297054 (PAT)DEPARTMENT OF 3UILDING & SAFETY FIELD OFFICE
BUILDING PERMIT a I
J F M A M J J A S O- N D-
PERMIT 0 NO.
2 97
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jDST
1
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. 'PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ - YARD SPKLR SYSTEM'
SQ. FT. @ .p r 00 MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ ' WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
USE O PERMIT
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
SUPP. O PERMIT"' PERMIT
VENT SYSTEM [J FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH).
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM DLE METER I KITCHEN SINK
ABSORPTION SYSTEM B.T.U. -EMP USE PERM SVC WATER CLOSET
COMPRESSOR' HP 'OLE, TEMP/PERM LAVATORY
MICROFILM FEE
HEATING SYSTEM' ❑ FORCED ❑ GRAVITY AMPERES' SERV ENT SHOWER
$
BOILER B.T.U. SQ. FT. @ a BATH TUB
BOOK PA E PARCE_
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/44 SEWAGE DISPOSAL
SQ.FT.GAR @ ?/44 HOUSE SEWER
J; — — 6
GAS PIPING
DBL
PERMIT FEE
FERMIT FEE PERMIT FEE
US
DBL.
I TOTAL FEES
IMO..11..FEEI
MICRO FEE MECH. FEE PL CK. =EE
i
CONST. FEE ELECT. FEE SMI FEE
�✓ii�
FEE PLUMB. FEE
J F M A M J J A S O- N D-
JOB ADDRESS SP NO
-OWNER
76
77
COMMUNITY
VAUIIATION,
DATE ` C/ /�-•�
DST
OFFICE
78
M H PERMIT FEE
$
USE O PERMIT
F.C.
SUPP. O PERMIT"' PERMIT
NO.
MICROFILM FEE
COPIES
$
BOOK PA E PARCE_
LEGAL DESCRIPTION
J; — — 6
MECHANICAL FEE
DBL
$
US
ZONc SET BACK OT SI
GRP
TYPE
CK er
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
-71
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
w
nD_DpEss''
clrr
STATE
STRONG MOTION'
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR ,
'SPECIAL INSP
DEMOLITION
REGISTRATION
FEEt�
ADDRESS' '' (+'
fi
b v
ADDRESS
�l
PLUMBING FEE
DBL
$
CITY ZIP CODE
Cm ZIP CODE
TOTAL FEES $
TEL. NO.
AREA CODE
TEL. NO.
AREA CODE
LICENSE u
CASH❑CHEC O.❑N.C.❑
,�...0-
4111
RECEIVED BY,,- TREES REQUIRED '
'jaORK
THIS"PERMIT SHAH BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS: CESSATION OF
FOR 120 DAYS :HALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
T LL P
I HEREBY AGREE THATALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RI\-ERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
C ()AAPFNCATlnSI IMCI IDMN!-C I IDnKI AAV CAAOInVCCC (- KADI IA—C %A/ITU TUC I A— / C TIBC CTATC nC
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THA' 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 IREV. 6-76> OF CALIFORNIA.