301989 (RPL)-FIELD OFFICE
DEPARTMENT OF BUILDING &.SAFETY
BUILDING PERMIT d6 ,,, ,,,,,�,,, ,,�� i, r •
'
PERMIT NO
3 V (/jj�
'Raw \ %JLPN 1 1 Vr Kl V CK3lUC
w
76
[DIST/
7.7
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
77
NO. PLUMBING FEES
V N LUATIO
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
FOR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL SQ. FT. @
SQxemd. FT. @ OC=s
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
j/
FLOOR DRAIN
d�
M H PERMIT FEE •
MECHANICAL FEES.
SWIM POOL, COMM '
WATER SOFTENER
F.C.
SUPP. O PERMIT FIE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL. ❑ HOOD,
SIGN
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER -
LL3f . eo/ I
GARBAGE DISPOSAL
FURNACE ❑ UNIT Cl WALL ❑ FLOOR ❑ SUSPENDED
8
LAUNDRY TRAY
COPIES
$
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION"SYSTEM B.T.U.
TEMP USE PERM SVC
DBL
WATER CLOSET
USE 90.
COMPRESSOR ' � HP
POLE, TEMP/PERM
LOT SIZE
LAVATORY
CK BY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
A2_1a
BOILER B.T.U.
SQ.FT. @ ¢
BATH TUB
SQ.FT.@ ¢
WATER HEATER
SQ.FT.RESID ,@" 11/4a
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢
PLAN CHECK FEE$
HOUSE SEWER
'
BOND AMT.
PLAN N67'PLAN CHECKER
FINAL DATE INSPEC70R
GAS PIPING
PERMIT FEE
PERMIT FEE
�
PERMIT FEE
DBL.
- TOTAL FEES
MOB.HM.FEE
MICRO FEE MECH. FEE
PC . CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB.FEE29
- I
J F M A M J J A S O N D
JOB ADDRESS SP NO
I
OWNER
76
f
77
COMMUNITY
V N LUATIO
A
DST
OFFICE
$ /�j ,yyyy
(Kir / /
j/
78
M H PERMIT FEE •
$
U E OF PERMIT
F.C.
SUPP. O PERMIT FIE
IT
NO.
LL3f . eo/ I
> ss
8
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
USE 90.
ZONt
SET BACK
LOT SIZE
GRP TYPE
CK BY
A2_1a
PLAN CHECK FEE$
BOND AMT.
PLAN N67'PLAN CHECKER
FINAL DATE INSPEC70R
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LEN INVOLVED
00
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
40.1
_
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
C6NTRACTO Y
INSTRUMENTATION FEE
�
4<1
SPECIAL
$
ADDRESS
AD RE55
INSP
DEMOLITON
�l
FEE
REGISTRATION
1
1.09—
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
400
TOTAL FEES $
TEL. NO. AREA
CODE
TEL. AF4EA CODE
LICENS
9
CASH ❑CHECK .O.❑N.C.❑
RECEIVED BY TREES"REQUIRED
HIS
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
J 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
T LL P
WIH
TTHE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
-- LUMI'ENJA I IUN INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 (REV. 6-7e) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA. ��