296820 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT
J F M A M J J A S O
PERMIT NO.
190
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OWNER
Act
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SQ.
2ND FL.
FOR.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to lie used as property tax valuation fflorSWIM POOL, PVT FLOOR DRAIN
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MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
VENT SYSTEM [) FAN ❑' EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
F.C.
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
NO.
296r
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
COPIES
HEATING SYSTEM ❑ FORCED (:]GRAVITY AMPERES SERV ENT SHOWER
BOILER C�B.T.U. SQ.FT. @ a BATH TUB
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a HOUSE SEWER
DBL
$
GAS PIPING
USE NO.
PERMIT FEE
PERMIT FEE PERMIT FEE
GRP
DBL.
I TO(,T,I�AL FEES
f I ro
IMOB.HM.FEE
MICRO FEE MEG H. FEE- PL. CK. FEE 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
r I
'ZTa
OWNER
Act
76
77
COMMUNITY
VALUATION
DATE DST OFFICE
i
$
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78
[. M H PERMIT FEE
$
USE OF -PERMIT
4.0
F.C.
SUP . TO PER [PERMIT
NO.
296r
MICROFILM FEE
COPIES
$
OOK PAGE PARCEL L GA DESC RIPT N
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK LOT SIZE
GRP
I TYPE ICK BY
/04
k
I S Sf R
f/I.
=PLAN CHECK FEE
$
BOND AMT.
PLAN NO. PLAN CHECKER
FINAL DATE
JINSPEITOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NU LEND R INVOLVED
4
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
OWN ER/AGENTS.SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
i
AQ��746r,
'SPECIALINSP
"DEMOLITONFEE
$
ADDRESS
REGISTRATION
PLUMBING FEE
DBL
$
CITY, ZIP CODE
CITY ZIP CODE
TOTAL FEES is
AREA
TEL. NO.�+�
RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
,.
0.
ORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM
LL
pj`
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
T
r'rIAAPFIJC A Tinki IKICI IO A r.1rF I1-1 —V CAA of l vccc l'l1 A10I IA "I C %A/ITU TUC I AU/C r1C TUC GTATF OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
FORM 264-206 IREV. 6-761 OF CALIFORNIA.