272543 (SFD)BUILDING PERMIT
•
CON STRUCTION°ESTIMATE
1ST FL.
LI �%� SQ,FT. @ A r t
2ND FL.
SO. FT. @
POR.
SO. FT. p -3
GAR.
92-% SO. FT. @ S�sv
CAR P.
SO.FI. @
WALL
$O. FT. @
DRINKING FOUNTAIN
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
WATER PIPING d
MFC•HANIC'AI FFFC
DEF
Ml v i-�F BUILDING & SAFETY
COUNTY OF RIVERSIDE. . i
NO. ELECTRICAL FEES.,
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL. PVT.
SWIM POOI. COMM
FIELD OFFICE
VENT SYSTEM ❑ FAN
DST
f
OWNER
NO. PLUMBING FEES •
SIGN
CJf> p.ft n/ t� 1 tt
YARD SPKLR SYSTEM
WASHER (AUTO) IDtSHI
BAR SINK
00
ROOF DRAINS
! r4
DRAINAGE PIPING _
68
DRINKING FOUNTAIN
URINAL
GARBAGE DISPOSAL
WATER PIPING d
FLOOR DRAIN
'FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
WATFR SOFTFNFR
UNITS
VENT SYSTEM ❑ FAN
❑ EVAP. COOL JYHOOD
OWNER
0
SIGN
CJf> p.ft n/ t� 1 tt
75
WASHER (AUTO) IDtSHI
F.C. JDATE
00
APPLIANCE
! r4
.fir
68
M H PERMIT FEE
GARBAGE DISPOSAL
$
'FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
DST
UNITS
ROOMS
VALUATION
SU PP. TO PERMIT
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
I
KITCHEN SINK
L t�
ABSORPTION SYSTEM
0 B.T.U.
LEGAL DESCRIPTION �7
TEMP USE PERM SVC
WATER CLOSET
jI
li c
COMPRESSOR
HP
00
POLE, TEMP/PERM
DBL
$
LAVATORY
SET BACK
LOT SIZE ZONE
HEATING SYSTEM FORCED El GRAVITY
Cf%Jp
�f.)f) AMPERES SERV ENT
94?
CK' Y r
SHOWER
BOILER B.T.U.
tt�
SQ FT @ a
/
BATH TUB-
PLAN CHECK FEE
04)
$
BOND AMT.
PLAN NO.
SQ FT @ C
/ "7
INSP TOR
WATER HEATER
D o
O O
SO FT RESID @!X
y
SEWAGE DISPOSAL
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
�� QO SQ FT GARAGE @
HOUSE SEWER
PERMIT FEE
ELECTRICAL FEE
DBL
$
ADDRESS CITY
GAS PIPING
MOBILE HOME PERMIT FEE
I TOTAL
212'904' 31 /
J F M A M ) J A $ O N D
JOB ADDRESS/ % SP NO
�7u�!
OWNER
74
fil
CJf> p.ft n/ t� 1 tt
75
USE OF PERMIT
moi
F.C. JDATE
1 r� �1�.�
5 4 3
T M
76
u�/r'�# �7 •rt ��
M H PERMIT FEE
$
COMMUNITY,
DST
UNITS
ROOMS
VALUATION
SU PP. TO PERMIT
OFFICE
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION �7
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE No.
GRP
TYPE
CK' Y r
F .2Gi Ste/ � .y L'r
tt�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSP TOR
,41)o
O O
y
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE .
STRONG MOTION
INSTRUMENTATION FEE
$
�iyC�°_•.--i%D
OWNER/AGENT'S SIGNATURE i ! d'
CONTRACTOR
/
L/
FEE•
$
ADDRESS
''
Piz.
"7-J -' oj'-; ` Pi v1,4- l .4
,��
ADDRESS f i-'-.
•
PLUMBI NGFEE
DBL
$
CITY ZIP CODE
6
CITY ZIP CODE
sa
hl : 7" r
� � G
.' -
TOTAL FEES *I$
TEL. NO.
TEL. NO. LICENSE
CASH CHECK ❑ M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
RECEIVED BY
TREES REQUIRED t1f�N
`�
OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
SEWAGE SYSTEM,�'"x�d,,jj}}
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
T7 -/v
LL
P tbJlr
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) QP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
L OF THE STATE OF CALIFORNIA.