349517 (SATT)BUILDING PERMIT DEPARTMENT OF BUILDING 8 SAFETY FIELD OFFICE
34957-
Supp. Permit
309 -
Job Address Space Zip
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Owner
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T
P
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
Date
1
NO. PLUMBING FEES
Off.
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT.. Q $
UNITS
MH Permit Fee $
Micro Film Fee Cop $
SQ.. FT. @ YARD SPKLR SYSTEM
Use of Permit
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SQ. FT. @ MOBILEHOME SVC. BAR SINK
Use No.
SQ. FT. Q POWER OUTLET ROOF DRAINS
Mech. Fee''v $ %
SQ. FT. (aj DRAINAGE PIPING
Set Backs
SQ. FT. Q DRINKING FOUNTAIN
Construction Fee Z 9FA- $
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
S
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
Zone
/
FLOOR DRAIN
Type
MECHANICAL FEES
SWIM POOL, COMM
SMI Fee $
WATER SOFTENER
Z DITI' $
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
Plan No.L,�
WASHER (AUTO) (DISH)
Final Date
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
Demol. Fee
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
Const. Lender. Branch "I certify that in the performopceof the work for which this permit is issued I sholl
- - i not employ any person in any manner so as to become subject to the workmen's mm.
- pensation laws of California. -
Addre� ity Zip Owner Signature
s
Builder Signature
LAUNDRY TRAY
Mileage Fee $
AIR HANDLING UNIT CFM
IDLE METER
$
KITCHEN SINK
Owner/Agent ' - r✓ � � �
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
- $
COMPRESSOR HP
POLE, TEMP/PERM
City%
LAVATORY
M.O. C]A N.C. ❑ Cash ❑ C k gS
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
Tel.
BOILER � B.T.U.
SQ. FT. Cja ¢
Trees required
BATHTUB
Address
SQ. FT. G ¢
Zip
WATER HEATER
SQ. FT. RESID @ I Aa
SEWAGE DISPOSAL
SQ. FT. GAR @ 1A
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
/o/ I�
MOB. HM. FEE
MICRO FEE
MECH. FEE �PL. CK. FEE
/ 7a
CONST. FEE
s� �-�
ELECT.. FEE
Zl 4t
SMI FEE
-FEE
PLUMB. FEE
,,? -W--
PERMIT NO.
3 4 9 51 7
Supp. Permit
309 -
Job Address Space Zip
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Owner
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Community
A/10
Valuation
is
Date
1
Dist.
Off.
F.C.
MH Permit Fee $
Micro Film Fee Cop $
Use of Permit
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Parcel No.
773 -rya -rJi
Use No.
Ck.by
S
Mech. Fee''v $ %
PI. Ck. Fee $
Set Backs
Lor Siz�
Construction Fee Z 9FA- $
Legal Description `
JQ�,,, /2, /J � ��V�-/� ..rij';/_
f- '� Jam• �/ �G.eP
IS ',
S
p�
7+ $
Elettrical Fee / Ttn
Zone
/
Grp
le3
Type
--
Unit
SMI Fee $
Plumbing Fee
Z DITI' $
17
Bond Amt.
$
Plan No.L,�
Plan Checker
Final Date
Inspector--
Sp. Insp. Fee $
Demol. Fee
$
Const. Lender. Branch "I certify that in the performopceof the work for which this permit is issued I sholl
- - i not employ any person in any manner so as to become subject to the workmen's mm.
- pensation laws of California. -
Addre� ity Zip Owner Signature
s
Builder Signature
Regivr. Fee $
Mileage Fee $
Witness Fee $
Reinsp. Fee
$
Owner/Agent ' - r✓ � � �
Tel.
' / r� Zi
Total Fees
- $
Address ,r^-
C/6t►/ ... C✓ _. ��
City%
�/ Q Zi
G �Y / � of p
M.O. C]A N.C. ❑ Cash ❑ C k gS
Received by
Contractor
Tel.
License #
Trees required
Sewage System
Address
City
Zip
Workers' Comp.
yes ❑ no ❑
11
Sewer District
Form 284.208 (Rev. 4.771 &S
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF verified by:
WORK FOR 120 DAYS SHAaL iO C SE PE IT TO BECOME VOID.
I. HEREBY AGREE THA/t�[[L)J ON WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RIV6RSIDE COUNT AND THE STATE OF CALIFORNIA.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF
CALIFORNIA.