290116 (BLCK)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
FIELD OFFICE
J F M A M J J A S O N D
' PERMIT NO.
29011-0
\-VVI\I 1 Vr RIYCR7IVL
DST
[it
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
M H PERMIT FEE
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
$
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
USE Or PER IT
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
SUPP. TO PERMIT
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
ff
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER OB.T.U. SQ.FT. @ a BATH TUB
SQ. FT. @ a WATER HEATER
MICROFILM FEE
SQ.FT.RESID @ 111/4a SEWAGE DISPOSAL
$
SQ.FT.GAR @ 3/4a HOUSE SEWER
BOOK PAGE PARCEL
LEGAL DESCRIPTION
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE
DBL.
r TOTAL F=S
7OB.HM.FEE
MICRO F E MECH. FEE PL. CK. FEE -
CONST.FEE ELECT. FEE SMI FEE
t
FEE PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
7 �G �/
OWNER '
It/
^76
.77
COMMUNITY
VALUATION h
$ 3j 5'b, --1-^'
DATE �y
�
DST
T/, OFFICE
78
/
$
`!
M H PERMIT FEE
$
USE Or PER IT
F.C.
SUPP. TO PERMIT
PERMIT NO.
ff
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE,NO.
ZONE
SET BACK
L T SIZE GRP
TYPE
C BY
I
IR
'PLAN
S
CHECK FEE$
-
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL D"/ �\
INSPECTOR
CONSTRUCTION FEE
DBL
$.
NAME OF CONST. LENDER. BRANCH
OFFKrE
NO LEND R INVOLVED
z'0
/
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
CONTRACTOR
INSTRUMENTATION FEE
F .
[1015RE�i§ gR�ENTS SIGNATURE
'SPECIAL INSP
$
" . I ADDRESS
DEMOLITION
FEE
4..,� ;
REGISTRATION
s�'t+. jZr4(4
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
E, ^ it
TOTAL FEESTEL.
NO. AREA
CODE TEL.
NO,
AREA CODE
LICENSE ss
CASH ❑CHECK O.❑N.C.❑$ AvRECEIVED
BY BY i TREES REQUIRE
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 1420 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
♦SEWAGE SYSTEMI
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P'
WITH THE LAWS C)F'RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
('rIAA DG wIC ATl/l .—.I w II I
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.