290047 (RPL). DEPARTMENT OF BUILDING & SAFETY � FIELD OFFICE
BUILDING PERMIT ,.,�„„T„ — ,,,"r„, ,,fir ,
J F M A M J J A S O
PERMIT NO.
2 90 71
JOB ADDRESS I SP NO
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76
77
DDST
J/
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
DATE
NO. PLUMBING FEES
I OFFICE
1ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL SQ.
6L'!VA#
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
/-A
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
MH PERMIT FEE
SQ. FT. @ POWER OUTLET ROOF DRAINS
$
SQ. FT. @ DRAINAGE PIPING
USE OF PERMIT
FT. @ DRINKING FOUNTAIN
SUPP. TO PERMIT
SQ. FT. @ URINAL
NO
VALUATION $ ATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
i
MECHANICAL FEES
SWIM POOL, COMM
90047
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
COPIES
WASHER (AUTO) (DISH)
BOOK PARCEL
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
,PAAGyE�^
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
MECHANICAL FEE
DBL
LAUNDRY TRAY
USE NO.
AIR HANDLING UNIT CFM
IDLE METER
GRP TYPE
KITCHEN SINK
kKBI
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
! I S S R
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
$
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
PLAN
SHOWER
FINAL DATE
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
:N:!!
SQ.FT. @ a
WATER HEATER
DBL
$
SQ.FT.RESID @ 11/4a
BRANCH OFFICE
SEWAGE DISPOSAL
'i
SQ.FT.GAR @ 1/4a
HOUSE SEWER
ELECTRICAL FEE
DBL
$
ADDRESS
GAS PIPING
STATE
PERMIT FEE!
/3
ERMIT FEE
O
PERMIT FEES
STRONG MOTION
INSTRUMENTATION
DBL.
TOTAL FEES
r •
JMOB.HM.FEEI
MICRO FEE
MECH. FEE PL. GK..FEE
�'.
CONST. FEE
, 0
ELECT. FEE
13.9
SMI FEE
X33
FEE
PLUMB. FEE
17, 4°
J F M A M J J A S O
N D
JOB ADDRESS I SP NO
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OWNER
,�
76
77
COMMUNITY
VALUATION
$ j�(i.
DATE
T
I OFFICE
78
/-A
%l
MH PERMIT FEE
$
USE OF PERMIT
�
SUPP. TO PERMIT
PE MIT
NO
i
��F...C.
90047
MICROFILM FEE
COPIES
$
BOOK PARCEL
LEGAL DESCRIPTIO/NN
,PAAGyE�^
MECHANICAL FEE
DBL
$
USE NO.
ZONE
LOT/SIIZZE
SET BACK LOT
GRP TYPE
kKBI
! I S S R
PLAN CHECK FEE
$
BONO AMT.
PLAN
PLAN CHECKER
FINAL DATE
:N:!!
JINSPECTOR
I 9-)s
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LEND R INVOLVED
'i
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
/3
STRONG MOTION
INSTRUMENTATION
$
OWNER/AGENTS SIGNATURE
CONTRACTOg! / Aver -
t�l,l f �' s� :=
FEE.�;�*j
SPECIAL INSP
$
ADDRESS
ADDRESS
DEMOLITION
REGISTRATION
FEE
j%G�
PLUMBING FEE
DBL
$
dz
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES * $
5
TEL. NO. AREA
CODE
TEL. NO.
AREACODE
LICENSE a
CASH ❑CHECK .O.❑N.C.❑
�`4-� e'.�
:/ /
.710
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
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THEINDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.