303397 (SATT)• DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT '
FIELD OFFICE
a
J F M A M 1 J A S O N D
PERMIT NO.
03 3 9�.
Row
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77
COMMUNITY
CONSTRUCTION ESTIMATE
DATE - DST
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Iyl.ts't
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
•i"
UNITS
M H PERMIT FEE
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC, BAR SINK
SUPP. O PERMIT
SQ. FT. @ _ ¢ POWER OUTLET ROOF DRAINS `
NO.
SQ. FT. @ DRAINAGE PIPING
COPIES
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
LEGAL DE5URIPTION
VALUATION $ vg 0 WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POO(, PVT
FLOOR DRAIN
MECHANICAL FEE
DBL
MECHANICAL FEES
ISWIM POOL, COMM
WATER SOFTENER
SET BACK OT SIZE
GRP
VENT SYSTEM [] FAN ❑ EVAP. COOL HOOD
SIGN
WASHER (AUTO )(DISH)
' QCr
APPLIANCE RYER
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A
GARBAGE DISPOSAL
PLAN CHECK FEE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
r.COMPRESSOR
LAUNDRY TRAY
PLAN CHECKER
FIN D? INS,
AIR HANDLING UNITCFMCFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
CONSTRUCTION FEE
DBL
� HP
POLE, TEMP/PERM'
LAVATORY
HEATING SYSTEMORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
ELECTRICAL FEE
DBL
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
STRONG MOTION
$
SQ. FT. @ a
WATER HEATER
SQ.FT.RESID @ 11/44
SEWAGE DISPOSAL
$
ADOR 5 ADDRESS
DEMOLITION FEE
SQ.FT.GAR @ 3/44
HOUSE SEWER
REGISTRATION
GAS PIPING
PLUMBING FEE
PERMIT FEE
$
PERMIT FEE
PERMIT FEE
OBL.
TOTAL FEES
m
MOB.HM.FEE
----
MICRO FEE
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-46
. FEE
PL. GK. FEE
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CONST. FEE42
ELECT. FEER'M
aux
SMI FEE
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II
FEE PL
.FEE
J F M A M 1 J A S O N D
JOB ADDRESS SP NO
OWNER
76
77
COMMUNITY
VALUATION
DATE - DST
OFFICE
Iyl.ts't
$ 6a
f 1
78SQ
M H PERMIT FEE
$
FF.C.
USE OF PERMIT - /+'
SUPP. O PERMIT
MIT
103397
NO.
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DE5URIPTION
7 7, A/Nt7 Q
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK OT SIZE
GRP
TYPE CK BY
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I
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A
PLAN CHECK FEE
$'
BOND AMT.PLAN
NO.
PLAN CHECKER
FIN D? INS,
✓TOR
A
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OW ER/AGS G Ar REQ _ . i CONTRACTOR
INSTRUMENTATION FEE
SPECIAL INSP
$
ADOR 5 ADDRESS
DEMOLITION FEE
REGISTRATION
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY ZIP CODE
TOTAL FEES $
TEL. NO./ AR
EA CODE TEL. NO.
AREA CODE
LICENSE
❑CASHCHECK ❑
.O. N.C.N.C.❑ tRef[�'
�Gi
71'"
RECEIVED BY in -�,� TREES REQUIRED
I IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
,SEWAGE SYSTEM !_ ,/i^t
���
AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL p (GJ�
MOTH OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
C.UMPt NSA I IUN INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT 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.