350642 (SFD)BUILDING PERMIT ggl& DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
N.C. I I Cosh
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Sewage System
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Sewer District
Form 284208 fRev. 4.771 05
Supp. Permit JobAddress /1 //� a/ �� Space Zip � Owner`
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/—V'alluootion Date S
Co mmunityy L� VDist. F.C. /
Use of Permit Parcel `. Use No. Ck.by
Ser Backs lot Size
Legal Description Q
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Const. Lender Branch I certify that in the performorice of the work for which this permit is issued I sholl
not employ ony person in ony manner so as io become subject to the workmen's com.
pensotion laws of California.'"
Address City Zip Owner Signature
Builder Signature
caner Agent /f;r
Ci Zip
Contractor Tel. License P
Address City Zip Workers' Comp.
/ yes ❑ no ❑
THIS PERMIT SHALL BECOM�1E VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF verified by
WORK FOR 120 DAYS SHALT O PER04T, TO BECOME VOID.
I HEREBY AGREE THA RK I CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RIVERSIDE COUNTY ND 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.