286986 (BLCK)iBUILDING PERMIT DEPARTMENT OF BUILDING.& SAFETY
FIELD OFFICE
PERMIT 4NO. R
N D
�.VV1�1 1 Vr R11IGR�IVG
7' _. _
DST
_ CONSTRUCTION 'ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ.
2ND FL.
POR.
GAR.
CAR P. SQ.
" WALL SQ.
r f3lp - 'SQ.
ESTIMATED CONSTRUCTION
FT. @ $
UNITS
VALUATION
DATE
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
78
FT. @ URINAL
h1 H PERMIT FEE,
VALUATION is WATER PIPING
$
NOTE: Not to be used as property tax valuation
SWIM POOL; PVT
FLOOR DRAIN
SUPFI. TO PER IT I PERMIT
' MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER(AUTO)`(DISH) ._
APPLIANCE- ❑`DRYER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR .❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
$
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERM SVC.
WATER CLOSET
COMPRESSOR 0 -HP
POLE, TEMP/PERM
LAVATORY
745
- HEATING SYSTEM' ❑ FORCED ❑ GRAVITYAMPERES
SERV ENT
SHOWER
$
BOILER B.T.U.
SQ.FT. @ ¢
BATH TUB
SET BACK 'LOT SIZE
GRP
SQ.FT' @ 4
WATER HEATER
'
SQ.FT.RESID @ 11/44
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢'
HOUSE SEWER
5
GAS PIPING
PERMIT, FEE 1i
PERMIT FEE
PERMIT FEE
- DBL.
TOTAL FEES
00
IMOB.HM.FEEI
- MICRO FEE
MECH. FEE PL. CK. 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
OWNER
76
7 T
57
COMMUNITY
VALUATION
DATE
D`ST. OFFICE
1,41 ur
78
h1 H PERMIT FEE,
$
USE OF PERMIT
F.C.
SUPFI. TO PER IT I PERMIT
NO.
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
745
,r j
{'
(MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK 'LOT SIZE
GRP
TYPE
BV
5 5
5
RICK
(PLAN CHECK FEE.
$ -
BOND AMT.
PLAN NO.
CHECKER.
FINAL DATE - .- INSPECTOR
7AN
I:ONSTRUCTIQN FEE-
DBL
$
D
NAME OF CONST. LENDER -
BRANCH OFFICE
NO LENDER INVOLVED
/
00
%
�
:ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
(STRONG MOTION
$
OWNER/ S SIGNATURE
CONTRACTOR
INSTRUMENTATION. FEE
T
.. y
(SPECIAL INSP^-
$
ADD
ADDRESS
,DEMOLITION
FEE
� :fREGISTRATION
gyp' 7 %. SA IA -41 4) -
;PLUMBING FEE
DBL
$
CITYZIP CODE
CITY ZIP CODE
Gj
TOTAL FEES
$
TEL. NO. AREA
CODE/
TEL. NO.
AREA CODE-.
LICENSE a
CASH❑CHEC .O.❑N.C.❑
10
64 11—^%5
.RECEIVED BY
TREES REQUIRE
THIS'PERMIT SHALL BECOME -VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 1.20 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
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, 1 ALSO AGREE TO CARRY
r'n(,n0cuc 4 T.nl .—. i
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 8.78) , - SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA. -