260083 (RPL)23
APPLIANCE
TOMB ADDRESS SP NO
FIELD OFFICE
BUILDING PERMIT
DEPARTMENT O.F BUILDING B'SAFE_TY
+'
LAUNDRY TRAY
'
COUNTY OF RIVERSIDE .
+
KITCHEN SINK
ABSORPTION SYSTEM O.B.T.U.
TEMP USE PERM SVC
M H PERMIT FEE
CONSTRUCTION ESTIMATE
COMPRESSOR - 0 HP
'NO. ELECTRICAL FEES
NO, "'PLUMBING FEES
1 ST FL. SQ.FT. , @
HEATING SYSTEM O FORCED O GRAVITY
UNITS '
VALUATION
2ND FL. SQ. FT. @
BOILER B.T.U.
SO FT @ a
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
-POWER OUTLET -
ROOF DRAINS
CAR P. SQ.FT. @
MICROFILM FEE
SQ FT GARAGE @ 'ha
DRAINAGE PIPING,
SQ. FT.' @ `A
PERMIT FEE
DRINKING FOUNTAIN
!NALL
cy )l'i/ref
r . SQ. FT. @
MOBILE HOME PERMIT FEE $
19
URINAL
ESTIM T D CONSTRUCTION VALUATION $
Q � -
PERMIT NO.
2 6,0 0 8 '3
WATER PIPING
NOTE: Not to be used as property tax valuation
MICRO FEE
SWIM POOL. PVT
` FLOOR DRAIN-,
MECHANICAL FEES
s
SWIM POOL. COMM
` 'WATER SOFTENER
DBL.
VENT SYSTEM .❑ FAN • O EVAP. COOL O HOOD
SIGN
-WASHER IAUTOIIDISHI
23
APPLIANCE
TOMB ADDRESS SP NO
GARBAGE DISPOSAL
FURNACE ❑ UNIT O WALL O FLOOR O SUSPENDED
JOWNER
75
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
76
KITCHEN SINK
ABSORPTION SYSTEM O.B.T.U.
TEMP USE PERM SVC
M H PERMIT FEE
WATER CLOSET '
COMPRESSOR - 0 HP
POLE, TEMP/PERM
COMMUNITY
LAVATORY
HEATING SYSTEM O FORCED O GRAVITY
AMPERES SERV ENT
VALUATION
SHOWER
BOILER B.T.U.
SO FT @ a
BATH TUB
SQ FT @ ` a
WATER HEATER
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
MICROFILM FEE
SQ FT GARAGE @ 'ha
$'
H�32S@OtFYrk �>�' . li{i
PERMIT FEE
GAS -PIPING +
MOBILE HOME PERMIT FEE $
19
f* PERMIT FEE
DBL.
PERMIT FEE
PERMIT NO.
2 6,0 0 8 '3
TOTAL FEES
.��-�-�.
MOB. HM.fEE
MICRO FEE
MECH. FEE
'DBL.
PL. CK. FEE
CONST. FEE
`'-,'
DBL.
ELECT. FEf
ly
A S1
DBL.
SMI FEE
FEE
11
PLUMB. FEE y
.l
DBL.
J F M A M, . J ,, J A S - O N D
TOMB ADDRESS SP NO
74
/
JOWNER
75
.USE OF PERMIT
✓ ice' �
F.C.'
o
DATE IfIT NO.
X60083
76
,;
ie)- �
M H PERMIT FEE
$
COMMUNITY
T
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
I
MICROFILM FEE
COPIES
$'
LEGAL DESC IPTION
19
MECHANICAL FEE.
DBL.
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
PLAN CHECK .FEE
$
BOND AMT.
PLAN CHECKER '
FINAL DATE
INSPECTOR f
JPLANNO.
CONSTRUCTION FEE -
DBL
$
-
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOL•
ED
ELECTRICAL FEE
DBL-
$
ADDRESS CITY-
STATE
STRONG MOTION
$ �
OWNER/AGENT'S SIGNATURE 1
JZONT.RAMR .4 ,. I
�
INSTRUMENTATION FEE
-
$
ADDRESS
ADDRESS +'
FEE
/
PLUMBING FEE
DBL
$ r.
CITY. Z_IPCODE
CITY ZIP CODE
,/
TOTAL FEES
$ -
.�^zr
TEL. NO.
j
TEL. NO. . - LICENSE
G"�• , 9
CASH ❑ CHECK T!<M.O: ❑ y N.C. ❑
THIS PERMIT SHALL BECOME VOID IF.WORKIISNOT COMMENCED WITHIN.120 DAYS. CESSARECEIVED
WORK FOR,120 DAYS,SHALL ALSO CAUSE PERMIT TO BECOME VOID.
A
BY 9
TREES REQUIREDNOF
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL•BE DONE IN AC
CORDANCE WITH THE LAWS -OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
T
LL
P
�� AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOY EES.,COMPLIANCE WITH THE
n.c �c r c crnrc �c r•n++ n rwcn+n+r^ r
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) OP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.