286818 (RPL)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT e^I IAITv ^C olvr C,r% I
J F M A M J 1 A S O N D
PERMIT NO.
817)/1
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COMMUNITY
VALUATION
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
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NO. PLUMBING FEES
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1 ST FL. SQ.
2ND FL. SQ.
FOR.
GAR. SQ.
CAR P. SQ.
/WjALL SQ.
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ESTIMATED CONSTRUCTION
FT. @ $
UNITS
[-W-H--P—ERMIT FEE
FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
F.C.
FT. @ POWER OUTLET ROOF DRAINS
PERMIT NO.
FT. @ DRAINAGE PIPING
FT. @— DRINKING FOUNTAIN
, s
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
;. MICROFILM FEE
FLOOR DRAIN
0
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
^L _ -0&/'CR✓s/
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
$
WASHER (AUTO) (DISH)
USE NO.
ZONE
APPLIANCE ❑ DRYER
I LOT SIZE
GRP
GARBAGE DISPOSAL
CK BY
A
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
r
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
R
LAVATORY
HEATING SYSTEM ❑ FORCED [:]GRAVITY
AMPERES SERV ENT
SHOWER
1p
BOND AMT.
BOILER B.T.U.
SQ. FT. @ 4
ECTOR
BATH TUB
SQ.FT. @ a
WATER HEATER
O�
CONSTRUCTION FEE
DBL
SQ.FT.RESID @ 11/4a
SEWAGE DISPOSAL
BRANCH OFFICE
NO LENDER INVOLVED
SQ.FT.GAR @ 3/441
HOUSE SEWER
ELECTRICAL FEE
DBL
$
GAS PIPING
ADDRESS
CITY
PERMIT FEE
PERMIT FEE
c3
PERMIT FEE
DBL.
TOTAL FEE
Ila"
MOB.HM.FEE
MICRO FEE
MECH. FEE FL. CK. FEE
I C'O`NS+T. FEE
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ELEC�Tg. FLEE'
SMI F E
FEE
PLUMB. FEE000
J F M A M J 1 A S O N D
JOB ADDRESS SP NO
OWNER - '
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76
4 77
COMMUNITY
VALUATION
$ b•
DATE) +�r..g
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DST
OFFICE
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78
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[-W-H--P—ERMIT FEE
$
USE O PER T
F.C.
SUPPP. TO PERMIT
PERMIT NO.
Q286818
;. MICROFILM FEE
COPIES
$
BOOK% PAGE PARCEL LEGAL DESCRIPTION
^L _ -0&/'CR✓s/
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
I LOT SIZE
GRP
TYPE
CK BY
A
r
f/
S f S
R
1 PLAN CHECK FEE
$
1p
BOND AMT.
PLAN NO.
PLAN CHECKER FINAL DATE I
ECTOR
Q0 C
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
' STRONG MOTION
INSTRUMENTATION FEE%
$
Zile,
OWNER/AGENTS SIGNATURE
CONTRACTOR
SPECIALINSP
$
ADDRESS
ADDRESS
DEMOLITON
FEE
�
REGISTRATION
PLUMBING FEE
DBL$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES $3
TEL. NO, AREA
CODE
TEL. N
AREA CODE
LICENSE n
CASH❑CHEC M.O.❑N.C.❑ 0C-
_p,
RECEIVED BY TREES REQUIRE
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
1
WORK 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
SEWAGE SYSTEM
T
LL
p
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
C-nMPFNGATInM IIJCI IDAmrc I lDnwl . v cunir vccc rr n \ TUC CTAT[ r C
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264-208 IREV. 6-761 SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STA
OF CALIFORNIA.