296823 (SFD)• FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
J F M A M J J A S O N D
PERMIT.
6
OWNER
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t Or KIVCK3IUC �'
DST
CONSTRUCTION ESTIMATE
VALUATION
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I OFFICE
1ST FL.
' 2ND FL. -
POR.
GAR:
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
M H PERMIT FEE
UNITS
$
SQ: FT. @ YARD SPKLR SYSTEM
F.C.
SQ. FT. e-0 MMOBILEHOME SVC. BAR SINK
`0,'
PE MI
SQ. FT. @ ✓�� POWER OUTLET '. ROOF DRAINS
MICROFILM FEE
SQ. FT. @ DRAINAGE PIPING
$
SQ. FT. @ DRINKING FOUNTAIN
PAGE PARCEL_ LEGAL DESC RIP ON
SQ. FT. @ URINAL
VALUATION $ cc WATER PIPING
NOTE: Not to be used as property tax valuation
MECHANICAL FEE
SWLM POOL, PVT
FLOOR DRAIN
USE NO.
MECHANICAL FEES
SET BACK LOT SIZE
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
PLAN CHECK FEE_
APPLIANCE ❑ DRYER
$
GARBAGE DISPOSAL
PLAN CO.
PLAN CHECKER
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
PECTOR
LAUNDRY TRAY
AIR HANDLING UNIT I CFM
IDLE METER
KITCHEN SINK .
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP./PERM
LAVATORY
$
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
BRANCH OFFICE
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
ELECTRICAL FEE
DBL
$
SQ. FT. @ a
WATER HEATER.
STATE
STRONG MOTION
$
SQ.FT.RESID '@ 1144
SEWAGE DISPOSAL
CONTRACTOR
INSTRUMENTATION FEE
SQ.FT.GAR @ 1/4a
HOUSE SEWER
^^X
GAS PIPING
SPECIALINSP
DEMOLITION
PERMIT FEE
$
PERMIT FEE
PERMIT FEE
ADDRESS
DBL,
TOTAL FEEE�S'''^^^'�''��
jM--+IA.FEEj
MICRO FEE
MECH. 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 SP NO
R
OWNER
77
COMMUNITY
VALUATION
DAT�Ef'--'
DST
I OFFICE
78
M H PERMIT FEE
$
USE O. PERMIT
. ..... . cAt,
F.C.
SUPP. TO PERMIT
PE MI
NO.
6823
MICROFILM FEE
COPIES
$
PAGE PARCEL_ LEGAL DESC RIP ON
r0OK
f"f
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK LOT SIZE
GRP TYPE CK BY
PLAN CHECK FEE_
$
BOND AMT.
PLAN CO.
PLAN CHECKER
FINAI4 DATEIN
PECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDLR
BRANCH OFFICE
NO LEN ER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
O NrRk/AGENTS SIGNAT JRE
CONTRACTOR
INSTRUMENTATION FEE
^^X
SPECIALINSP
DEMOLITION
FEEj,�jk.&,
$
ADDRESIS S
ADDRESS
REGISTRATION
Y+ Y �
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY' ZIP CODE
'
✓fes 6 +
TOTAL FEES $
TEL. NO. A
EA CODE
TEL. NO.
AREA CODE
LICENSE tt
CASH❑CHECK .O.❑N.C.❑ •
/3�
RECEIVED BY TREES REQUIRED
S PERMIT SHALL 3ECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
,
K FOR 120 DAY.,' SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
6.2%.
I EREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
Tom' LL p
WITH THE LAWS OF EIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY. CERTIFY TEAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-76) - SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.