290735 (PLBG)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
I
PERMIT No.
290 7 351
COUNTY OF RIVERSIDE
DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. - 50.
2ND FL. SQ.
FOR.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $ UNITS
FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
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
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
VENT SYSTEM [j FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
F.C.
AIR HANDLING UNIT r—� CFM IDLE METER KITCHEN SINK
MIT
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR U HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ a BATH TUB
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/aa SEWAGE DISPOSAL
735
SQ.FT.GAR @ 3/aa HOUSE SEWER
COPIES
$
GAS PIPING^
BBO/OKK PAGE PARCEL
PERMIT FEE
PERMIT FEE PERMIT FEE'
DBL.
I TOTAL FEES
]MOB.HM.FEEI
MICRO FEE MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. �FEE
JOB ADDRESS SP NO
/rF1�% f//
OW ER
s,✓
76
77
COMMUNITY
VALUATION
DATE .c-� DSTT�
OFFICE
M H PERMIT FEE
$
USE OFF PERMIT
F.C.
SUPP..TTOO PSE IT PE
MIT
NO12.
pp yr
r &Ale Ca
c
735
MICROFILM FEE
COPIES
$
BBO/OKK PAGE PARCEL
LEGAL DESCRIPTION
j
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
TYPE
I
111P
I
JkBY
I
S
S
R<
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE JINSPECTOR_
1.i ' ' � � 1
`hQl�n—
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LEN ER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONJ-
ACTOR f
, t
INSTRUMENTATION FEE
SPECIAL SP
$
ADDRESS ADDRESS
DEMOLITION I
FEET
REGISTRATION
�✓ �L/
PLUMBING FEE
DBL
$
CITY ZIP CODE clr
i zIP CODE
TOTAL FEES
TEL. NO. AREA
CODE TEL,
NO.
ARrE�A CODE
LICENSE I
CASH ❑CHECK .O.❑N.C.❑�?
J
�y f
RECEIVED BY TREES REQUIRED
oo,
THIS PERMIT SHALL BECOME VOID 1F 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
-- C.OMPE N SAIIVN IINSu R A NC E uPON MY EMV LOY It It S. C OMYLIANC,t WITH IHt LAWS Or Irit Z,IAIt VF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL 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.