268976 (SFD)CAR P. SO.FI. @
WALL SO. -FT. @�
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $ ` s�
NOTE: Not to be used as property tax voluation
MECHANICAL FEES
VENT SYSTEM FAN ❑ EVAP. COOL 21 HOOD 14P
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
SWIM POOL, PVT FLOOR DRAIN
SWIM POOL, COMM WATERSOFTENER
SIGN /I w AC NFD I A I ITnNFlICWI
</ I,In
APPLIANCE
/ -
74
FIELD OFFICE
BUILDING_ PERMIT
GARBAGE DISPOSAL
DEPARTMENT OF•BUILDING & SAFETY
FURNACE ❑ UNIT ❑ WALL ❑ FLOC) ❑ SUSPENDED
USE OF PERMIT
'-'
F.C. JDATE
COUNTY OF RIVERSIDE
JPM-476
LAUNDRY TRAY
i &// .: -far 0c'
AIR HANDLING UNIT
DST
'CONSTRUCTION ESTIMATE
IDLE METER
NO. ELECTRICAL FEES
NO. PLUMBING FEES
KITCHEN SINK
ST FL.. CJ~
SOFT. @
, 7
" UNITS
TEMP USE.PERM SVC
SO. FT. @YARD
—57
+.5—G�5MOBILEHOME
4�/
SPKLR SYSTEM
2ND FL.
POR. ��
SO. FT. @ �
POLE, TEMP/PERM
SVC.
BAR SINK z"
GAR ,:r6 5F
SO FT Q. 0 "`
- f
^�� ^ POWER OUTLET
ROOF DRAINS - A" n
CAR P. SO.FI. @
WALL SO. -FT. @�
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $ ` s�
NOTE: Not to be used as property tax voluation
MECHANICAL FEES
VENT SYSTEM FAN ❑ EVAP. COOL 21 HOOD 14P
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
SWIM POOL, PVT FLOOR DRAIN
SWIM POOL, COMM WATERSOFTENER
SIGN /I w AC NFD I A I ITnNFlICWI
</ I,In
APPLIANCE
/ -
74
�¢^ j
JOWNER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOC) ❑ SUSPENDED
USE OF PERMIT
'-'
F.C. JDATE
JPM-476
LAUNDRY TRAY
i &// .: -far 0c'
AIR HANDLING UNIT
I CFM
M H PERMIT FEE
IDLE METER
$
�%
KITCHEN SINK
i 22
ABSORPTION SYSTEM
0 B.T.U.
VALUATION
TEMP USE.PERM SVC
;
WATER CLOSET
4�/
COMPRESSOR
HP
7
POLE, TEMP/PERM
JANITS
LAVATORY
- �p
HEATING SYSTEM IN FORCED
❑ GRAVITY QD
AMPERES SERV ENT
$
fI
SHOWER
BOILER O.B.T.U.
SOFT •@ ¢
DBL
BATH TUB
CS
SIZE ZONE
USE NO.
SO FT @ ¢
TYPE
/
WATER HEATER
i J
f
�
SOFT RESID @ ,�Fr
SEWAGE DISPOSAL
V
(1
PLAN CHECK FEE
$
fj SO FT GARAGE @ 'ha
!_
NO.
HOUSE SEWER
FINAL DATE
�/ - � � .
SPECTOR
i
INQM.,
a
PERMIT FEE
t OU
$
/
GAS PIPING
NO LENDER INVOLVED
MOBILE HOME PERMIT FEE
$
.rr--
PERMIT FEE
Op
ELECTRICAL FEE
PERMIT FEE
$
PE MIT N
26�76
TOTAL FEES
-
.F
MOB. HMEE
MICRO FEE -
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE„
DBL.
ELECT. FEE
DBL.
SMI FEE„
FEE
PLUMB. FEE
�-•
JDBL.
J F M A M J J A S O N D
J08 ADDRESS T SP NO
74
�¢^ j
JOWNER
]rj
USE OF PERMIT
'-'
F.C. JDATE
JPM-476
]6
i &// .: -far 0c'
M H PERMIT FEE
$
COMMUNITY
DST
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
JANITS
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SETBACKLOT
a
SIZE ZONE
USE NO.
GRP
TYPE
CK BY
f
�
F S
R2
PLAN CHECK FEE
$
BOND AMT.PLAN
NO.
PLAN CHECKER
FINAL DATE
�/ - � � .
SPECTOR
i
INQM.,
a
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
75
.rr--
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
,
STRONG MOTION
INSTRUMENTATION FEE
$
�l
OWNER/AGENT'S SIGNATURE
CONTRACTOR
1 'i i N1
!
( r� }
..FEE
$
ADDRESS
ADDRESS
PLUMBING FEE
DBL
$
CITYZIP CODE
ITV
C ZIP CODE
� r
TOTAL FEES
$
;�
,�� �
TEL. NO.
TEL. NO.
CASH ❑ CHECK (,V M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
ION OF WORK FOR T20 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
T
LL
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COAAPLIANCE WITH THI
I " I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
FORM 28d-208 (Rev, 10-74) OP L
1 OF THE STATE OF CALIFORNIA.