296903 (SFD). DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT
J FIM A M J J A S O N D
PERMIT NO. 31
60
'ROW
<.VVIV 1 t Or RIYCR�IYC
77
COMMUNITY
VALUATION
CONSTRUCTION ESTIMATE
DST
NO. ELECTRICAL FEES
NO. PLUMBING FEES
, y!.'
GGi4
1ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ + $ L
UNITS
78
M H PERMIT FEE
SQ. FT. @ YARD SPKLR SYSTEM
$
SQ. FT. Qi°l MOBILEHOME SVC. BAR SINK
PERMIT / `
US/E� F
SQ. FT. @ QBE POWER OUTLET ROOF DRAINS
SUPF. TO PE IT
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT: @ URINAL
VALUATION $ 00 WATER PIPING
JEy�
v
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MICROFILM FEE
MECHANICAL FEES
$
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑. HOOD
SIGN
WASHER (AUTO) (DISH)
DBL
$
APPLIANCE ❑ DRYER
USE NO.
ZONE
GARBAGE DISPOSAL
LOOT SSIZE'[
GRP
FURNACE ❑ UNIT ❑ WALL [:)FLOOR ❑SUSPENDED
LAUNDRY TRAY '
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
%f
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
PLAN CHECK FEE
AMPERES SERV ENT
SHOWER
BOND AMT.
BOILER B.T.U.
PLAN CHECKER
SQ.FT. @ ¢
BATH TUB
7
�
SQ.FT. @ a
WATER HEATER
(f� `� �
CONSTRUCTION FEE
SQ.FT.RESID @ 11/44
SEWAGE DISPOSAL
NAME OF CONST. LENDER BRANCH
OFFICE
NO LEND R INVOLVED
1
SQ.FT.GAR @ 3/4(1
HOUSE SEWER
$
ADDRESS CITY
STATE
STRONG MOTION
GAS PIPING
$
PERMIT FEE
INSTRUMENTATION FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
93.
MOB.HM.FEE
MICRO FEE
MECH. FEE
PL. CK. FEE
9.
CONST. FEE ELECT. FEE.
SMI FEE
FEE
PLUMB. FEE
J FIM A M J J A S O N D
JOB ADDRESS SP NO
I
I
OWNER
76
77
COMMUNITY
VALUATION
DATE^
DST
OFFICE
, y!.'
GGi4
$
/
-5A
78
M H PERMIT FEE
$
PERMIT / `
US/E� F
F.C.
SUPF. TO PE IT
PE MIT NO.
JEy�
v
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL LEGAL DESCRIPTION
0� /J l ilio C?`G3 %
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET B CK
LOOT SSIZE'[
GRP
TYPE Cfj`13YY
yy
%f
PLAN CHECK FEE
$ ®
BOND AMT.
PLAN NO.
PLAN CHECKER
FI N)AL D`AT'E IIfSR�CTOR
-)`l
J3
7
�
�0s
(f� `� �
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LEND R INVOLVED
1
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOR
INSTRUMENTATION FEE
SPECIAL
$
ADDRESS ADDRESS
INSP
DEMOLITON
FEE
REGISTRATION
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
{;- �j
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
NO.
AR CODE
LICENSE a
CASH❑GREG O.❑N.C.❑ � �
a
5,7!5_5 6?_;�
7/
r1Z %"
RECEIVED BY. 'J TEES REQUIRED
-'
I PERMIT SHALL BECOME VOID IF WORK IS NQT COMMENCED WITHIN 120 DAYS. CESSATION OF
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
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
CUMF'tNSA I ION 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 284-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.