341002 (AR)BUILDING PERMIT ;Aft DEPARTMENT OF BUILDING & SAFETY ` FIELD OFFICE
PERMITNO.
3410021
PERMIT NO.
1W
COUNTY OF RIVERSIDE
q'
DST
Valuation
cC
341002
Di .
Off.
F.C.
Qw2
MH Permit Fee $0gliIAZZ:e!�is
CONSTRUCTION ESTIMATE
Use of Permit //�� nn !� 9
do Jva V�R r %U aid �/
11Za
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Ck.by
r
1ST FL. SQ. FT. Q V $
rIaZ
UNITS
Lot Size
Construction Fee Dbl E
26S. SQ FT Ga Pp
F �
S '�
YARD SPKLR SYSTEM
R
FOR. SQ. FT. (B}_
Zone
P,-/
MOBILEHOME SVC.
BAR SINK
Unit
GAR. SQ. FT. .G^
SMI Fee $ `
{
POWER OUTLET
ROOF DRAINS
Plan No.
CAR P. SQ. FT. @
Final Dote
— 2-1—
—Demal.
Inspector
DRAINAGE PIPING
Sp. Imp. Fee $
WALL SQ. FT. Ga
Const. Lender Branch I certify that to the performance of the work for which this permit is issued I sholl
ne! employ any person ,n any manner so as to become subject to the workmen's com-
pensation laws of California
Address—"1 /^ City Zip Owner Stgnawre
// !\J ,/!/ �. Bolder Signature
Registr. Fee $
DRINKING FOUNTAIN
[ Witness Fee $
SQ. FT. Ga
O^'ner7A9
Tel. Zip
�o41 _' l�.�6L�
URINAL
f Total Fees s x
IIII
ESTIMATED CONSTRUCTION VALUATION $
00
M.O. ❑ N.C. ❑ Cash ❑ Check
WATER PIPING
�Ly
NOTE: Not to be used as property tax valuation
License H
SWIM POOL, PVT
FLOOR DRAIN
City Zip
Workers' Comp.
yes ❑ no ❑
MECHANICAL FEES
Sewer District
Form 284208 IRev. 4771 ®s
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) M1
APPLIANCE RYER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM O B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR 0 HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. 6 ¢
BATH TUB
SQ. FT. 6 ¢
WATER HEATER
FT. RESID Ga 1'Air
SEWAGE DISPOSAL
SQ. FT. GAR Cai Y -c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
OO PERMIT FEE
DBL.
TOTAL FEES
MOB. HM. FEE
" MICRO F E
MECN. FEE
PL. CK. FEE
CONST. FEE
ELECT. FEE SMI FEE
FEE
PLUMB. FEE
a
�,,0
00i
/9
/A
pa
PERMITNO.
3410021
SuppPermit
Job Address Space
Zip
Owner
Community
Valuation
cC
Date
r/O
Di .
Off.
F.C.
Qw2
MH Permit Fee $0gliIAZZ:e!�is
Micro Film Fee Cop $
Use of Permit //�� nn !� 9
do Jva V�R r %U aid �/
11Za
Parcel No.
A0 S-- 9Q
Use No.
Ck.by
r
Mech. Fee Dbl s
I Pl. Ck. Fee $ A qn
Set Backs
Lot Size
Construction Fee Dbl E
Description
;_-I��-lo-/7�s.i�,C0a T"
F �
S '�
S �}`-
R
iElectrical Fee Dbl $
Zone
P,-/
Grp
-
fl -3
Type
Unit
SMI Fee $ `
{
Plumbing Fee ON b AAJBond
Plumbing
Amt.
$
Plan No.
Plan Checker
Final Dote
— 2-1—
—Demal.
Inspector
Sp. Imp. Fee $
Denial. Fee $
Const. Lender Branch I certify that to the performance of the work for which this permit is issued I sholl
ne! employ any person ,n any manner so as to become subject to the workmen's com-
pensation laws of California
Address—"1 /^ City Zip Owner Stgnawre
// !\J ,/!/ �. Bolder Signature
Registr. Fee $
k Mileage Fee $
[ Witness Fee $
it Reinsp. Fee $
O^'ner7A9
Tel. Zip
�o41 _' l�.�6L�
f Total Fees s x
IIII
ress
n
City Zip
M.O. ❑ N.C. ❑ Cash ❑ Check
Received by
Trees required
Contractor
Tel. %
License H
Sewage System
T LL P
Address
City Zip
Workers' Comp.
yes ❑ no ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF vvJ,ed by
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 ACCORDANCE
WITH THE LAWS OF RIVEQSIDE COUNTY AND THE STATE OF CALIFORNIA
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 OF THE STATE OF
CALIFORNIA.
Sewer District
Form 284208 IRev. 4771 ®s