301839 (SATT)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY,
BUILDING PERMIT
J F M A M J J A S O N D
PERMIT NO. 9
0183
OWNER
Cmutm 1 i Or KI V CKWUC
COMMUNITY
TION
$
DST
�l
CONSTRUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
H PERMIT FEE
NO. PLUMBING FEES
$
1ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ, FT. @ $
UNITS.
I
T NO
.
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ '10o. MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
839
SQ. FT. @ URINAL
COPIES .
VALUATION is WATER PIPING
Q�
NOTE: Not to be used as property tax valuation
LEGAL DESCRIP7 N
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
.
SWIM POOL, COMM
DBL
WATER SOFTENER
VENT SYSTEM XFAN ❑ EVAP. COOL CWHOOD
470
SIGN
LOT SIZE
WASHER (AUTO) (DJW
TYPE CK BY
APPLIANCE RYER
3co -
S
R
J
GARBAGE DISPOSAL
CIO
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
r
LAUNDRY TRAY
AIR HANDLING UNIT CFM
PLAN CHECK FEE
IDLE METER
$
KITCHEN SINK
! GYM
ABSORPTION SYSTEM B.T.U.
PLAN CHECKER
r
TEMP USE PERM SVC
TOR
,5- WATER CLOSET
COMPRESSOR E:::� HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEMORCED ❑ GRAVITY
e"
AMPERES SERV ENT
Qp
SHOWER
BOILER B.T.U.
SQ.FT. @ 4
BATH TUB
S
$
SQ.FT. @ a
OFFICE
I.WATERHEATER
l�C>
efiQ.FT.RESID @ 11/4c
ILI
SEWAGE DISPOSAL
ELECTRICAL FEE
DBL
SQ.FT.GAR @ 3/4¢
HOUSE SEWER
STATE
GAS PIPING
L7�S
PERMIT FEE?
PERMIT FEE
PERMIT FEE
t�f;
DBL.
I TOTAL FEES�y/�
C� /�+e
IMOB.HM.FEEI
MICRO FEE
M H. FEE�E^�(
�L/
PL. CK. FEE
�wr:
CONST. FEE
i� fr x ✓
EL
y , j. FEE
rJ X" 91
SMIFFs,EE
FEE
PLU B.FE/E�'�}
J F M A M J J A S O N D
JOB ADDRESS SP NO
I-
OWNER
76 _t77
COMMUNITY
TION
$
DAYE
6 1w
DST
OFFICE
78
H PERMIT FEE
$
USE OPERIT
PP. PERMITPE
I
T NO
.
/s
01
839
MICROFILM FEE
COPIES .
$
BOOK 41PAGE PARCEL
LEGAL DESCRIP7 N
.
MECHANICAL FEE
DBL
$
USE NO.
SET BACK
LOT SIZE
GRP
TYPE CK BY
I
S
S
R
J
r
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.*
PLAN CHECKER
r
FINAL DATE INSPE
TOR
f
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO ER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
o0
d
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACFTORa,`.
.. J
Y...y
INSTRUMENTATION FEE
`SPECIALINSP
$
ADDREST—
DEMOLITION
FEE
jADORESS
REGISTRATION
,
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
�L A
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
N
AREA CODE
n
CASH❑CHECK fOl.O.❑N.C.❑ (:
JL.ICENSE
RECEIVED BY TREES REQUIRED
T SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
R 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
�V/
SEWAGE SYSTEM
T
LL
P r
jI2EBY GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
H THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, -1 ALSO AGREE TO CARRY
— " 'C-UMPENSATION'INSURANCE UPON -MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THEINDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-78). SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.