286661 (SFD)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a r /11 u1Tv f%e ol%I clue
J F I M A M
PERMIT NO.
A S O
--wUN1 1 Vr r%jv r%JIVG
JOB ADDRESS SP NO
I
Dim
OWNER
it 7 n
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST Fl. /
2ND FL.
POR.
GAR.
CAR P.
" WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ S✓ $ ^
UNITS
SQ. FT. @ YARD SPKLR SYSTEM
71�`7i
SQ. FT. @ t*% MOBILEHOME SVC. BAR SINK
SQ. FT. @• :,� POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
F.C.
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
g^r
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
=.MICROFILM FEE
MECHANICAL FEES
$
SWIM POOL, COMM
WATER SOFTENER
BOOK PAGE PARCEL
VENT SYSTEM WAN ❑ EVAP. COOL kHOOD
SIGN
WASHER(AUTO�DISH)
APPLIANCE DRYER
t,
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
Lot 19, 91.4 Santa G1erselita Vale #1
AIR HANDLING UNIT CFM
DBL
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
ZONE
TEMP USE PERM SVC
WATER CLOSET
BACK
COMPRESSOR ? HP
LOT SIZE
POLE, TEMP/PERMLAVATORY
TYPE ICK BY
HEATING SYSTEM ORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
9
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
5'
Is 5, 1,25,
SQ.FT. @ a
WATER HEATER
b
- *r SQ.FT.RESID @ 11/441
SEWAGE DISPOSAL
,
S
e/AWSQ.FT.GAR @ 3/4a
�' HOUSE SEWER
-z
PLAN CHECK FEE
11
GAS PIPING
2 �. t
PERMIT FEE
BOND AMT.
PERMIT FEE
1 PERMIT FEE
-3
DBL.
TOTAL FEES
9f
MOB.HM.FEEJ
MICRO FEE
ME FEE
j G
PL. K. FEE
CONST. FEE
'y
ELECT. FEE MI FEE
FEE
PLUMB. FEE
J F I M A M
J J
A S O
N D
JOB ADDRESS SP NO
I
Dim
OWNER
it 7 n
'r 76
'77
.—�W"vesida
DAT fl
71�`7i
"I I FT—A I
M H PERMIT FEE
$
F.C.
Su . T RMT4 PE MIT
R6661
=.MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
773-2-12-004
Lot 19, 91.4 Santa G1erselita Vale #1
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET
BACK
LOT SIZE
GRP
TYPE ICK BY
R -I
1.50SX1001
-
201
5'
Is 5, 1,25,
,
S
-z
PLAN CHECK FEE
$
BOND AMT.
PLAN NO,
PLAN CHECKER
FINAL DATE
INSPECTOR
+
11 v�
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
fa
' STRONG MOTION
a�
$
OWNER/AGENTS SIGNATURE
CONTRACTOR
=INSTRUMENTATION FEEVella
I
Cnnst- Co.,
SPECIALINSP
$
ADDRESS
ADDRESS
`'DEMOLITION
FEE
.'REGISTRATION
PLUMBING FEE
DBL
$
• ZIP CODE
CITY ZIP CODE
CA
TOTAL FEES $
T NO. AREA C DE
TEL. NO. AREA CODE LICENSE tt
O
iCASH ❑CHECK .O.❑N.C.❑
00
RECEIVED BY
"
TREES REQUIRED
ArOCWPERMIT
SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WO FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I REBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
.SEWAGE SYSTEM
r
T
LL
P
�� /
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY "
Wim• C.UNIPtINJAIIUIN IINSUKANC.t UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF IFtt SIAIt OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 264-206 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF.THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.