290168 (AR)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT -.—y �e nlveneu ne I
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J F M A M J J A S O 1 N I D
PERMIT NO.
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DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL. SQ.
POR. SQ.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $ UNITS
FT, @ YARD SPKLR SYSTEM
FT. @ MOBILEHOME SVC. BAR SINK
FT. @ POWER OUTLET ROOF DRAINS
FT- @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION$ WATER PIPING
NOTE: Not to be used os property tax valuation SWIM POOL, PVT FLOOR DRAIN
I
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
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APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
M H PERMIT FEE
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
$
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
USE O PERMIT
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
SUPP.lT0PER IT
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
NO.
BOILER C�B.T.U. SQ.FT. @ ¢ BATH TUB
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/a¢ HOUSE SEWER
{F�.C.
GAS PIPING
PERMIT FEE
PERMIT FEE tTp PERMIT FEE
'MICROFILM FEE
DBL.
I TOTAL FEES
]MOB.HM.FEEI
MICRO FEE MECH. FEE . CK. FEE
4047
I CONST. FEE ELECT.FFj�E`�E S{MIII FFFEE
FEE PLUMB. FEE
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J F M A M J J A S O 1 N I D
JOB ADDRESS SP NO
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OWNER
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76
.77
COMMUNITY -
VALUATION
DATE
DST
OFFIC
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78
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M H PERMIT FEE
$
USE O PERMIT
SUPP.lT0PER IT
PERMIT
NO.
{F�.C.
'MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
EGALL DEESC�RIPTION
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,TYPE
MECHANICAL FEE
DBL
$
USE NO.
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SET BACK
L T SIZE GRP
Y
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PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
j.INrS)CTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
4"
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGN T CONTRACTOR
INSTRUMENTATION FEE
w
SPECIAL INSP
$
A S ADDRESS
REGISSTRATTIION FEE
x,. r
'PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
f
TOTAL FEES $
TEL. NO.
CODE TEL,
NO.
AREA CODE
LICENSE a
CASH❑CHECK M.O.❑N.C.❑
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;RECEIVED BY TREES REQUIRED
S PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
r
K FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
fTHHERTEHBEY
SEWAGE SYSTEM
AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL p
LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
f'nAAD FNCATInM IAICI1DAki(C I ID(l I AAV CAADIl1VCCC ATC PLC
• EALl'FORNA .0'6'VEE.RvINv,G'-'C'O'NTvR' AvC,TfO-R-S tI,S'„ALSO GUARANTEED. ♦�,I,I II1L LI1 f�J vl II�.A I,",r�v,
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264-206 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.