296787 (MISC)FIELD OFFICE
• DEPARTMENT OF BUILDING & SAFETY - * 3
BUILDING PERMIT ,....... „ —� � , "
J F M A M J J A S O N D
PERMIT NO.
96 87
-low bVV1Y1 T Or RIYCR3IUC
76
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
M H PERMIT FEE$
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
USE OF ERMI
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
SUPP. TO PERMIT
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM E::::= B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR � HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ ¢ BATH TUB
JEMqO.
SQ. FT. @ ¢ WATER HEATER
SQ.FT.RESID @ 11/4¢ SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢ HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE
COPIES
DBL.
I TOTAL FEES
IMOB.HM.FEEI
MICRO FEE MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS I SP NO
I
f ^'
OWNER
/7
76
77
COM//MUNI
VALUAT
DATE
DST
OFFICE
[�
/Ai
M H PERMIT FEE$
USE OF ERMI
F.C.
SUPP. TO PERMIT
JEMqO.
787
MICROFILM FEE
COPIES
$
BOOK PAGEPARCEL
LEGAL DESCRIPTION
`
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE GRP
TYPE
ICORBY
I
S
S
R�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSP TOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$ADDRESS
a
CITY
STATE
STRONG MOTION
$
OWNE /AGENTS SIGNATURE CONTRACTOR
INSTRUMENTATION FEE
�.c!
'SPECIAL
$
A D ADDRESS
INSP
DEMOLITONFEE
t
REGISTRATION
PLUMBING FEE
DBL
$
CITY I ZIP MDE CITY
ZIP CODE
!
TOTAL FEES $
TEL. NO AREA
CODE TEL,
NO,
AREA CODE
LICENSE tt
CASH HECK❑M.O.❑N.C.❑
/
RECEIVED BY .
TREES REQUIRED
HIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
RK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH 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 284.208 (REV. 8-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.