286363 (SFD)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
FIELD OFFICE
J F M A M J J A S O N D
PERMITNO.
286363
OWNER
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Ig/ N
bVVlr11 Vr RIYCRJIVC
7"
—a57 G
DjjjjST
i
CONSTRUCTION ESTIMATE
VALUATION
$
NO. ELECTRICAL FEES
DST
NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL. SQ.
POR. SQ.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $
UNITS
M H PERMIT FEE
FT. @ YARD SPKLR SYSTEM
$
FT. @ MOBILEHOME SVC. BAR SINK
USE PERMIT 0/
AAL
47r
FT. @ POWER OUTLET ROOF DRAINS
SU . TO PERMIT �PEZR
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
COPIES
SQ. FT. @ URINAL
VALUATION $ .4-0 WATER PIPING
LEGAL DESCRIPTION
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
0""a6A X _
MECHANICAL FEE
MECHANICAL FEES
$
SWIM POOL, COMM
USE NO.
WATER SOFTENER
SET BACK
LOT
LOT SIZE
AOIX rO
VENT SYSTEM >OAN ❑ EVAP. COOL XHOOD
I
SIGN
S A
WASHER (AUTO)
PLAN CHECK FEE
APPLIANCE XRYER
BOND AMT.
PLAN NO.
GARBAGE DISPOSAL
DATERS
OR t
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
jS
AIR HANDLING UNIT, CFM
IDLE METER
DBL
KITCHEN SINK
NAME OF CONST, LENDER v BRANCH
ABSORPTION SYSTEM B.T.U.
NO LENDER INVOLVED
TEMP USE PERM SVC
WATER CLOSET
00
COMPRESSOR 3 770jt)E�� HP
C-9
POLE, TEMP/PERM
DBL
LAVATORY
ADDRESS CITY
HEATING SYSTEM FORCED ❑ GRAVITY
BOILER B.T.U.
Gid
400 AMPERES SERV ENT
SQ.FT. @ a
Q„Q
SHOWER
BATH TUB
UCa
J
SQ.FT. @ a
WATER HEATER
�3
OWNER/AGENTS SIGNATURE CO
ACTOR
N � + P.
Q.FT.RESID @ I lAc
SEWAGE DISPOSAL
'q%fj
SPECIAL INSP
SQ.FT.GAR @ 3/4a
'
HOUSE SEWER
ADDRESS ADDRESS
DEM
REGISOTRATTIION
FEE
GAS PIPING
PERMIT FEE
00
PERMIT FEE
PLUMBING FEE
PERMIT FEE
$
33
DBL.
TOTAL FEES
jMOB.HM,FEEj
MICRO FEE
MECH. FEE
PL. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
J F M A M J J A S O N D
JOB ADDRESS SP NO
hvQ �`*0 i
OWNER
e� .JO•J
Ig/ N
'
76
—a57 G
77
COMMUNITY
0410 f -A
VALUATION
$
DATE
�/
DST
OFFICE
76
/ A
M H PERMIT FEE
$
USE PERMIT 0/
AAL
47r
F.,
'00
SU . TO PERMIT �PEZR
MICROFILM FEE
COPIES
$
BOOK AGE PARCEL
LEGAL DESCRIPTION
-�f� 0
0""a6A X _
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT
LOT SIZE
AOIX rO
GRP TYPE CK By
.
I
S/
S A
R /
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLANECKEFINAL
DATERS
OR t
jS
-��
CONSTRUCTION FEE
DBL
$
NAME OF CONST, LENDER v BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
J
/,
J
STRONG MOTION
INSTRUMENTATION FEE
$
�3
OWNER/AGENTS SIGNATURE CO
ACTOR
N � + P.
.�I
'q%fj
SPECIAL INSP
$
ADDRESS ADDRESS
DEM
REGISOTRATTIION
FEE
�C
PLUMBING FEE
DBL
$
33
CITY ZIP CODE CITY
ZIP CODE
9:2A 71/
,
TOTAL FEES
$ s�
TEL. NO. AREA
CODE TEL,
NO.AREA
CjO(D�E
LICENSE n
CASHQCHECK .O.E)N.C.❑
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RECEIVED BY
REES REQUIRED
kORM11SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
REBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T 149,091
LL
P�
ITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
I FORM 2114-208 IREV. 6-761
C-VMPENSAIR)IV InJUKANCE UPON MT EMPLOYEES. C OMPUANCE WnN THE LAWS OFTHE STATE Vr
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 THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.