
NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
USE O PER T
i r
F.C.
0/1
SQ. FT. @ YARD SPKLR SYSTEM
PERMIT
SQ. FT. @ MOBILEHOME SVC. BAR SINK
842
SQ. FT. @ POWER OUTLET ROOF DRAINS
MICROFILM FEE
SQ. FT. @ DRAINAGE PIPING
$
SQ. FT. @ DRINKING FOUNTAIN
BOOK PAGE PARCEL
SQ. FT. @ URINAL
MECHANICAL FEE
VALUATION $ ryc9 WATER PIPING
�d
NOTE: Not to be used as property tax valuation
USE
SWIM POOL, PVT
BACiF
FLOOR DRAIN
GRP
TYPE CK BY
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
JOT
VENT SYSTEM AN ❑ EVAP. COOL OOD
(yp
SIGN
WASHER (AUTO) (nmka00
APPLIANCE RYER
GARBAGE DISPOSAL
�Ca
s
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
PLAN CHECK FEE
LAUNDRY TRAY
$
AIR HANDLING UNIT CFM
PLAN NO.
IDLE METER
DATE INSPF¢YOR
KITCHEN SINK
cavi
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
DBL
POLE, TEMP/PERM
LAVATORY
OFFICE
No DER INVOLVED
HEATING SYSTEMORCED ElGRAVITY
lft'�
MPERES SERV ENT
QO
SHOWER
BOILER B.T.U.
DBL
�. SQ.FT. @ a
BATH TUB
STATE
SQ.FT. @ a
gD
WATER HEATER
CX>
Q.FT.RESID @ 11/4¢
SEWAGE DISPOSAL
STRONG MOTION
SQ.FT.GAR @ 1/4¢
5fHOUSE
SEWER
INSTRUMENTATION FEE
�
GAS PIPING
PERMIT FEE
DBL. TOTAL FEES MOB.HM.FEE MICRO FEE
�MECH. FEE
PERMIT FEE
SPL. CK. FEE CONST, FEE
CPO
EL FE _
PERMIT FEE
SMI FEE FEE
PL .FEE
F M A M A S Q N D
JOB ADDRESS I SP NO
OWNER
76
77
COMMUNITY VALUATION
DST '
OFFICE
/TEE }} f./.
78
M H PERMIT FEE
$
USE O PER T
i r
F.C.
0/1
SUP . TO PERMIT
PERMIT
N
01.
842
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESC 11 TION
MECHANICAL FEE
DBL
$
USE
ZONESET
BACiF
SIZE
GRP
TYPE CK BY
JOT
S
s
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKERNAL
DATE INSPF¢YOR
.40
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
No DER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
gD
,
$
OWNER/AGENTS SIGNATURE CONTRACTOR
STRONG MOTION
i -..—•'
INSTRUMENTATION FEE
�
SPECIAL NSP
$
ADDRESS A
s
DEMOLITON
FEE
R
REGISTRATION
'
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
TEL. NO.
AREA CODE TE
AREA CODE
..'LICENSE
u
CASH ❑CHECK O.❑N.C.❑
—�3 %
/
RECEIVED BY TREES REQUIRED
hI SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
O 20 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I H B AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE '
SEWAGE SYSTEM
T LL
p
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
(IM PFwIC ATI(1w11A1C1 IDAwlI'C I Dllwl ♦ TC l C
✓ - -� - ��.•�. .... ... v.. I .�
..�v�rrI�-� vl vl� ,rll LIr�LV ILLJ. �. VIv1r LIMl��_L rrllll IIIL LI'1 rrJ VI II IL J1I�IL vl
CALIF•.ORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
FORM 284-206 IRE V. 6-761 OF CALIFORNIA.