260445 (RR)BUILDING PERMIT . DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE Id
I:
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
APPLIANCE
CONSTRUCTION ESTIMATE
1 ST FL.
SQ.FT. @
2ND FL.
SO. FT. @
POR.
SO. FT. @
GAR.
SO. FT. @
CAR P.
SO.FT. @
I WALL
SO. FT. @
SO. FT. @
ESTIMATED CONSTR CTION
VALUATION $
NOTE: Not to be used as property tox voluation
I
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
I:
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
APPLIANCE
'JOB ADDRESS SP NO
`S 6.A 4_c.C-_ cl
OWNER
�0 P,
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
01.W r --D 7-
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
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
ROOMS
SQ FT @ a
BATHTUB
OFFICE
SQ FT @ a
WATER HEATER
SQ FT RESID @ 1 a
SEWAGE DISPOSAL
I
SQ FT GARAGE @ 1/2a
HOUSE SEWER
PERMIT FEE
COPIES
$
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
PERMIT FEE
PERMIT NO.
260445
lL F�E�S
��-
MOR. HM.FE.E
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
cft,4�
DBL.
ELECT, FEE
DBL.
SMI FEE
FEE
PLUMB FEE
DBL.
J I FM A M J J A S O N D
'JOB ADDRESS SP NO
`S 6.A 4_c.C-_ cl
OWNER
�0 P,
74
01.W r --D 7-
75
USE OF PERMIT }
fcJic jt rs /w
F.C.
DATE
PERMIT NO.
76f
„��r��T� <�
-r��1260445_
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATIONSUPP.
TO PERMIT
OFFICE
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
,GATS L '.3t 5cri'T (_Lc.c�3 f - TQC C-GvZ-
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONEUSE
NO.
GRP
TYPE
CK BY
F 5
A`�a�
PLAN CHECK FEE
$
`=
BOND AMT.IPLAN
tN
CHECKER
FINAL DATE
INSPECTOR
/
P.
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
_
S
STRONG MOTION
$;L
OWNER/AGENT'S SIGNATURE
INSTRUMENTATION FEE
/ isL c --TS C-3-0 57,
$
ADDRESS
ADDRESS
FEE?rX
i tJ -�;- f + -a G' [
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
Y
TEL. NO.
TEL NO. LICENSE
CASH ❑ CHECK M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 120 DAYS. CESSA
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY t
TREES REQUIRED
ric
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
%
SEWAGE SYSTEM
T
LL
FP
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
%ATC iI C TUC CT ATC l EI Al lC/IDAIIA!-/ %icmmr, nNITOAt rNOC IC A I Cnr-I IA DA AITCCII
I 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
L FORM 284-208 (Rev. 10-74) Qr L OF THE STATE OF CALIFORNIA.