296822 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT ,,,�„.. ,�„
J F M A M J J A S O N D
PERMIT NO.
A
t.VuIV 1 T Vr RI V CRSIIJC
76t
/ f
DST
CONSTRUCTION ESTIMATE
COMMUNITY VALUATION
NO. ELECTRICAL FEES
NO. PLUMBING FEES
OFFICE
1 ST FL.
2ND FL.
POR.SQ.
GAR.
CAR P.SQ.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
p�
/
5/77
UNITS
78
SQ. FT. @ YARD SPKLR SYSTEM
FT. @Ael,� G7C? MOBILEHOME SVC. BAR SINK
SQ. FT. @ g 0110 POWER OUTLET ROOF DRAINS.
F.C.
FT. @ DRAINAGE PIPING
PERMIT
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
f,�"
NOTE: Not to be used as property tai valuation
1296821
SWIM POOL, PVT
FLOOR DRAIN
MICROFILM FEE
COPIES.
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
MECHANICAL FEE
DBL
APPLIANCE ❑ DRYER
USE NO.
GARBAGE DISPOSAL
SET BACK LOT SIZE
G,RPP�vp�. TYPE CK BY
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR, ❑ SUSPENDED
LAUNDRY TRAY
��///�
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
PLAN CHECK FEE
COMPRESSOR E::� HP
POLE, TEMP/PERM
LAVATORY
FINAL DATE IN SfP
CTOR
HEATING SYSTEM ❑ FORCED []GRAVITY
IIAMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ.FT. @ a
BATH. TUB
SQ.FT. @ a
WATER HEATER
CONSTRUCTION FEE
DBL
$
SQ.FT.RESID @ 11/4a
SEWAGE DISPOSAL
NO LEN; ER
a
INVOLVED
SQ.FT.GAR @ 1/4a
HOUSE SEWER
ELECTRICAL FEE
DBL
GAS” PIPING
ADDRESS
PERMIT FEE
STATE
STRONG MOTION
PERMIT FEE
PERMIT FEE
OWNER/AGENTS SIGNATURE
DBL.
I TOTAL FEES
CPO,
I
IMOMHM.FEE1
MICRO FEE
MECH. FEEPL.
CK, FEE
00
I
CONST. FEE ELECT. FEE
SMI FE7
FEE
PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
- .fir I
1
OWNER
76t
/ f
4,101 Y/e "/iq-e
77 -
COMMUNITY VALUATION
-
DATE
DST
OFFICE
014 IA) Aa
p�
/
5/77
78
M H PERMIT FEE
$
USE OFRMI f /
41A�KllC,IC
ZE
F.C.
SUPP. TO PERMIT
PERMIT
NO.
f,�"
1296821
MICROFILM FEE
COPIES.
$
BOOK PA,wRC L
LEGAL DESCRIPTIO
yA�G�E.
10
MECHANICAL FEE
DBL
$
USE NO.
11ONE
SET BACK LOT SIZE
G,RPP�vp�. TYPE CK BY
��///�
.yg',
I.
PLAN CHECK FEE
$
BOND AMT.
PLf`N NO. PLAN CHECKER
FINAL DATE IN SfP
CTOR
'
& > > 7
t.
`� lU
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LEN; ER
a
INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
SPECIAL INSP.
$
ADD ESS
ADDRESS
FEE
3d�\ A
REGISTRATIONDEMOLITI
i
/� itl
pIPLUMBING
FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
t, 1J 17 z 3
TOTAL FEESTEL.
NO.
AREA CODE
TEL. NO.
AREA CODE
LICENSE n
CASH❑CHECK .O.❑N.C.❑$ /
too
"-""
�J"��;�r
RECEIVED BY fes/ TREES REQUIRED
S PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
1K
K FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SIREBYAGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM
S;
T '�
LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
r'nAAPFNCAT.ln 11M, to A 111. 1lollw�.
CALIFORNIA'COVERING CONTRACTORS IS AL"III 1 1111
SO 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. 6.76) OF CALIFORNIA.