341119 (SFD)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY A -11k FIELD OFFICE
PERMIT NO.
341119
PERMIT No.
34111
Job Address Space Zip
3 l ats- -
COUNTY OF RIVERSIDE
Owner
-
DST
CONSTRUCTiON'ESTIMATE
NO. ELECTRICAL FEES
- •
NO. PLUMBING FEES
Dist.
1 ST FL.. SQ.
2ND.FL.
POR.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. Q $
UNITS
YARD SPKLR SYSTEM
SQ._FT. @ '
Micro Film Fee
SQ. FT. ,�_ MOBILEHOME SVC. BAR SINK
Use of Permit
L lar r/
POWER OUTLET ROOF DRAINS
FT. Q
Parcel No.
F.T. DRAINAGE PIPING
Use No.
DRINKING FOUNTAIN
FT. Q
k.by
SQ. FT. Ca3 URINAL
sl. Ck. Fee $
VALUATION It WATER PIPING
Lot Sae
. NOTE: Not to be used as property tax valuation r.
SWIM POOL, PVT
Legal Description /� ..
J
f� �.% �• �J G. `.� ,�, f 4�
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
Electrical Fee Dbl $
WI Fee $ /
WATER SOFTENER
Grp
-
VENT SYSTEM ❑ FAN ❑ EVAP. COOL • ❑ HOOD
SIGN
Plumbing Fee
WASHER IAUTOIIDISHI
s
Pion No.
APPLIANCE ❑ DRYER
Final Date Imp
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
ip. Insp. Fee $
)emol. Fee
LAUNDRY TRAY
Const. Lender Branch
- -
Aclrens 'City Zip
"I certify that in the performance of the
not employ any person in any manner so as
pensation laws of California."
Owner Signoture
Builder Signature
AIR HANDLING UNIT CFM
IDLE METER
tegisir. Fee $
KITCHEN SINK
Witness Fee $
teinsp. Fee
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
Zip
COMPRESSOR 0 HP
POLE, TEMP/PERM
Address -
'.
LAVATORY
City
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
_,%
SHOWER
Tel.
BOILER B.T.U.
SQ. FT. p ¢
BATH TUB
,ewage System -
Address.
SQ. FT. Lai ¢
- Zip
WATER HEATER
SQ: FT. RESID p 1 Ac
SEWAGE DISPOSAL
SQ. FT. GAR C '/.¢
HOUSE SEWER
GAS PIPING
PERMIT.FEE
PERMIT FEE
PERMIT FEE
D L,
♦ TOTAL FEES
, M08. HM. FEE
'MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
PERMIT NO.
341119
Supp. Permit
�=6 e,
Job Address Space Zip
3 l ats- -
Owner
-
Ile&
Community -
.,/ !�/1�1fa
Valuation
$
Date /) ~ � O
Dist.
Off.
F.C.
MH Permit Fee $
Micro Film Fee
Cop $
Use of Permit
L lar r/
Parcel No.
Use No.
k.by
Mech. Fee Dbl $
sl. Ck. Fee $
Set acks
Lot Sae
=onstruction Fee Dbl $
Legal Description /� ..
J
f� �.% �• �J G. `.� ,�, f 4�
�_
S
Electrical Fee Dbl $
WI Fee $ /
Zon�ej
1. '
Grp
Type
Unit
Plumbing Fee
Dbl $
Bond Amt.
$
Pion No.
Plan Checker
Final Date Imp
ip. Insp. Fee $
)emol. Fee
$
Const. Lender Branch
- -
Aclrens 'City Zip
"I certify that in the performance of the
not employ any person in any manner so as
pensation laws of California."
Owner Signoture
Builder Signature
work for which this permit is issued
to become subject to the workmen's.
I shall
com-
tegisir. Fee $
Mileage Fee $
Witness Fee $
teinsp. Fee
$
Owner/Ahent
Tel.
Zip
'otol Fees $
M.O. ❑ N.C. ❑ Cash ❑ Check
Address -
'.
City
Zip
Received by
_,%
Contractor
Tel.
License 4
frees required
,ewage System -
Address.
City
- Zip
Workers' Comp.
yes ❑ no ❑
T LL P
{ewer District ^
corm 284.208 (Rev. 477) Oo s
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.
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RIVWSIDE COUNTY AND THE STATE OF CALIFORNIA.
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.
venhed by: