290545 (RPL)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a /`n11w[TW ne mvenclne 1
FIELD OFFICE
S O
J F M A M J 1 A N D
PERMIT NO.
7w+VVI\
1 1 Vr RI V GRJI{/G
ST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
DATE
NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
STIM D CONSTRUCTION
FT. @ $
UNITS
SQ. FT. @ YARD SPKLR SYSTEM
M H PERMIT FEE$
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
USE O PER IT
FT. @ DRAINAGE PIPING
SUP . TO PER IT
FT. @ DRINKING FOUNTAIN
NO.
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
%
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
COPIES
$
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER
tA.,1-1-
MECHANICAL FEE
DBL
GARBAGE DISPOSAL
USE NO.
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
SET BACK
LOT SIZE
LAUNDRY TRAY
TYPE
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
M
y,e%
COMPRESSOR HP
POLE, TEMP/PERM
'PLAN CHECK FEE
LAVATORY
$
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
PLAN CHECKER
SHOWER
TOR
BOILER B.T.U.
SQ.FT. @ a
00
BATH TUB
SQ.FT. @ ¢
CONSTRUCTION FEE
WATER HEATER
$
NAME OF CONST. LENDER BRANCH OFFICE
SQ.FT.RESID @ 11/4¢
SEWAGE DISPOSAL
00
SQ.FT.GAR @ 114a
ELECTRICAL FEE
HOUSE
$
ADDRESS clrr
STATE
GAS PIPING
PERMIT FEE
TRONG MOTION
INSTRUMENTATION
PERMIT FEE3
'Oc
PERMIT FEE
OWNER/AG S SIGNAYJRE, CONTRACTOR
FEE
DBL.
I TOTAL FEES
MOB.HM.FEE
MICRO FEE
MECH. FEE . CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
S O
J F M A M J 1 A N D
JOB ADDRESS SP NO
' I
OWNER
COMMUNITY
VALUATION
DATE
y77
I
78
M H PERMIT FEE$
USE O PER IT
F.C.
SUP . TO PER IT
PE MI
NO.
'
%
0545
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL LEGAL DESCRIPTION
tA.,1-1-
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE
I
S O S/
R
r�
M
y,e%
kBY
'PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSP
TOR
00
.�....�
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH OFFICE
NO LENDE VOLVED
00
ELECTRICAL FEE
DBL
$
ADDRESS clrr
STATE
TRONG MOTION
INSTRUMENTATION
$
-y
OWNER/AG S SIGNAYJRE, CONTRACTOR
FEE
5PECIALINSP
$
ADD ADDRESS
DEMOLITION
FEE
kEGISTRATION
�
PLUMBING FEE
DBL
$
CITY` IP CODE CITY ZIP CODE
>7di
1 �+
TOTAL FEES * $
TEL. NV.., AREA
CyODE TEL. NO.
AREA CODE
LICENSE 4
`
�CASH❑.
CHECK O.❑N.C.❑ 7/
3
, /'
BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE I
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY'
LVMYCry DH I ION INOUKAIN(-t UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE VP
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
L7-
zea-zoa IRE V. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.