260772 (CP)0
DST
l/
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
JOB ADDRESS SP NO
7�,��
FIELD OFFICE
BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
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75
COUNTY OF RIVERSIDE
CFM
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
SQ.FT. @
UNITS
ABSORPTION SYSTEM
SQ. FT. @
TEMP USE PERM SVC
YARD SPKLR SYSTEM
2ND FL.
SO. FT. @
MOBILEHOME SVC.
BAR SINK
I POR.
SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAR.
SOFT. @
DRAINAGE PIPING
CAR P.
SO. FT. @
DRINKING FOUNTAIN
WALL
co"I'4 j".1 SO, FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
C6P
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM d
Q WATERSOFTENER
SQ FT @ ¢
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑HOOD SIGN
WASHER (AUTO) IDISHI
j
APPLIANCE
LOT SIZE Z,,,O(((N���E
GARBAGE DISPOSAL
0
DST
l/
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
JOB ADDRESS SP NO
7�,��
OWNER
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74
LAUNDRY TRAY
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75
AIR HANDLING UNIT
CFM
IDLE METER
ERMIT NO.
76
KITCHEN SINK
/0
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
$
WATER CLOSET
DST
I UNITS
COMPRESSOR
HP
POLE, TEMP/PERM
OFFICE
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
6 o
BOILER 0 B.T.U.
COPIES
SQ FT @ ¢
LEGAL DESCRIPTION
j
BATH TUB
tj
SQ FT @ ¢
DBL
$
WATER HEATER
/J
LOT SIZE Z,,,O(((N���E
SQ FTRESID @ 1¢
GRP
TYPE
SEWAGE DISPOSAL
SQ FT GARAGE @ 'h¢
HOUSE SEWER
PERMIT FEE
PLAN CHECK FEE
$
7
GAS PIPING
PLAN NO.
e
MOBILE HOME PERMIT FEE
Is
I I
I I PERMIT FEE
fj
/
PERMIT FEE
oe)
PERMIT NO.
260772
TOTAL EES_
M08. HMSEE
MICRO FEE
MECH. FEE
DBL.
�PL. CK. FEE
pcvi�v
�CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB...FLEE
�D�"
DBL.
J F M A M ) ) A S Q N D
JOB ADDRESS SP NO
7�,��
OWNER
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74
,x% y'oo (! G'Ldh,-Ir ,4
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75
USE OF PERMIT
C���Mt�A,'r. X00/ azo
F.C.
DATET260772
ERMIT NO.
76
/0
M H PERMIT FEE
$
COMMUNITY /
/'4,1
DST
I UNITS
ROOMS
I VALUATION
SUPP. TO PERMIT
OFFICE
A/ , .4
6 o
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
j
tj
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE Z,,,O(((N���E
USE NO.
GRP
TYPE
CK BY
,+
-3o IS IR /
`J
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
: a � - ) b
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER 1 plvo VED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR +f
INSTRUMENTATION FEE
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
(�
SU
CITY ZIP CODE
CITY} ZIP CODE
1AA0/0
TOTAL FEES
$
3
s-
TEL. NO.
'17
TEL. NO. LICENSE
CASH ❑ CHECK M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY J
TREES REQUIRED
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
'4 CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM0(
l
T
LL
P 6�f
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
nm roc Tuc CT n Tc un r-rwn nn nrccn
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) pL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.