301821 (RPL)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
FIELD OFFICE
J F M A M 1 1 A S O N D
PERMIT NO•fl
301
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DST
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CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SQ.
2ND FL.
FOR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMAT�CONTRUCTION
FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ . URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN �„L%►
USE OF PERMIT �.e
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
SUPP. TO PERMIT PE
VENT SYSTEM [f FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
NO.
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR r_� HP IPOLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
21
BOILER C�B.T.U. SQ.FT. @ ¢ BATH TUB
MICROFILM FEE
SQ. FT. @ a WATER HEATER 2d
$
SQ.FT.RESID @ l Y4a SEWAGE DISPOSAL
BOOK PAGE P//A,�RCEL
SQ.FT.GAR @ 3/48 HOUSE S&W&A.
GAS PIPING d
PERMIT FEE
PERMIT FEEC7C3' PERMIT FEE
MECHANICAL FEE
DBL.
TOTAL FEES
L.,
IMOB.HM.FEEI
MICRO FEE MECH. FEE L. CK. FEE CONST. FEE ELE � . FEE SMI FEE
FEE P MMB. FEE
J F M A M 1 1 A S O N D
'OB ADDRESS I SP NO
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OWNER
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76
77
COMMUNITY
VALUATION
DATE
ST
OFFKE
M H PERMIT FEE
$
USE OF PERMIT �.e
F.C.
SUPP. TO PERMIT PE
MIT
NO.
I f2A M i Aj 01 1,fl_
21
MICROFILM FEE
COPIES
$
BOOK PAGE P//A,�RCEL
L AL DESCRIPTION
—���•T i.if
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0 * Il
MECHANICAL FEE
DBL
$
USIr NO.
ZONE
'ofu..
SET BACK
LOT SIZE
I I'�
GRP
TYPE
CK BY
I
S
5
R
PLAN CHECK FEE
$
BOND AMT,
PLAN NO.
PLAN CHECKER A TLS I
ECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO L DER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
�
OWNER/AGENTS SIGNATURE
CONTRACTOR%' ,/`
-r�,
Ir
SPECIAL INSP
$
ADDRESS
ADDR SS
DEMOLITION
�j
FEE
REGISTRATION
t
PLUMBING FEE
DBL
$
CITY ZIP CODE
ClTY ZIP CODE
/
TOTAL FEES $
TEL. NO. AREA
CODE
TEL. NO. AREA CODE
LICENSE 0
CASH [-)CHECK.O.❑N.C.❑
RECEIVED BY TREES 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
T LL P
I HEREBY AGREE THATALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
I IVN INJUKAINL.t VYVN MT tMl'LVTttS. COMYLIANC.t WITH THE LAWS VY THE STATE Or
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264.208 IREV. 6.76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.