286940 (RPL)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
FIELD .OFFICE
J F M A M J J A S O N D
PERMIT NO.
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D(1ST
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
DATE
♦ �A %%
NO. I PLUMBING FEES
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1ST FL.
2ND FL.
POR.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
USE OF ERMIT
SQ. FT, @ YARD SPKLR SYSTEM
SUPP. TO PERMIT
SQ. FT. @ MOBILEHOME SVC. BAR SINK
FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT.@ URINAL
O286940
VALUATION $ r►d WATER PIPING
NOTE: Not to be vsed as property tax valuation
SWIM POOL, PVT
&
FLOOR DRAIN
COPIES
$
MECHANICAL FEES
SWIM POOL, COMM
41
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
AOS 2.4 • t�o1 , �57�'.
WASHER (AUTO) (DISH)
DBL
$
APPLIANCE ❑ DRYER
USE NO.
ZONE
GARBAGE DISPOSAL
LOT SIZE
GRP
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
CK BY
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
i
f %! O
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED []GRAVITY
AMPERES SERV ENT
SHOWER
'w
BOILER B.T.U.
SQ.FT. @ a
$
BATH TUB
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
EATER
SQ.FT. _ 1 1/aa
SEWAGE DISPOSAL'
27
SQ.FT.GAR @ 3/4a
HOWCErSEWER s
:i
GAS PIPING`
DBL
$
PERMIT FEE
NAME OF CONST. LENDER
PERMIT FEE
WO LENDER INVOLVED
IPERMIT FEE
DBL.
I TOTAL FEES
97
IMOB.HM.FEE
MICRO FEE
MEC H. FEE L. CK}}. FEE.h
CONST. FEE
ELECT.FEE
SMI6FEEE
FEE
PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
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z " hile
OWNER
%!�
t76
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77
COMMUNITY ,,
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[VALUATION
$ � %+�, ��
DATE
♦ �A %%
DST OFFICE
/
�'
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�78
t M H PERMIT FEE$
USE OF ERMIT
F.C.
SUPP. TO PERMIT
PERMIT NO.
Pc 37 Nyco ZZ
O286940
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
'
463/- .3,
AOS 2.4 • t�o1 , �57�'.
(MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BAC
LOT SIZE
GRP
TYPE
CK BY
i
f %! O
S
R
'w
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
27
CONSTRUCTION FEE
DBL
$
a�
NAME OF CONST. LENDER
WO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
/3
�o
�+r
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOR
.INSTRUMENTATION FEE
SPECIALINSP
$
ADDRESS ADDRESS
'DEMOLITION
FEE
R rj0X �'
'REGISTRATION
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
/ ZIP CODE
.All
TOTAL FEES � $
TEL. NO. AREA
CODE TE''L.
N??O.
��
AREA CODE
4
LICENSE �a/
/37�
CASH❑CHECK O•❑N.C.❑ !
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RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
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
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
SEWAGE SYSTEM
T
LL
P
('()MPFNCATICIN INC( IDA Ali[ I wD I,1 AAV CAADI ( -c l'IlAA D1IA wIl"C \A/ITU TUC I A\A/G !1C TUC CT ATC !'1C
LFORM84-208 (REV. 6-76)
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.