290837 (PLBG)DEPARTMENT OF BUILDING & SAFETY.
BUILDING PERMIT
FIELD OFFICE
J I F I M A• M I J I J A I S 1 O 1 N D,y
PERMIT NO.
2.90837
bVUIVI T Or KIVCK31UC -
DST
CONSTRUCTION ESTIMATE NO. 'ELECTRICAL FEES NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
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
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
1 M H PERMIT FEE
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
$
VENT SYSTEM [I FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
USE O PERMIT
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
SUPP. TO' PERMIT
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
r Jr� P
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
11500
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
' MICROFILM FEE
BOILER B.T.U. SQ.FT. @ a BATH TUB
$
SQ.FT. @ a WATER HEATER
BOOK' 'PAGE P RCEL LEGAL DESCRIPTION
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a HOUSE SEWER
f �
GAS PIPING
DBL
PERMIT FEE
PERMIT FEE PERMIT FEE CACI
NO.
OBL.
TOTAL FEES
•r•f��
MOB.HM.FEE
MICRO FEE MECH. FEE PL. CK. FEE
J
CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. FEE
' J_ I .�iQ
J I F I M A• M I J I J A I S 1 O 1 N D,y
JOB ADDRESS SP NO
I
OWNER
77
COMMUNITY y 0VALUATION
$-Q
DATE �y DST
l��
�J
O IC
i 78/r
%-y�
!
1 M H PERMIT FEE
$
USE O PERMIT
F.C.
SUPP. TO' PERMIT
r Jr� P
11500
' MICROFILM FEE
COPIES
$
BOOK' 'PAGE P RCEL LEGAL DESCRIPTION
f �
MECHANICAL FEE
DBL
$USE
NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE CK BY
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
F/AL V
JINSPECTOR
c
V
'CONSTRUCTION FEEDBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
i�
ELECTRICAL FEE
DBL
$
ADDRESS clTr
� #
STATE
j
STRONG MOTION
$
OWNER/AGENTS SIGNATURE - CONTRA
OR'
-
:INSTRUMENTATION FEE
f�
CSPECIAL INSP
=DEMOLITION
6 REGISTRATION
FEE
$
ADDRESS ADDRESS
} (2 3
p PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
r� ZIP CODE
cy
TOTAL FEES $ /
T.L. NO. AREA
CODE
AREA
LICENSE tt
:CASH ❑CHECK O.❑N.C.❑ luJ/h/
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�CODE
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RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 1/20 DAYS. CESSATION OF
t
♦ WORK 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
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I A150 AGREE TO CARRY
COMPENSATION 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.