286867 (PLBG)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
FIELD OFFICE
J F M A M J A S Q
PERMIT NO.
8686
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DST
II
t CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
P
1 ST FL.
2ND FL.
' FOR.
GAR.
• CAR P.SQ.
' WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used os 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)
USE OrPERXIIT
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
SUINP. TO PERMIT
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
'MICROFILM FEE
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
$
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
BOOK PA E PARCEL
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
'MECHANICAL FEE
BOILER B.T.U. SQ.FT. @ a BATH TUB
$
SQ. FT. @ a WATER HEATER
_
SQ.FT.RESID @ 11/44 SEWAGE DISPOSAL
SET BACK
SQ.FT.GAR @ 3/4a HOUSE SEWER
GRP
TYPE
GAS PIPING
I
PERMIT FEE
PERMIT FEE PERMIT FEE C3
R
DBL.
I TOTAL FEES
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jMOB,HM,FEEj
MICRO FEE MECH. FEE PL. CK. FEE I
CONST. FEE ELECT. FEE SMI FEE --F
FEE PLUMB. FEE
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J F M A M J A S Q
JOB ADDRESS I SP NO
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OWNER
76
IND
77
COMMUNITY
o
VALLUUAITUN�
DATE
�
DST% OFFICE
LZ
:M H PERMIT FEE
$
USE OrPERXIIT
F.G.
SUINP. TO PERMIT
IRl�
-
'MICROFILM FEE
COPIES
$
BOOK PA E PARCEL
LEGAL DESCRIPTION
'MECHANICAL FEE
DBL
$
USE NO.
ZONE
�"'^
SET BACK
LOT SIZE
GRP
TYPE
CK BY
4A
I
S
S
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE I
��
ECTOR
CLQ -
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NOLENDERINVOLVED
ELECTRICAL FEE
DBL
ADDRESS CITY
STATE
.STRONG MOTION
INSTRUMENTATION FEE
a$
$
OWNER/AGENTS SIGNATURE CONTRACTOR
ij�e f -,a --
'SPECIAL :NSP
DEMOLITION
REGISTRATION
FEE
$
ADDRESS A
'-�
DRESS
!t —o j_
c�"
'PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES$ }
CASH ❑CHECK .O.❑N.C.❑ip
TEL. NO. AREA
CODE TEL.
NO,
r
AREA C�IODE
7!
LICENSE 9
3/al-,54
:RECEIVED BY� TREES REQUIRED
HIS IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
O 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I REBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
H THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
,SEWAGE SYSTEM'
5
T
LL
P
jy "C.VMI tNSA I M4 INSUKANC.t UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS VY THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264-206 IREV. 6.76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.