297130 (SFD)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
FIELD OFFICE '
-
PERMIT NO.
,•
+VVI\1 t Vr RIVCnzi Lor9713
1 77
VAL/ UATIO
Pei
DA E
DST
0
CONSTRUCTION ESTIMATE
78
NO. .ELECTRICAL FEES
1'M H PERMIT FEE
NO., PLUMBING FEES
$..
1 ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
FOR. SQ. FT. @
GAR. SQ. FT. @
CAR P.SQ. FT. @
WALL SQ. "FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $'?
i
Q.
=
UNITS
MOBILEHOME SVC.
POWER OUTLET
°
PERMIT
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
i
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
297130
MECHANICAL FEES,.,
SWIM POOL, COMM
!
WATER SOFTENER
'
VENT SYSTEM. ❑ FAN-. REVAP. COOL 1 OOD.
�•
SIGN ,:LL
WASHER (AUTO)(DISH)`
�
APPLIANCE, RYER -
.,
$
GARBAGE DISPOSAL?da
ZONE
j�
S-EETT BACK
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
GRP TYPE CK BY
LAUNDRY TRAY ,
AIR HANDLING UNIT CFM.
IDLE'METER
KITCHEN SINK
0-41
r
ABSORPTION SYSTEM B.T.U.
TEMP USE,PERM SVC
WATER CLOSET
I
COMPRESSOR HP
S
POLE, TEMP/PERM
LAVATORY
PLAN CHECK FEE
HEATING SYSTEM XORCED ❑ GRAVITYAMPERES
SERV ENT
L�3a
SHOWER
INSPECTOR
BOILER 0 B.T.U.
SQ.FT. @ a
BATH TUB
'
SQ.FT. @ a
DBL
WATER HEATER'
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER VOLVED
Q.FT.RESID @ 11/44
SEWAGE DISPOSAL
��GY
'SQ.FT.GAR @ s/4a
DBL
HOUSE SEWER
ADDRESS
CITY
STATE-
TATE -
l GAS PIPING
463
O3
PERMIT FEE
,
01 PERMIT FEE-
PERMIT FEE.!
OWNE /AGENT'S SIGNATURE t
F444iiifff�
DBL,
TOTAL FEES
jMOB.HM.FEEj
MI RO FEE�y
MECH. FEEPL.
'ea
CK. FEE
- CONST. FEE
ELE ./FFEE
SMI FEE
FEE
.PLUMB. FEE
I -
a J F M A M J. J A N D
JOB ADDRESS - SP NO
I
q J
OWNER '
76
1 77
VAL/ UATIO
Pei
DA E
OFFI
78
1'M H PERMIT FEE
$..
US9 o PE IT F.C.
SUPP. TO PERMIT
PERMIT
Nb.
00/1
297130
;'MICROFILM FEE
COPIES
$4
BOOK PAGE PARCEL
LEGAL DESCRIPTION
'
+�4l
MECHANICAL FEE
EIBL
$
USE NO.
ZONE
j�
S-EETT BACK
LOT SIZE
GRP TYPE CK BY
11 -
I
SGl •I
S
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
e.
PLAN CHECKER
INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER VOLVED
;ELECTRICAL FEE
DBL
$//
ADDRESS
CITY
STATE-
TATE -
463
O3
,
;'STRONG MOTION
.INSTRUMENTATION FEE
$
OWNE /AGENT'S SIGNATURE t
F444iiifff�
CONTRACTOR
�'i: Pr Y�, Y►f r
,SPECIALINSP
$
ADDRESS
DEMOLITION
'REGISTRATION
FEErj
` ^ W
d"" 7(�/
IPLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
a
®Q%y
%�
0.4 Ch d d A ZZ
TOTAL FEES $
TEL. NO.
AREA CODE
TEL, NO,
AREA CODE
LICENSE F
,.CASH❑CHEC .O.❑N.C.❑
..
.RECEIVED BY TREES REQUIRED}
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN T20 DAYS. CESSATION OF
►T
fIS
RK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
EREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
s
EWAGE SYSTEM
T LL
p
H THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
(`(1MDFNG A TI(1A1111111 o A 1.1— 110 11 11v ��• _
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284.208 (REV. 6-78) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.