301954 (SATT)DEPARTMENT OF BUILDING & SAFETY. FIELD OFFICE
BUILDING PERMIT
J F I M A M J J A S O
SURANCE UPON
PERMIT NO.
3019
w
VV V1911 Vr RIYLR�IVC
77-
DST
CONSTRUCTION ESTIMATE
VALUATION
NO. ELECTRICAL FEES
OFFICE
NO. PLUMBING FEES
1ST FL. SQ.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @
;,
UNITS
SE,OFRE
FF.^G�.
SUPP. fOPER' TPERMIT
SQ. FT. @ YARD SPKLR SYSTEM
No.
SO. FT. @ MOBILEHOME SVC. BAR SINK
SO. FT. @ A POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
301
VALUATION. $ . WATER PIPING
954
NOTE: Not to be used as property tax valuation '
MICROFILM FEE
SWIM POOL, PVT
$
FLOOR DRAIN
BOOK flPAGE PARCEL LEGAL DESCRIPTION
MECHANICAL FEES
SWIM POOL; COMM
WATER SOFTENER
DBL
$
VENT SYSTEM ❑ FAN (3 EVAP. COOLOOD
USE NO.
SIGN
SET BACK
WASHER (AUTO)IWSH)"+�
G P
TYPE CK BY
APPLIANCE RYER
[jd
GARBAGE DISP SAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE -METER
KITCHEN SINK
.
S
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
PLAN CHECK FEE
COMPRESSOR.,. HP4A
4,7
0 .
POLE, TEMP/PERM
PLAN NO.
LAVATORY'
JINSPECTOR
tlNAL;�,E!
HEATING SYSTEMORCED ❑ GRAVITY
4
rt'}� MPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ.FT. @ a
DBL
BATH TUB
NAME OF CONST. LENDER BRANCH
OFFICE
NO LE DER INVOLVED
SQ. F.T.. @ - a
WATER HEATER
FT.RESID @ 11/4¢
DBL
SEWAGE DISPOSAL
6N�
ADDRESS CITY
STATE
,y SQ.FT.GAR @ 3/44
Go
HOUSE SEWER
�+y
STRONG MOTION
GAS PIPING
�.
OWNER/AG NTS SIGNATURE CONTRACTOR
PERMIT FEE
t7Q
PERMIT FEE
PERMIT FEE
QCT
DBL.
TOTAL FEES yr
Igg
IMOB.HM=E
M H. FEE
04
PL. GK. FEE
CONST. FEE
EL T. FEE
SMI FEE
FEE
PL B. FEE
J F I M A M J J A S O
SURANCE UPON
N I D
JOB ADDRESS SP NO
I
;0— /
OWNER
76
77-
COMMUNITY
.r
VALUATION
DATE DST
OFFICE
78
M H PERMIT FEE
$
SE,OFRE
FF.^G�.
SUPP. fOPER' TPERMIT
No.
301
954
MICROFILM FEE
COPIES
$
BOOK flPAGE PARCEL LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
G P
TYPE CK BY
S
PLAN CHECK FEE
$BOND
AMT.
PLAN NO.
PLAN CHECKER
JINSPECTOR
tlNAL;�,E!
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LE DER INVOLVED
Av
ELECTRICAL FEE
DBL
ADDRESS CITY
STATE
�+y
STRONG MOTION
$
�.
OWNER/AG NTS SIGNATURE CONTRACTOR
INSTRUMENTATION FEE
}� -
'SPECIALINSP$
ADDRESS
DEMOLITION
FEE
Z�412X
REGISTRATION
+
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
�]
TOTAL FEES . $
TEL. NO: AREA
CODE TEL.
NO.
AREA CODE
LICENSE ss
CASH ❑CHECK .O.❑N.C.❑ j
t
RECEIVED BY TREES REQUIRED
T PF IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE'
SEWAGE SYSTEM
T LL
P
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY,
_, , !�� _, ,
QA4PENSATION IN
EMOYE. COMPLIANCE WITH 7HE 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
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
FORM 284-208 (REV. 6-761 - OF CALIFORNIA.