286662 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT �•�� ulTv �r nlv0nrl
J F M A M J J A S O N 0
PERMIT NO.�r
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77
COOMMMMUNITY
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DST
J/
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
f �7 /
1 ST FL.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $ '
M H PERMIT FEE
UNITS
$
USE F PE MIT
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ sit MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
e�
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
MICROFILM FEE
VALUATION $ WATER PIPING
$
NOTE: Not to be used as property tax valuation
BOOKPAG[E� P;Q LEGAL DESCRIPTION
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
DBL
SWIM POOL, COMM
t
WATER SOFTENER
ZONE,/%
LOT SIIZZ[E %0� GRP
SET BACK LOT
VENT SYSTEM 5<AN ❑ EVAP. COOL OOD
Q
SIGN
WASHER(AUTO ISH)
APPLIANCE RYER
I S S w.I R �I �I
GARBAGE DISPOSAL
—04,
$
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
BOND AMT.
`
PLAN CHECKER
lop
LAUNDRY TRAY
INSP CTOR
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
;:L :5 T?
ABSORPTION SYSTEM B.T.U.
CONSTRUCTION FEE
TEMP USE PERM SVC
WATER CLOSET
NAME OF CONST. LENDER
BRANCH OFFICE
COMPRESSOR. A) � HP
`.
POLE, TEMP/PERM
LAVATORY
,
HEATING SYSTEMORCED ElGRAVITY
Q2
AMPERES SERV ENT
$
SHOWER
QQ
cm
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
.a
STRONG MOTION
SQ. FT. @ a
$
WATER HEATER
OVINMERIAGENIS SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
` Q.FT.RESID @ 11/4¢
SEWAGE DISPOSAL
:'SPECIAL INSP
qkl4ZQ.FT.GAR @ t/4¢
$
HOUSE SEWER
ADDRESS
ADDRESS
,,REGISSTRATTIION
FEE
GAS PIPING
PERMIT FEE
Q ISL
DBL
PERMIT FEE
PERMIT FEE
CITY ZIP CODE
DBL.
TOTAL FEES
MOB.H M.FEE
MICRO FEE
MEC H. FEE
L. CK. FEE
CONST, FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEEAT
J F M A M J J A S O N 0
JOB ADDRESS SP NO OWNER
1
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A
276
- O j �
77
COOMMMMUNITY
u-li) lI
$ ,U+AATION DATE .r.�
"%t
/DST JOFFICE
78
X3'7
f �7 /
/
M H PERMIT FEE
$
USE F PE MIT
F.C. SUPPI TO PE T PERMIT NO.
e�
MICROFILM FEE
COPIES
$
BOOKPAG[E� P;Q LEGAL DESCRIPTION
'MECHANICAL FEE
K
DBL
$ /
t
USE NO.
ZONE,/%
LOT SIIZZ[E %0� GRP
SET BACK LOT
TYPE C K BY
I�
S
I S S w.I R �I �I
`PLAN CHECK FEE
—04,
$
BOND AMT.
PLAN NO,
PLAN CHECKER
lop
FINAL DATE
INSP CTOR
AV4
;:L :5 T?
_1_s�
CONSTRUCTION FEE
DBL$
sa
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
`.
'ELECTRICAL FEE
DBL
$
A°°res a
cm
STATE
.--
STRONG MOTION
$
g
OVINMERIAGENIS SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
Indian Wlllis Const. Co.
:'SPECIAL INSP
$
ADDRESS
ADDRESS
,,REGISSTRATTIION
FEE
P 0 Box 917
".PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
37
'
La Quinu, CA 92253
TOTAL FEES $
00
TEL. NO. AREA
CODETEL.
7///,
NO.
AREA CODE
LICENSE.n
CASH❑CHECK O.❑N.C.❑ 01
-'RECEIVED BY �• REES REQUIRED
I ERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
W RK 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
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
i(1M0FAICATlI &I—CIIDA—cI
l
.SEWAGE SYSTEM T /�!�
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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.