301830 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT ! r.^1IkIrw „e slvEnrime A
•
PERMIT NO.
0183
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COMMUNITY
-
DST
�I
CONSTRUCTION ESTIMATE
I OFFICE
NO. ELECTRICAL FEES
LZ
NO: PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ / $
UNITS
M H PERMIT FEE
$
SQ. FT. @ YARD SPKLR SYSTEM
USE OF PERMIT
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SUPP. TO PERMIT PERMIT NO,
SQ. FT. @ ./ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING, FOUNTAIN
Dw4r t3
SQ. FT. @ URINAL
' 30
VALUATION $ WATER PIPING
MICROFILM FEE
NOTE' -.Not to be used as property tax valuation
$
SWIM POOL, PVT
BOOK WAGE PARCEL
FLOOR DRAIN
MECHANICAL FEES
ISWIM POOL, COMM
WATER SOFTENER
DBL
$
VENT SYSTEM AN ❑ EVAP. COOL ' OOD
4 "3,
SIGN
TYPE G/IKK By
WASHER (AUTO)(
�
APPLIANCE RYER
+EfD
I S S -5- R 3
F./'�✓
GARBAGE DISPOSAL
G?
$
FURNACE [IUNIT [IWALL ❑ FLOOR El SUSPENDED
BOND AMT.
PLAN NO.
PLAN CHECKER
LAUNDRY TRAY
INSPESi OR
AIR HANDLING UNIT -1 CFM
IDLE METER
KITCHEN SINK
®p
ABSORPTION SYSTEM 0 B.T.U.
CONSTRUCTION FEE
TEMP USE PERM SVC
$
WATER CLOSET
G17.
BRANCH OFFICE
COMPRESSOR HP
RC2
POLE, TEMP/PERM
1/
LAVATORY
eaP3
HEATING SYSTEM ORCED ❑ GRAVITY
yld
AMPERES SERV ENT
Y ��
SHOWER
ADDRESS -
CITY
BOILER B.T.U.
SQ. FT. @ a
BATH TUB
r✓�
SQ.FT. @ a
WATER HEATER
CIO
STRONG MOTION
FT.RESID @ 1.1/na
$
SEWAGE DISPOSAL
OWNER/AGENTS' SIGNATURE
CONTR TO j;,�- -%f P
£,✓ . v- 4�
•INSTRUMENTATION FEE
SQ.FT.GAR @ 3/44
HOUSE SEWER
'SPECIALINSP
$
GAS PIPING
ADDRESS
ADDRESS
PERMIT FEE
FEE
PERMIT FEE
a.)p.
PERMIT FEET
'
DBL.TOTAL
FEES
MOB.HM.FEE
MICRO FEE
ME . FEE
2tl
' 0
L. CK. FEE
-,
CONST. FEE
. wo,
ELECT. FEE
SMI FEE
S
- FEE
UB.
PLFEE
r oe
1 F I M A M J J A S O N D
JOB ADDRESS I SP NO
'`fq f. 1
&3e
OWNER
[- O
t-
_t
77
COMMUNITY
VALUATION
DATEE�
DSf
I OFFICE
LZ
M H PERMIT FEE
$
USE OF PERMIT
F.C.
SUPP. TO PERMIT PERMIT NO,
Dw4r t3
' 30
MICROFILM FEE
COPIES
$
BOOK WAGE PARCEL
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONIff ET BACK LOT SIZEGRP
TYPE G/IKK By
I S S -5- R 3
F./'�✓
(PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPESi OR
CONSTRUCTION FEE
DBL
$
.NAME OF CONST. LENDER
BRANCH OFFICE
NO DER INVOLVED
1/
:ELECTRICAL FEE
DBL
$
ADDRESS -
CITY
STATE
rf
STRONG MOTION
$
OWNER/AGENTS' SIGNATURE
CONTR TO j;,�- -%f P
£,✓ . v- 4�
•INSTRUMENTATION FEE
'SPECIALINSP
$
ADDRESS
ADDRESS
(DEMOLITION
FEE
�l
REGISTRATION
I
-
e d7.
'PLUMBING FEE
DBL
$ - - •
CITY ZIP CODE
CITY ZIP CODE
3V
:.
de
?•
TOTAL FEES is
TEL. NO.
AREA CODE
TEL. NOr AREA CODE
LICENSE n�]
CASH ❑CHECK O.❑N.C.❑
files/`')RECEIVED
BY TREES REQUIRED
MIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
R 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
VORAGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE ¢
SEWAGE SYSTEM
/BY
l
T
11
P
HE' LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
ATI(lwl Iwl[1 IDAwl!'c i ori.
-FORM 264.208 (REV. 6-76)
\ LVICCJ. t-:L/IV\r LIAIV LC Y111n 1 n LAWJ V[ Inc JIAI C LJr
CALIFORNIA 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
OF CALIFORNIA.