297167 (AR)BUILDING • PERMIT
. DEPARTMENT OF BUILDING & SAFETY
FIELD OFFICE
J F M A M J J A S O N
PERMIT NO.
2971
NEW
CV VIV 1 T Or RI V CK3IUC
COMMUNITY VALUATION
s $l.��Q"moo
04 0 %
DATE DST
j
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
1ST FL.
2ND FL. ,
POR.
GAR.
CAR P.
WALL
a-4),
MATED
ESTICONSTRUCTION
SQ. FT. @ $
UNITS
SUP TO PER I
PE MIT
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
i
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
MICROFILM FEE
@ URINAL
SQ. FT.A
$
VALUATION $ r WATER PIPING
dam,
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
DBL
WATER SOFTENER
USE NO.
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
TVPE CK BYJ
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
�JLOTSIZE
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
S119
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
BOND AMT.
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
F HALF NAL D� INSPECTOR
SHOWER
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
J
SQ. FT. @ 4
DBL
WATER HEATER
NAME OF CONST. LENDER BRANCH
OFFICE
Q.FT.RESID @ 1l/4¢
e f
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢
HOUSE SEWER
DBL
$
ADDRESS CITY
GAS PIPING
PERMIT FEE
j PERMIT FEE(1
PERMIT FEE
STRONG MOTION
DBL.
TOTAL FEES
1116
MOB.OIM.FEE
MICRO FEE
MECH. FEE IrL. CK. FEE
I CONST. FEE
Ove7 10 0
4A o
ELECT. FEE fZr
SMI FEE
FEE
PLUMB. FEE
400
J F M A M J J A S O N
JOB ADDRESS ' I SP -NO
OWNER
r
77
COMMUNITY VALUATION
s $l.��Q"moo
04 0 %
DATE DST
j
OFFICE
78
.ren•
M H PERMIT FEE
$
5 O PE RMIT
F.C.
SUP TO PER I
PE MIT
i
Oejg-Z
MICROFILM FEE
COPIES
$
BOOK P E AR
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZO E
BACK
GRP
TVPE CK BYJ
�JLOTSIZE
�jj
1
WS�ET
S J
S119
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER -
F HALF NAL D� INSPECTOR
J
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENPA INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONYrRAC
R
INSTRUMENTATION FEE
�
` LJ
i
'SPECIALINSP$
ADDRESS ADDRESS—
DEMOLITION
FEE
REGISTRATION
r�
.+
! '
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
C3 Ca
-[-
TOTAL FEES $
TEL. NO.
AREA CODE TEC
NO.
AREA CODE
LICENSE a
CASH ❑CHECK .O.❑N.C.❑
RECEIVED BY TREES REQUIREDIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
K FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I HIS
AGREE THAT ALL WORK IN CONNECTION WITki 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
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 284-20e (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.