290191 (SPIN)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
-I
PERMIT NO.
911
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L.VVIVI I Vr RIvCR.':IIVC
.77
COMMUNITY
DST
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
;. 1ST FL.
2ND FL.
POR.
'. GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
SQ. FT. @ YARD SPKLR SYSTEM
M H PERMIT FEE
SQ. FT. @ MOBILEHOME SVC. BAR,SINK
$
SQ. FT. @ POWER OUTLET ROOF DRAINS
USE OF PERMIT s
SQ. FT. @ DRAINAGE PIPING
SUPP.IrO PERMIT
FT. @ DRINKING FOUNTAIN
NO.
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
191
VENT SYSTEM [] FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
$
APPLIANCE ❑ DRYER
BOOK PAd.E PARCEL LEGAL DESCRIPTION
GARBAGE DISPOSAL
FURNACE ❑ UNIT' ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
.MECHANICAL FEE
AIR HANDLING UNIT' CFM
IDLE METER
KITCHEN SINK
USE NO.
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
GRP
COMPRESSOR HP
POLE,-TEMP/PERM'
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT-
SHOWER
T
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
v
SQ.FT. @ a
WATER HEATER
SQ.FT.RESID @ 11/4a
SEWAGE DISPOSAL
SQ.FT.GAR @ . 3/4a
HOUSE SEWER
S
S
R
GAS PIPING
PERMIT FEE
PLAN CHECK FEE
PERMIT FEE
PERMIT FEE
DBL.
I TOTAL FEES
l �✓
jMOB.HMFEEj
MICRO FEE
MECH. FEE . PL. CK. FEE
I CONST. FEE ELECT. FEE
SMI FEE EE
,
PLUMB. FEE
J F M A M J J A S O N I D
JOB ADDRESS I SP NO
fG7y' .sf/t% fl�'l�Af
OWNER
76
.77
COMMUNITY
VALUATION
DATE
S
OFF1111111
i 14'tk.
$__;2//s-/.7-/
78 TL.I-At
M H PERMIT FEE
$
USE OF PERMIT s
F.C.
SUPP.IrO PERMIT
11T
NO.
f91i °
- y
191
;MICROFILM FEECOPIES
$
BOOK PAd.E PARCEL LEGAL DESCRIPTION
.MECHANICAL FEE
DBL
$ -
USE NO.
ONE
SET AGK
LOT SIZE
GRP
TYPE
lKK/��BV�
T
v
S
S
R
(,.rJI
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
\/Ipf`�JA�CCJT�Jj'//L�p
a5' 71
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE'
yCONT
A 0
INSTRUMENTATION FEE"
s•��l' T
SPECIALINSP
$
ADDRESS ADDRESS
!DEMOLITION
(REGISTRATION
EEr'
lea
1�
1
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
,r
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
NO.
AREA CODE
LICENSE 4
�
/
CASH HECK❑M.O.❑N.C.❑
'RECEIVED BY T EES REQUIREP, 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.
M I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
is WAGE SYJET LL P WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
COMPENSATIONINSURANCE 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 264-208 (REV. 6-761 SO•IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.