297377 (RER)FIELD OFFICE
BUILDING PERMIT -DEPARTMENT OF BUILDING &SAFETY
J F M A M J J A S O N D
PERMIT No.
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76
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
VALUATIO
NO. PLUMBING FEES
DST
1 ST FL. SQ. FT. @ '
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $ Od
NOTE: Not to be used as property tax valuation
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
M H PERMIT FEE
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
$
MECHANICAL FEES
SWIM POOL, COMM
SUPP. TO PERMIT
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER
COPIES
$
GARBAGE DISPOSAL
BOOK PAGE PARCEL
LEGAL DESCRIPTION
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
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Zi f. /U
AIR HANDLING UNIT CFM
IDLE METER
$
KITCHEN SINK
USE NO.
ZONE /
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
GRP
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
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HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
/y
SHOWER
PLAN CHECK FEE
BOILER B.T.U.
SQ.FT. @ ¢
BATH TUB
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
SQ.FT. @ a
WATER HEATER
SQ.FT.RESID @ l l/i4
SEWAGE DISPOSAL
CONSTRUCTION FEE
'
SQ.FT.GAR @ 3/44
HOUSE SEWER
BRANCH OFFICE
NO LE DER INVOLVED
GAS PIPING
PERMIT FEE
DBL
PERMIT FEE
PERMIT FEE
CITY
STATE
DBL.
TOTAL FEES
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MOB.H M.FEE
MICRO FEE MEC H. FEE
PL. CK. FEE
CONST. FEE
ELECT.FEE
S.1 FEE
3
FEE
PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
I
I
OWNER
76
!
77
COMMUNITY
VALUATIO
DATE j� .J/ 7
DST
OFFICE
78
M H PERMIT FEE
$
USE OFrPERNflT harev 54m;
} 1
F.C.
SUPP. TO PERMIT
PE MIT NQ
377
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
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MECHANICAL FEE
DBL
$
USE NO.
ZONE /
SET BACK
LOT SIZE
GRP
TYPE CK BY
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I S�/
R
/y
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
Jv -13 77
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LE DER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
OWNER/AGENTS SIGNATURE
CONTR fOR(,,,+ r0 1" e
�- +
INSTRUMENTATION FEE
t''�_
O
SPECIAL INSP
$
ADDRESS
A
ADDRESS
DEMOLITION
REGISTRATION
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v
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEE$ is
TEL. NO. AREA
J
CODE
TEL. NO.AREA
CODE
LICENSE tt
CASH ❑CHEC .O.❑N.C.❑ ,2
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RECEIVED BY TREES REQUIRED
IN IN
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.
r
SEWAGE SYSTEM
AWITH
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T
LL
P
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
L.UrArtNOA I IUN IINZlUKAINLt UNUN 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 -20e (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.