290995 (BLCK)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY i
FIELD OFFICE
J F M A M J J A S Q N D
PERMIT NO.
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DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
Si SQ. FT. @ $ UNITS
ND• SQ. FT. @ YARD SPKLR SYSTEM
POP; SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
=CAR P. SQ. FT. @ DRAINAGE PIPING
WALL, SQ. FT. @ DRINKING FOUNTAIN
SQ -FT. @ URINAL
ESTIMATED CONSTRUCTION'VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
DATE
MECHANICAL FEES SWIM POOL, COMM I IWATER SOFTENER
OFFICE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
,±
A PLIANCE ❑ DRYER GARBAGE DISPOSAL
$
%RNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
USE OF PERMIT Sit^
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
SUPP. YO PERM
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
NO.
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ a BATH TUB
SQ. FT. @ ¢ WATER HEATER
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SQ.FT.RESID @ 1114a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a HOUSE SEWER
GAS PIPING
PERMIT FEE '' , PERMIT FEE PERMIT FEE
.MICROFILM FEE
DBL,
TOTAL FEE
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MOB.HM.FEE
v
MICRO FEE MECH. FEE PL. GK. FEE
CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. FEE
J F M A M J J A S Q N D
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COM/MU�N/ITYY .
VALUATION
DATE
DST
OFFICE
'78
M H PERMIT FEE
$
USE OF PERMIT Sit^
F.C.
SUPP. YO PERM
PE MIT
NO.
61170 � �/x�n z' r� lr , I
.MICROFILM FEE
COPIES
$
BOOK�y PAGE PARCEL
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
&I
GRP TYPE
�CK BY
/
SS
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHE� KER
FINAL!�TE
INSPECTOR
CONSTRUCTION FEE '
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDERINVOLVED
'ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OW$rRlA3GNM SIGNATURE r Fi CONTRACTOR
✓y i
INSTRUMENTATION FEE
�-+
'SPECIAL INSP
DEMOLITIONPFEE
$
ADDRESS r ADDRESS
/_p� .tA%�r`�
REGISTRATION
f /
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
A�
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TEL... ) AREA
CODE TEL.
NO.
AREA CODE
LICENSE a
CASH HECK❑O.❑N.C.❑
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RECEIVED BYTR ES REQUIRE
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I. EWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO 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 HAS DONE
FORM 284-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.