297048 (SPIN)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT CO NT E
�—
FIELD OFFICE
/2
PERMIT NO.
970481
U Y OF RIVERSID
DST
�/
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. 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
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
V
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
DST
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 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
F.C.
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE
DBL.
TOTAL FERE„
I
MOB.HM.FEEMICRO
FEE MEC H. FEE PL. CK. FEE
CONST. FEE ELECT. FEE SMI FEE
0 �FEE PLUMB. FEE
JA
} CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM zea•zoB (REV. s-7BI 50 IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.
JOB ADDRESS I SP NO
OWNER
J F I M A M J J A S O
N D
V,I�lJJ
76__t
77
COMMUNITY -
V
DATE
DST
OFFICE
M H PERMIT FEE
$
USE O PERMIT
F.C.
SUPP. O PERMIT PERMIT NO.
s lAlF-ge
.400 297048
MICROFILM FEE
COPIES
$
B PA E PARCEL LEGAL DESCRIPTION
j.�O
IV l,y6 ' y�e_ ail
MECHANICAL FEE
DBL
$
USE NO.
ZO ESET
BACK
LOT SIZE GRP
TYPE
CK BY
1
5
S
R
yp
�"
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
CHECKER
FINAL DATE
INSP CTOR
[PLAN
T-
uz�
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
rr
$
OWNER/AGENTS SIGNATURE CONTRACTOR
STRONG MOTION
INSTRUMENTATION FEE
iG '•
.�
OWL&
SPECIAL
$
ADDRESS ADDRESS
INSP
DEMOLITON'EE
d�
REGISTRATION
10
'�'�
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP C DE
s
TOTAL FEES 411. $
TEL. NO. AREA
CODE TEL.
NO.
CODE
LICENSE a
CASH HECKflM.O.❑N.C.❑
`!
14kEA
I
RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK 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
— j T LL p
ITH 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 zea•zoB (REV. s-7BI 50 IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.