301845 (SFD)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PE4 5RMIT
J FIM A M J J A SIO N D
PERMIT NO.
3 01
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COMMUNITY {
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VALUATION D E
DSTf
DST
CONSTRUCTION ESTIMATE
M H PERMIT FEE
NO. ELECTRICAL FEES
$
NO. PLUMBING FEES
USE OF PERMIT F.C. SUPP. TO PERMIT
1 ST FL.
2ND FL.
POR.
GAR. 1
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ 4"?00'4 •$
d7/ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @--41 44 *'+ MOBILEHOME SVC. BAR SINK
SQ. FT. @ d POWER OUTLET ROOF DRAINS
SQ. FT. @ 'ofDRAINAGE PIPING
MICROFILM FEE
SQ. FT. @ DRINKING FOUNTAIN
$
SQ. FT. @ URINAL
BOOK PAGE PA EL
VALUATION $ 7 WATER PIPING
NOTE: Not to be used os property tax valuation
r
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEE
DBL
MECHANICAL FEES
SWIM POOL, COMM
ZONE
WATER SOFTENER
LOT SIZE
GRP
VENT SYSTEM 5fFAN ❑ EVAP. COOL SZHOOD
CK BY
SIGN
WASHER(AUTO)(D
APPLIANCE DRYER
Q jj
IFSVjq
GARBAGE DISPOSAL
I
S
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
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R 2 J
PLAN CHECK FEE
LAUNDRY TRAY
BOND AMT.
AIR HANDLING UNIT CFM
PLAN CHECKER
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
' &
CONSTRUCTION FEE
COMPRESSOR -0. "� HP
$
POLE, TEMP/PERM
NAME OF CONST, LENDER
LAVATORY
NO LET INVOLVED
HEATING SYSTEM FORCED ❑GRAVITY
AMPERES SERV ENT
SHOWER
ELECTRICAL FEE
BOILER B.T.U.
$jr
SQ.FT. @ a
ADDRESS
BATH TUB
STATE
SQ.FT. @ a
WATER HEATER
STRONG MOTION
INSTRUMENTATION FEE
$
j2jpAySQ.FT.RESID @ 11/aa
OWNER/AGENTS SIGNATURE
SEWAGE DISPOSAL
SQ.FT.GAR @/aa
HOUSE SEWER
$
ADDRESS
GAS PIPING
INSP
DEMOLITON
REGISTRATION
�l
PERMIT FEE
PERMIT FEE
PERMIT FEE
`
DBL.
TOTAL FEES
, �z- 33
IMOB,HM.FEE1
MICRO FEE
M H. FEE
rd
PL. CK. FEE
CONST. FEE
EL -- FEE
6r.9��
SMI FEE
FEE
PLUMB. FEE
3-7
J FIM A M J J A SIO N D
JOB ADDRESS I SP NO OWNER
I
c.+ G f > C elm Si
76
77
COMMUNITY {
t 3� 0 t Ai
VALUATION D E
DSTf
OFFICE
78
M H PERMIT FEE
$
USE OF PERMIT F.C. SUPP. TO PERMIT
PE
MIT NO,
F 00
MICROFILM FEE
COPIES
$
BOOK PAGE PA EL
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE
CK BY
�F. l
Jf'
IFSVjq
I
S
5
!♦ .,yl
R 2 J
PLAN CHECK FEE
$
BOND AMT.
PLAN NO,
PLAN CHECKER
FINAL DATEINSPECTOR
.�.
' &
CONSTRUCTION FEE
DBL
$
NAME OF CONST, LENDER
BRANCH OFFICE
NO LET INVOLVED
ELECTRICAL FEE
DBL
$jr
ADDRESS
CITY
STATE
� .—
STRONG MOTION
INSTRUMENTATION FEE
$
C3
OWNER/AGENTS SIGNATURE
CONTRACTOR
SPECIAL
$
ADDRESS
ADDRESS
INSP
DEMOLITON
REGISTRATION
�l
FEE
`
PLUMBING FEE
DBL
$ ''j
�
CITY ZIP CODE
CITY ZIP CODE
F
TOTAL FEES $
TEL. NO. AREA
CODE
TEL. NO.
CODE
LICENSE 4
CASH❑CHECK .O.❑N.C.❑
4AREA
7d -TA
/t•
91 %fQ40
RECEIVED BY TREES REQUIRED
SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
Kt 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Y GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM
�-40
�T/o
�y
P✓`
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
CVmrtINJA IIUN INDUKANCE 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 2e4-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.