290677 (ELEC)FIELD OFFICE
MENT OF BUILDING & ,. SAFETY.
BUILDING PERMIT ,.,,.,T„ �r n,vrnr,nr
1 J F M A M J J A S Q
PERMIT NO.
.290 6
-low %AJUNII t Vr RIYLR7IUC
DST
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
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ . POWER OUTLET ROOF DRAINS
SQ. 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
COPIES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL [:)FLOOR Cl SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
�7
.GUS
ABSORPTION SYSTEM B. U. TEMP USE PERM SVC WATER CLOSET
"
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
.'PLAN CHECK FEE
BOILER B.T.U. SQ.FT. @ a BATH TUB
$
SQ.FT. @ a WATER HEATER
BOND AMT.
SQ.FT.RESID .@. 1 I/4a SEWAGE DISPOSAL
PLAN CHECKER
SQ.FT.GAR @/4a HOUSE SEWER
INSPECTOR
GAS PIPING
PERMIT FEE
PERMIT FEE OC PERMIT FEE
DBL.
I TOTAL FEES
IMOB.HM.FEEI
MICRO FEE MECH. FEE L. CK. FEErNST.
FEE ELECT.FEE SMI FEE
7
'FEE PLUMB. FEE
1 J F M A M J J A S Q
.IOB ADDRESS I SP NO
!"
OWNER
TND
'.77
COMMUNITY VALUATION
DATE DST OFFICE
78
M'H PERMIT FEE
$
USE OF PERM T
F.C.
SUPFK. TO PERMIT �IPE MIT NO.
MICROFILM FEE
COPIES
$
.677
BOOK PAGE PARCEL 'LEGAL DESCRIPTION
�7
.GUS
"MECHANICAL FEE FEE
DBL
$
.
USE NO. ZONE SET B CK LOT SIZE JGRP TYPEC B
1hj�JryY
_
5 S R ��
.'PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
",ELECTRICAL FEE
pgl
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE-
CONTRACTOR
INSTRUMENTATION FEE
f.
,SPECIAL INSP
$
ADDRESS
ADDRESS .
''DEMOLITION
FEE
!;REGISTRATION
'
`.PLUMBING FEE
DBL
$
CITY ZIP CODE
CIT'r CI'ZIP CODE
S`z 2
TOTAL FEES $
TEL. Na.
AREA CODE
TEL. NO. AREA CODE
LICENSE a
`CASH❑CHECK .O.❑N.C.❑�^�
,RECEIVED BY. TREES REQUIRED,.
THIS "PERMIT SHALL BECOME VOID IF WORK 15 NOT'COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEMWAGE SYSTE
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
I.UMrtINJA I IUN IINJUKANCE 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 2B4-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.