296750 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT —
PERMIT NO.
967-5
OWNER
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COUN 1 T Or KI V CKNUC
COMMUNITY VALUATIQmp
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F;�]DST
CONSTRUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
M H PERMIT FEE
1 ST FL. '
2ND FL.
POR.
GAR.
CAR' P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
On
UNITS
C
U
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. 4 00 MOBILEHOME SVC. BAR SINK
SQ. FT. @ 00 POWER OUTLET ROOF DRAINS
,
.
SQ. FT. @ 'f DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
MICROFILM FEE
SQ. FT. @ URINAL
$
VALUATION $M6.4*0 j WATER PIPING
46
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
'5;�' /0-3- 19 /W 6 f0 -f -Q nr`'
USE NO.ZO E SET BACK LOT SI GRP�Ck-gY
MECHANICAL FEE
MECHANICAL FEES
$
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL 5eHOOD
r�lJj-} I S S R �Yi
SIGN
WASHER (AUTO ISH)
Pr
APPLIANCE WRYER
C Co
PLAN CHECKER
GARBAGE DISPOSAL
eso
CONSTRUCTION FEE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
$
LAUNDRY TRAY
BRANCH OFFICE
NO LE ER INVOLVED
AIR HANDLING UNIT CFM
IDLE METER
I KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
ELECTRICAL FEE
TEMP USE PERM SVCWATER
CLOSET
ADDRESS
COMPRESSOR HPe2
STATE
POLE, TEMP/PERM
LAVATORY
0-
t�
��
9 -HEATING SYSTEM &ORCED ❑ GRAVITY
400
AMPERES SERV ENT
4>6 SHOWER
�o
BOILER T. U.
SQ.FT. @ ¢
BATH TUB
Cycv
$
SQ. FT. @ ¢
WATER HEATER
pQ
REGISTRATION
"IAQ.FT.RESID @ 11/a¢��
SEWAGE DISPOSAL
HCl
PLUMBING FEE
DBL
SQ.FT.GAR @ 3/a¢
HOUSE SEWER
CITYZIP CODE
CITY ZIP CODE
GAS PIPING
C�
PERMIT FEE
OBL. Tol FEES MOB.HM.FEE MICRO yEEQ
Com:
ME . FEE
PERMIT FEE
AL. CK. Fj CONST. FEE
PERMIT FEE
ELE T. FEE SMI FEE I FEE
PL B. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
I
OWNER
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76
77
at
COMMUNITY VALUATIQmp
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DATE
D sr
OFFICE
78
M H PERMIT FEE
USE OP'PERMIT
C
U
PERMIT NO.
,
.
2967
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL LEGAL DESCRI ION
--
'5;�' /0-3- 19 /W 6 f0 -f -Q nr`'
USE NO.ZO E SET BACK LOT SI GRP�Ck-gY
MECHANICAL FEE
DBL
$
r�lJj-} I S S R �Yi
PLAN CHECK FEE
10
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
4PI
INSPEC
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LE ER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
t�
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OWNER/AGENTS SIGNATURE^. f
{ t-
-�•TL" r�
CONTRACTOR
sw bj
SPECIALINSP
DEMOLITON
FEE
$
ADDRESS
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ADDRESS
REGISTRATION
,
PLUMBING FEE
DBL
$ �+-j
��j
CITYZIP CODE
CITY ZIP CODE
TOTAL FEES$ %
TEL.NO. J
AREA CODE
TEL. NO.
AREA CODE
LICENSE a
CASH❑CHEC O.❑N.C.❑i
0
RECEIVED Bl( �� TREES REQUIRED
jj0IrHIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM
T
LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
COMPENSA
TION 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 264-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.