286414 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT NT a
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J F I AA A M J 1 A S O N D
PIER MIT NO.
OWNER
COU Y OF RIVERSIDE
��p
77t
DST
CONSTRUCTION ESTIMATE
DATE y� «y/
II^ 3 716
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL. SQ.
FOR. SQ.
GAR. ANQ SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $
...
UNITS
M H PERMIT FEE
FT. @ YARD SPKLR SYSTEM
FT. @ 3,V . 4' MOBILEHOME SVC. BAR SINK
F.C.
FT. @.. " i POWER OUTLET ROOF DRAINS
PERMIT NO.
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ r. WATER PIPING
dol
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
COPIES
$
MECHANICAL FEES
BOOK PAGE j PARCEL
SWIM POOL, COMM
.MECHANICAL FEE
WATER SOFTENER
$
VENT SYSTEM ❑ FAN ❑ EVAP. COOL KHOOD
QQ
SIGN
LOT
LOTT SIZE
WASHER (AUTO) (QaU)
S
APPLIANCE RYER
00
GARBAGE DISPOSAL
/d
FURNACE ❑ UNIT Cl WALL ❑ FLOOR ❑ SUSPENDED
[f
I/
1 19
S I'
LAUNDRY TRAY
/.
116
X/00
AIR HANDLING UNIT --� CFM
IDLE METER
KITCHEN SINK
BOND AMT.
ABSORPTION SYSTEM 0 B.T.U.
PLAN CHECKER
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR -" � HP
POLE,'TEMP/PERM
LAVATORY
A
"CONSTRUCTION FEE
HEATING SYSTEM XORCED ❑ GRAVITY
00
AMPERES SERV ENT
NAME OF CONST, LENDER BRANCH
SHOWER
NO LENDER INVOLVED
BOILER B.T.U.
SQ.FT. @ ¢
BATH TUB
t7G1
.ELECTRICAL FEE
DBL
$
SQ. FT. @ a
ADDRESS CITY
WATER HEATER
STATE
f.�
Az Q.FT.RESID @ 11/4a
SEWAGE DISPOSAL
STRONG MOTION
INSTRUMENTATION FEE
$
qi&SQ.FT.GAR @ 1/4¢
41,
HOUSE SEWER
GAS PIPING
FEE
PERMIT FEE
O�,Q
PERMIT FEE
00
PERMIT FEE
+
DBL.
TOTAL FEES
J9�.
MOB.H M.FEE
MICRO FEE
MECH. FEE
1
P . C FEE
CONST. FEE
ELECT. FEE
SMI FEE
?�
FEE
PLUMB. FEE
a33,
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J F I AA A M J 1 A S O N D
JOB ADDRESS SP NO
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OWNER
1
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COMMUNITY !.
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VALUATION
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$47 H41
DATE y� «y/
II^ 3 716
DST
f OFFICE
� 7S
r,
M H PERMIT FEE
$
USE OF PERMIT
AL
F.C.
SUPP. TO PERMIT
PERMIT NO.
dol
MICROFILM FEE
COPIES
$
BOOK PAGE j PARCEL
LEGAL DESCRIPTION
.MECHANICAL FEE
DBL
$
USE NO.
ZONE
BACK
LOT
LOTT SIZE
GRP
GRR "P/�a TYPE
CK BY
�SEET
/d
[f
I/
1 19
S I'
S I IR
/.
116
X/00
•W�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
[SAL DATE E'PECTO
A
"CONSTRUCTION FEE
DBL
$
NAME OF CONST, LENDER BRANCH
OFFICE
NO LENDER INVOLVED
.ELECTRICAL FEE
DBL
$
AN
ADDRESS CITY
STATE
f.�
'; 4
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENTS SIGNATURE CONTRACTOR
SPECIAL INSP
DEMOLITION
FEE
$
ADDRESS ADDRESS
�
PLUMBING FEE
DBL
$
CITY .yZZIIP CODE CITY
TOTAL FEES $
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RECEIVED BY TREES REQUIRED
H IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
OR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
MPENSATIONINSURAN
SEWAGE SYSTEM
T /��
/J�
LL
p
IF, ;/!
CE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAW5 OF 11 -it— A ItOF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 204-208 IREV. 6-761 SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.