286233 (BLCK)DEPARTMENT OF BUILDING & SAFETYFIELD OFFICE
.
BUILDING PERMIT �, A Imo— — � ,
J F M A M J J A S O
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PERMIT NO.
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DST
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CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM Q.Q.
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
VENT SYSTEM [J FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED 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
M H PERMIT FEE
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
$
BOILER B.T.U. SQ.FT. @ a BATH TUB
usE O ER IT
SQ.FT. @ a WATER HEATER'
SUPP. O PERMIT�PEZI�0-
SQ.FT.RESID @ 111/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 1/4a HOUSE SEWER
GAS PIPING
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PERMIT FEE
PERMIT FEE PERMIT FEE a„Q
DBL.
TOTAL FEES
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IMOB.HM.FEEI
MICRO FEE TECH. FEE PL. CK. FEE
CONST. FEE ELECT. FEE I SMI FEE
I FEE PLUMB. FEE
J F M A M J J A S O
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JOB ADDRESS SP NO
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OWNER
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77
COMMUNITYLUUA�A^TI--IO/OW�N
DATE
DST
OFFICE
78
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M H PERMIT FEE
$
usE O ER IT
F.C.
SUPP. O PERMIT�PEZI�0-
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7 V3
6233
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE
ICK 8V
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SIS
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE IN
CTOR
r.l -1 �
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CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOR
INSTRUMENTATION FEE
:SPECIALINSP
$
7�TJDRE55 ADDRESS
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DEMOLITION
FEE
REGISTRATION
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PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
pAREA
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TEL. . AREA
CODE TEL.
NO.
CODE
LICENSE u
CASH ❑CHECK .O.❑N.C.❑ f
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56#-4430
RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T
LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
CUIVIrcI-i0AiiU, 11`IJVRAIVL,C UFO" MT CMPLVTCco. COMFLIANt-C VV! In InC LAYVJ yr in J1 -W -
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THEINDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264-206 (REV. 6.76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.