302211 (SPIN)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
J F M A M J J A S O N D
PERMIT NO, 1
0221
LULINI 11 Vr RIYCIibluc
76 1
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES' NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION Is WATER PIPING
NOTE: Not to be used os property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
M H PERMIT FEE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
$
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
E P R1511'
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
PP. JtO PE RMft1'302211
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
MIT
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP I POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ a BATH TUB
e�
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
"
SQ.FT.GAR @ 3/44 HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE
<ap
DBL.
[�IFEES
IMOB.HM.FEEI
MICRO FEE MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE SMI FEE ' y� �EE PLUMB. FEE
,! I n
J F M A M J J A S O N D
JOB ADDRESS SP NO
I
tPY_-,7.Za
OWNER
'
76 1
77
M NIT
VALUATION
DATE
DST -OFFICE
4
$
78
M H PERMIT FEE
$
E P R1511'
HFC.SU
PP. JtO PE RMft1'302211
E
MIT
N
e�
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MICROFILM FEE
COPIES
$
1401
EP56K PA "E PA EEL LEGAL DESCRIPTION
J. o 19,,13, la RL- 2(AAJ 11
MECHANICAL FEE
DBL
$
t5SLfNGF SET BACKOT S ZE GRP TYPE
�;IBIY
I S S R
PLAN CHECK FEE
$
BOND AMT.
PLAN CHECKER
FINAL DATE JINSPECTOR
IPLANNO.
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOL ED
ELECTRICAL -FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS"SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
LAI
'SPECIAL INSP
$
ADDR Ss
DEMOLITON
EE
o�
REGISTRATION
rP
s jf
PLUMBING FEE .
DBL
$
C TV ZIP CODE
CITY ZIP CODE
�I.
TOTAL FEES $
TEL. NO
AREA CODE
TEL. NO.
AREA CODE
LICENSE u
00
CASH ❑CHEC .O.❑N.C.❑
RECEIVED BTREES REQUIRED
THIS -PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
y�. T LL P
TH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
' OMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284.208 (REV. e-zs) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.