296825 (SFD)FIELD OFFICE
. DEPARTMENT O=°BIjIID�NG,BL SAFETY -
BUILDING PERMIT
J F M A M J J A S O N D
PERMIT NO.
"llow CVUIV 1 i Or KI V CR3IUC
DST
77
COMMUNITY -
VALUATION
$
DATE•
J
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL. SQ. FT. @� UNITS
2ND FL. SQ. FT. @ YARD SPKLR SYSTEM
POR. SQ. FT. @ Of! MOBILEHOME SVC. BAR SINK
GAR. SQ. FT. @ e POWER OUTLET ROOF DRAINS
CAR P. SQ. FT. @ DRAINAGE PIPING
WALL SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
ESTIMATED CONSTRUCTION VALUATION $� WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM- WATER SOFTENER
'
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN W45HER (AUTO) (DISH) -
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
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
COPIES
COMPRESSOR E:� HP POLE, TEMP/PERM LAVATORY
_
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ a BATH TUB
SQ.FT. @ ¢ WATER HEATER
ef 7 Z
SQ.FT.RESID.@ 11/4a SEWAGE DISPOSAL
DBL
SQ.FT.GAR @ 1/4a HOUSE SEWER
USE NO.
PIPINGPERMIT
BACK LOT SIZE
FEE
'GAS
PERMIT FEE RMIT FEE
FEES
MOB.H M.FEE
MICRO FEE MEC H. FEE FL. CK. FEE CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. F CE
*GRP
�
[E9E7F7AL
$
5
BOND AMT.
PLA�NLAI.IIECIER
FINAL DATE IN
r
CONSTRUCTION FEE
DBL -
$
J F M A M J J A S O N D
JOB ADDRESS a SP NO
/ Yy e-5-5- i o.3I A/ - iall 9 no1
OWNE -
76
77
COMMUNITY -
VALUATION
$
DATE•
J
DST -
OFFICE
7B1
M H PERMIT FEE
$
USE OF PERMIT 1
&
F.C.
SUPP. TO PERMIT
[P�ff
NO.
'
6
,MICROFILM FEE
COPIES
$
BOO}K� PAGE PARCEL LEGAL DESCRIPTION
ESCRI ION`"
ef 7 Z
MECHANICAL FEE
DBL
$
USE NO.
ZONE
BACK LOT SIZE
TYPE C K BYS
ySET
%
R •I.
*GRP
�
PLAN CHECK FEE
$
BOND AMT.
PLA�NLAI.IIECIER
FINAL DATE IN
PE TOR
CONSTRUCTION FEE
DBL -
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LE7ERINVCLVEO
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
O a /AGEN�S�NATURE
CONTRACTOR \
INSTRUMENTATION FEE
1
SPECIAL NSP
I
DEMOLITON
REGISTRATION
FEE
-
?
D
ADDRESS -
'T' A"04.)
A DORESS
PLUMBING FEE
DBL
$
CITY 1, IP CODE
CITY ZIPCODE
1
TOTAL FEES $
CASH❑CHECK .O.❑N.C.❑
TEL. NO. AREA
. .'f(
CODE
TEL. NO.
AREA CODE
LICENSE a
RECEIVED BY TREES REQUIREDS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
SEWAGE SYSTEM e
FOR 120 DAYS -SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I EBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANC-
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I'ALSO AGREE TO CARRY
CUMPtINSA IILN INSUMANL.t UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA C DVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY. CERFIFY THAT THE INDIVIDUAL WHO PREPARED THE -PLANS AND SPECIFICATIONS HAS DONE
FORM 2e4 -20e (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STALE
OF CALIFORNI V