341111 (SATT)BUILDING PERMIT jft, DEPARTMENT OF BUILDING & SAFETY : FIELD OFFICE
PERMITNO.
3411
PERMIT NO.
3 4111 I'
-JobAddress Space Zip
WCOUNTY OF RIVERSIDE
OST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES , NO. PLUMBING FEES
1ST FL.. "
2ND FL.,
POR.
GAR.
CAR P.SQ..FT.,
WALL
ESTIMATED CONSTRUCTION
SQ. FT... ® $ UNITS
SQ. FT. (a} YARD SPKLR SYSTEM
SQ. FT• 8— M031LEHOME SVC. BAR SINK f
POWER OUTLET ROOF DRAINS
SQ. FT. 8
® DRAINAGE PIPING '
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT.. URINAL
VALUATION $ WATER PIPING
'NOTE: Not to be used os property tax valuation SW M POOL, PVT FLOOR DRAIN
MECHANICAL FEES SW:M POOL, COMM WATER SOFTENER
VENT SYSTEM,' ❑ FAN ❑ EVAP. COOL ❑ HOOD SIG".J WASHER (AUTO) (DISH)
Micro Film Fee -
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
Parcel No.
AIR .HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TENS USE PERMIT SVC WATER CLOSET
Aech. Fee Dbl 8
COMPRESSOR HP POL=, TEMP/PERM LAVATORY
t ocks -
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AM'ERESSERV ENT SHOWER
BOILER B.T.U. SQ. FT. @ ¢ BATH TUB
Legal Description
_ '
/ �0% ��, •/.r�J G- C� -G� ��� ' oZ•e�
SQ. FT. Cw ¢ WATER HEATER
r
SQ. FT. RES ID Q 1'A¢ SEWAGE DISPOSAL
R
SCS. FT. GAR @ 1/.¢ HOUSE SEWER
Zone
��
Grp
GAS PIPING
Unit
PERMIT FEE
PERMIT FEE PERMIT FEE
slumbing Fee'
_
/
TOTAL FEES -
/L✓� ��
MOB. rt M. FEE
� MICRO FEE, MECH. FEE �- PL. CK. FEE .
CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. FEE
PERMITNO.
3411
Supp.Permit.
-JobAddress Space Zip
.Owner
Community
Community
�'0,
Valuation
8
Date
Dist,
/ f
Off..
F.C.
NH Permit tee. $
Micro Film Fee -
Cop $
Use of Permit
Parcel No.
Use No. -
Ck.by
Aech. Fee Dbl 8
sl. Ck. Fee $
t ocks -
Lot Size
.S"G
:onstruction Fee Dbl $ '7
Legal Description
_ '
/ �0% ��, •/.r�J G- C� -G� ��� ' oZ•e�
F
S-
R
Electrical Fee Dbl $
Zone
��
Grp
Type
Unit
WI Fee - 8
slumbing Fee'
Dial $
r
Bond Amt.
8 �.
Plan No. -
-
Plan Checker -
Final Date Inspr
�'�'/
r
'
-
ip. Insp. Fee - 8
)emol. Fee
$
Const. Lender - Branch - 'I certify that in the performance of the work for which this permit is issued I shall
not employ any person in any manner so as to become subject to the workmen's com-
- pensotion laws of California.:'
Ad ss -- City Zip Owner Signoture
Builder Signature
tegistr. Fee $
Mileage Fee - $
Nitness Fee $
teinsp. Fee
•$
-
Owner/A •,>
Tel. - _
Zip .
'otol Fees
$
Address
J
City -
_
Zip
M.O. ❑ N.C. ❑ Cash ❑ Check I,
teceived by
,�
Contractor
Tel.
-
License #
'reel required -
iewoge System
�G Ll
Address - •,
Zip.
Ftly
Workers' Comp.- .
eyes E] no ❑
THIS PERMIT SHALL BECOME VOID 1F WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF verified by:
WORK FOR 120 DAYS SHALL -ALSO CAUSE PER!`11T TO BECOME VOID. _ 'A
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
NITH THE LAWS OF RIVF$SIDE COUNTY AND T iE STATE OF CALIFORNIA.
; HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 CF THE. BUSINESS AND PROFESSIONS CODE, OF THE STATE OF
CALIFORNIA. - -
'
fewer District
1r\\ \IlOr
:arm 284.208 (Rev. 4.77) 0S .