296927 (RPL)FIELD OFFICE`
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT • `
J F M A M J J° A S O N D
PERMIT NO.
96927
•
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77
{
'
DST
CONSTRUCTION
ESTIMATE
NO. ELECTRICAL.FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
1ST FL.
2ND FL.
FOR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMAT D CO+STRUCTION
SQ. FT. @ $
UNITS
SUP .'TOPE IT
NO.
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE 'PIPING
�'P21T
96927
FT. @• DRINKING FOUNTAIN
MICROFILM FEE
SQ. FT. @ ° URINAL
$
VALUATION $ J.. WATER PIPING
BOOK PAGE PARCEL LEGAL DESC TION``
' NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
bti
MECHANICAL FEE
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
NE
S 7 BACK
VENT SYSTEM ❑ FAN, ❑ EVAP. COOL ❑ HOOD
SIGN
C%K�^�B�r
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
IS
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
$
AIR HANDLING UNIT CFM
IDLE METER
PLAN NO.
KITCHEN SINK
INSPECTOR
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER:CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
DBL$
LAVATORY
.NAME OF CONST. LENDER BRANCH
HEATING SYSTEM Cl FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
�/•✓
BOILER B.T.U.
SQ.FT. @ ' a
BATHTUB
DBL
$
SQ. FT. @, ¢
WATER HEATER
SQ.FT.RESID .@ 11144
SEWAGE DISPOSAL
STRONG MOTION
SQ.FT.GAR @ 3/4¢
;
dQUS6SEWER
G�1J
INSTRUMENTATION FEE'`
GAS PIPING
'SPECIALINSP
PERMIT FEE
PERMIT FEE
610PERMIT
FEE
SS
DEMOLITION
REGISTRATION
DBL.
I TOTAL FEES
MOB.HM.FEE
MICRO FEE
MECH. FEE FIL. CK. FEE
CONST. FEE .
ELECT. FEE
SMI FFEEE—
FEE
PLUMB. FEE
J F M A M J J° A S O N D
JOB ADDRESS - SP NO
I
OWNER
76
77
COMMUNITY
i0
VALUATION _
$
P3G►
DATE'—
�/ %
DST OFFICE
/
78
M H PERMIT FEE
$
s O P R 1
F.C.
SUP .'TOPE IT
NO.
_4
,•
�'P21T
96927
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL LEGAL DESC TION``
/
MECHANICAL FEE
DBL
$
USE 140.zo
NE
S 7 BACK
LOT SIZE GRP
TYPE
C%K�^�B�r
IS
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECK R FINAL GATE /
INSPECTOR
CONSTRUCTION FEE
DBL$
.NAME OF CONST. LENDER BRANCH
OFFICE_•
NO LEND VOLVED
�/•✓
ELECTRICAL FEE
DBL
$
ADDRESS CITY,
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE ' . CON4RACTOR
INSTRUMENTATION FEE'`
'SPECIALINSP
$
ADDRESS AD
SS
DEMOLITION
REGISTRATION
FEE
?&6 lam' „••.
PLUMBING FEE
DBL
$
clTr ZIP CODE CITY
ZIP/CODE
1 yL-
TOTAL FEES 10. $ -
TEL. NO. AREA
CODE - TEL.
NO. AREA CODE -
LICENSE R
53
CASH❑CHECK O.❑N.C.❑ .
r � 714
3e
RECEIVED BY
SEWAGE SYSTEM
'. T
TREES REQUIRED
aI
LL P IA10
IS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
7RK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
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
COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
FORM 284-208 (REV. 8-761
-••
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SOIN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA. - - A