302231 (SFD)• BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY.
FIELD OFFICE
J F M A M J J A S O N D
PERMIT NO,
OWNER
`
�_VVIV IT Or KIVCKWUC
•
COMMUNITY
VAL:UATtlM9
$ 1��
DST
CONSTRUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @IffA% $
UNITS
$
SQ. FT. @ YARD SPKLR SYSTEM
F.C.
SQ. FT. @ C. MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. IT, @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ ! 00 WATER PIPING
1 302231
NOTE: Not to be used as property tax valuation jrSWIM
POOL, PVT
COPIES
FLOOR DRAIN
BOOK PAIGE PARCEL
MECHANICAL FEES
ISWIM POOL, COMM
WATER SOFTENER
MI
VENT SYSTEM [j- FAN ❑ EVAP. COOL OOD
a0_
SIGN
WASHER(AUTO)(D"
OQ
MECHANICAL FEE
APPLIANCE RYERC%
$
NO.
GARBAGE DISPOSAL
4,0
TYPE CK BY
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
00USE
LAUNDRY TRAY
I S S g R
^�
5
AIR HANDLING UNIT CFM
PLAN CHECK FEE
IDLE METER
$
KITCHEN SINK
00
PLAN NO.
ABSORPTION SYSTEM 0 B.T.U.
SPECT
TEMP USE PERM SVC
WATER CLOSET
C?f+
COMPRESSOR HP
�C"yHEC�KrER� _ }
POLE, TEMP/PERM
ZJLAVATORY
00
HEATING SYSTEM AR�ORCED ❑ GRAVITY
C>C3
MPERES SERV ENT
GY.3
SHOWER
Qv
$
BOILER B.T.U.
NAME OF CONST. LENDER
SQ.FT. @ a
NO LENDER INVOLVED
BATH TUB
C91C3
OGi
SQ. FT. @ a
WATER HEATER
r C7T'j
$
ADDRESS
Q.FT.RESID @ l Y4¢
/
SEWAGE DISPOSAL
SQ.FT:GAR @ 3/aa'jj
HOUSE SEWER
$
OWNER/AGENTSSIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
GAS PIPING
V-3
PERMIT FEE
0
PERMIT FEE
#�
PERMIT FEE
.....-
$
DBL.
TOTAL FEES I�
IMOB-HM,FEEI
MICRO FEE
M H. FEE
PL. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
193
FEE
PL S. FEE
J F M A M J J A S O N D
JOB ADDRESS - - SP NO
I
" 5lle,jLogoee3
OWNER
`
76
77
COMMUNITY
VAL:UATtlM9
$ 1��
DATE
DST
OFFICE
78
M H PERMIT FEE
$
USE OF RMI
F.C.
SUPP. O IERMI
NI
1 302231
MICROFILM FEE
COPIES
$
BOOK PAIGE PARCEL
LEGAL DESCRIPT ON
MI
MECHANICAL FEE
DBL
$
NO.
ZONE SET BACK
LOT SIZE GRP
TYPE CK BY
00USE
I S S g R
^�
5
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN FINAL DATE
SPECT
�C"yHEC�KrER� _ }
(OR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
OGi
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTSSIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
V-3
At
SPECIAL INSP
DEMOLITION
FEE
$
ADDRESSADDRESS
t�^^
REGISTRATION
7 7 3 ,,,rile{ 00
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
1PAhn c 0
TOTAL FEES 010, $
TEL. NO.
AREA CODE
TEL, NO,
AREA CODE
LICENSE 0
CASH❑GREG O.❑N.C.❑le
r
RECEIVED BY TREES REQUIRED
IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
U*BY
'�
SEWAGE SYSTEM
I AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
�"?
LL
P
H THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO CARRY
-I.UMFtNSA I IUN 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. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.