297051 (BLCK)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING $ SAFETY
,
J F M A M J J A 'S O N D
-"� PERMIT NO
5
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76
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST Fl.-
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT.' @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. ,n 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)
USEOFPERMIT
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
SUPP: TO PERMIT
FURNACE ❑ UNIT [:)WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ 4 BATH TUB
SQ.FT. @ 4 WATER HEATER
SQ.FT.RESID @ 11/44 SEWAGE DISPOSAL
SQ.FT.GAR @ 3/44 HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE
DBL.
- TOTAL FEES
MOE.HM.FEE
MICRO FEE MECH. FEE PL. CK. FEE
I CONST. FEE 1 ELECT. FEE SMI FEE
FEE PLUMB. FEE
J F M A M J J A 'S O N D
JOB ADDRESS SP NO
J1 ♦ I
7 411
OWNER -
76
77
COMMUNITY VALUATIOLN01
DATE
DST
OFFICE
M H PERMIT FEE �.
$
USEOFPERMIT
F.C.
SUPP: TO PERMIT
PE MIT NlQl
p
97-051
MICROFILM FEE
COPIES
$
BOOK PAGEPARCEL
LEGAL DESCRIPTI N
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MECHANICAL FEE
DBL
$
USE NO.
SET BACK
LOT SIZE
GRP
TYPE
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PLAN CHECK* FEE -
$ •.
BOND AMT.
PLAN NO. PLAN CHECKER
FINAL DATE I
'
,PSE\C\TOR ,n
CONSTRUCTION FEE
DBL
$ ,-_
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
O /A
•p
VENTS SIG 'TURF CONTRACTOR
a .�•+•�
INSTRUMENTATION FEE
g
'SPECIALINSP
$
ADDRESS ADDRESS
DEMOLITON
FEE`4j
l
REGISTRATION
.:. y 9 IF1` 10
PLUMBING FEE
DBL
$
CITY . ZIP coo CITY
ZIP CODE
TOTAL 'FEES. $
TEL. NO. .
AREA CODE TEL.
NO.
CODE
LICENSE tt
[AREA
CASH ❑CHEC .O.❑N_C.❑
RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
O RK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
1 EREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE '1
T LL P
I WITH THE. LAWS OF RIVERSIDE COUNTY'AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
FORM 284-208 -(REV. 6-76)
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
SO 1N ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.