301820 (SFD)BUILDING PERMIT DEPARTMENT , OF BUILDING & SAFETY
FIELD OFFICE
J F M A M J J A S' O
PERMIT NO.
'REV
\. UUN v i Vr RI Y CR7IYC
76
' 77
DST
CONSTRUCTION
ESTIMATE
DST
NO.' ELECTRICAL FEES
NO. PLUMBING FEES
78
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL SQ.
_
ESTIMATED CONSTRUCTION
SQ. FT. @ U G
UNITS
M H PERMIT FEE
SQ. FT. @ YARD SPKLR SYSTEM
SO. FT. @ �.IO MOBILEHOME SVC. BAR SINK
F.C.
SQ. FT. @ POWER OUTLET ROOF DRAINS
PERMIT
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SO. FT. @ URINAL
VALUATION $ iG WATER PIPING
GIQ
NOTE: Not to be used as property tax valuation
i
SWIM POOL, PVT
FLOOR DRAIN
COPIES
$
MECHANICAL FEES
BOOK PAGE PA L
ISWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM fZFAN ❑ EVAP. COOL q HOOD
eL GCy
SIGN
DBL
WASHER (AUTO) (DISH)
Q
USE NO.
APPLIANCE' S2DRYfR
SET BACK
LT SIZE
OS
GRP
GARBAGE DISPOSAL
BV
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
f^ 66
`y
�..i�
AIR HANDLING UNIT r--� CFM
IDLE METER
KITCHEN SINK
QIQ
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR 2_ / HP
dLi
POLE, TEMP/PERM
LAVATORY
BOND AMT.
HEATING SYSTEM 2046RCED ❑ GRAVITY
t Q
AMPERES SERV ENT
qEj
SHOWER
too
$
BOILER B.T.U.
NAME OF CONST. LENDER BRANCH
SQ.FT. @ a
N0LENDER INVOLVEO
BATH TUB
o
SQ.FT. @ a
WATER HEATER
DBL
$
ADDRESS CITY
j' SQ.FT.RESID @ l Yaa
STATE
SEWAGE DISPOSAL
GL%
Q.FT.GAR @ 3/aa
IHOUSE SEWER
$
OWNER/AGENT'S SIGNATURE CONTRACTOR
" • ' .^ A't.4. f
INSTRUMENTATION FEE
GAS PIPING
2
PERMIT FEE
(fxj
PERMIT FEE
Ari
PERMIT FEE
p
ADDRESS ADDRESS
DBL.
I TOTAL FEES
`
7"..'
JMOB.HTMICRO
FEE
MECH. FEE
-?
PL, CK. FEE
CONST. FEE .
E X A'' �
f ...r
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
J F M A M J J A S' O
N D
JOB ADDRESS I SP NO
�/3f3 r /h C a �11�/'
OWNER
u rt C-
76
' 77
CO//MMUNITYf'� - VALUATION
$ pg,'%
i5AYE *�
6+P /-1
DST
OFFICE
78
4 Ck'U!Aj
M H PERMIT FEE
$
USE OF PERMIT t
F.C.
SUI. TO PERMIT
PERMIT
NO.
30182.0
,MICROFILM FEE
COPIES
$
BOOK PAGE PA L
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LT SIZE
OS
GRP
BV
/y ri
f^ 66
`y
�..i�
��CK
ZadsS-5-
EV
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL ,D[A'TE7 INSPECTOR
J
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
N0LENDER INVOLVEO
o
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
l�
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE CONTRACTOR
" • ' .^ A't.4. f
INSTRUMENTATION FEE
2
,SPECIALINSP
$
ADDRESS ADDRESS
'DEMOLITION
FEE
7F 41 '�
REGISTRATION
1l
�� '
PLUMBING FEE
DBL
$
a�
CITY ZIP CODE CITY
}� ZIP CODE
I
S ?�«
✓,//
sy, P �'"''
x�c`�m ..?may
TOTAL FEES $
TEL. NO.
AREACODE TEL.
NO,
AREA CODE #
'CASH OCHECK .O.E1N.C.0
V40
`
�^ /
Cj
/TLICtNSE
RECEIVED BY TREES REQUIRED
THIS PE I SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATIONbF
0 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
E GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
I HE LAWS OF RIVERSIDE TO CARRY
I'SEWAGE SYSTEM
T
LL
P ,
COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE
,APFNGATIr)M IAIGI IDAMrr I IDnkI AAV Cl CCC l"/IAA DIIAAI!•C \A/ITU TUC I AIA/C: nr TUC CTATF nr
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM zea-zoe (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
� r r
OF CALIFORNIA.