290201 (ELEC)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY •
BUILDING PERMIT NT &I
J F M A M J J ({ S O N D
PERMIT NO.
2 90
COU Y OF RIVERSIDE
DJ/SIT
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
USE O PERMIT
5, he 7/ fr tr'g90201
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
SUPF7. TO PERMIT PE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
NO.
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
MICROFILM FEE
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
-,
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
BOOK PAGE PARCEL
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
:MECHANICAL FEE
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT I SHOWER
$
`
BOILER B.T.U. SQ. FT. @ a BATH TUB
USE NO.
SQ. FT. @ a WATER HEATER
SET BACK
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
GRP TYPE
SQ.FT.GAR @ 3/4a HOUSE SEWER
C/jKBY
I
GAS PIPING
5
PERMIT FEE
PERMIT FEE PERMIT FEE
DBL.
I TOTAL FEE$
IMOB.HM./�F E
MICRO FEE MEC H. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE SMI FEE
E
FEE PLUMB.'VE
J F M A M J J ({ S O N D
JOB ADDRESS I SP NO
OWNER r
77
COMMUNITY � j
,/ jy� / AV 7A •
VALUATION
$
DATE
C
DST/
OFFICE
78
M H PERMIT FEE
$
USE O PERMIT
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F.G.
SUPF7. TO PERMIT PE
MIT
NO.
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION % Sj ^ry
:MECHANICAL FEE
DBL
$
`
USE NO.
ZONE
11.0 q/
SET BACK
LOT SIZE
GRP TYPE
C/jKBY
I
S
5
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS j� CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/A ENT.'S SIGNATU It - CONTRACTOR
, x
SPECIALINSP
DEMOLITION
REGISTRATION
FEE
$
ADDRESS ADDRESS
�%
r .'e�� r
P
PLUMBING FEE
DBL$
CITY f ZIP CODE CITY
ZIP CODE
TOTAL FEES $
CASH❑CHECK❑M.O.❑N.C. /
TEL. NO. �j� a AREA
^�64 f/�+
CODE TEL,
/
NO,
AREA CODE
LICENSE a
RECEIVED BY,, F TREES R' QUIRED
HIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITRIN 120 DAYS. CESSATION OF
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
TH THE LAWS Of RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
SEWAGE SYSTEM
T LL
k�K
P
l.vmrtNJA I ION INJUKANCt UPON MY tMPLOYEE5. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS 15 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.
DEPARTMENT OF BUILDING AND SAFETY
SOB ADDRESS
OWNER
CC
COUNTY OF RIVERSIDE
USE OF PERMIT
MOBILEHOME
INSTALLATION
SP NO.
DATE/
PERMIT NO.
108779
MOBILEHOME
INSTALLATION PERMIT
COMMUNITY
DST
1OFFICE
nil1
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�'
FI L I NG FEE
b
LEGAL DEESCRI PTION
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al'
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c..;� *
SETBACK
ZO�N'Ey
USE NO.
-
CK BY
PERMIT FEE
FINAL DATE
INSPECTOR
REINSPECTION FEE
b
TOTAL FEES �
�6
as
ESCROW COMPANY
BRANCH OFFICE
a
CASH ❑ CH EC MO. ❑
N. C. ❑
ADDRESS
CITY
ZIP CODE
-
RECEIVED BY r•-�"'-
OWNER/AGENT' S SIGNATURE
CONTRA $,_
rf'
j
MH MANUF f r f I �
/�"+ ?/ Cr�,,j!
NEW
ADDRESS
ADDRESS
SI ZE 41 X
❑ RELOCATED
CITY
ZIP CODE
CITY ZIP CODE
.'�cJ 1n
SUPPORT STRUCT. PERMIT H
TEL. NO.
TELE. NO. LICENSE
�-,.
3i` 7-1%20 �' 3-/`2_
GRADING PERMIT N
�j D0 X"
UTILITIES PERMIT N4
WHITE -HO. Wr
YEL L OW -AUDIT
GREEN -OWNER
P INK-FIEL D OFFICE
284-6 10-75 BEIGE -FIELD
THIS PERMIT SHAL L BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.
CESSATION OF WORK FOR 120 DAYS SHAL L ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE T HAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL B E DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF
CALIFORNIA. I ALSO AGREE TO CARRY COMPENSATION 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 SO IN ACCORDANCE WITH SECTION 5541 OF THEio
BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA,
DEPARTMENT OF BUILDING AND SAFETY
108 ADDRESS T
�t%
OWNER `; 7
COUNTY OF RIVERSIDE
GREEN -OWNER
✓ i-/
.s.//iWs
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND
SPECIFICATIONS HAS DONE SO BJ ACCORDANCE WITH SECTION 5541 OF THE
USE OF PERMIT
SP NO.DATE
ERMIT NO.
' MOBILEHOME
MOBILEHOME � INSTALLATION
,3 _
O g T 5 H
INSTALLATION- PERMIT `
COMMUNITY
DST
OFFICE
LEGAL DQXR1P ON
FILING FEE
$
_ . ,p.+. an Pap wA7,_ (
S.
-
SETBACK
ZONE
USE NO.,
r.
CK BY
FERMI T FEE
$
, S ,
F S�� R ii
FINAL DATE
REINSPECTION FEE
$
�j � -77
li(.PJCTORp
J
TOTAL FEES »
ESCROW COMPANY
BRANCH OFFICE
-
$ ��
CASH ❑ CHECK MO. ❑
N. C. ❑
ADDRESS
CITY _
ZIP CODE
RECEIVED BY
+
OWNER/AGENT' S SIGNATURE
CONTRACTOR r /
�•
MH MANUF5otroze %��
`�
%~
NEW
ADDRESS
ADDRESS
SI ZE X®-
❑ RELOCATED
11 6'r
- '
CITY' ZIP CODE
CITY
ZIP CODE
'
SUPPORT STRUCT. PERMIT p
TEL. NO.TEL.
NO.
LICENSE
GRADING PERMIT q
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.
UTILITIES PERMIT # ��
' WHITE -HO. �`
YELLOW -AUDIT
G" CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE T HAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL B E DONE
I N ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF'
CALIFORNIA. 1 ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON NAY .f
EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING +
GREEN -OWNER
CONTRACTORS IS ALSO GUARANTEED.
• PINK -FIELD OFFICEI
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND
SPECIFICATIONS HAS DONE SO BJ ACCORDANCE WITH SECTION 5541 OF THE
284-6 10-75 BEIGE -FIELD
BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.