286393 (RPL)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a ' _ _ _ __ ___ ___ _
J f M A M J J A S O N D
PERMIT NO.
3 93
<.VVIY 1 T Vr Rivcrt�ivc Vii'
DST
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CONSTRUCTION ESTIMATE NO. ELECTRICAL.FEES NO. PLUMBING FEES
1 ST FL. SQ. FT. @ $ UNITS
2ND FL. SQ. FT. @ YARD SPKLR SYSTEM
POR. SQ. FT. @ MOBILEHOME. SVC. BAR SINK
GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS
CAR P. SQ. FT. @ DRAINAGE PIPING
WALL SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
77
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
DATE !
/�/,/ % iP
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO)(DISH)
OFFICE
.�
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
M H PERMIT FEE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
$
AIR HANDLING UNIT IDLE METER KITCHEN SINK
USE OF PERMIT s
ABSORPTION SYSTEM 0 B.T.U. _ TEMP USE PERM SVC WATER CLOSET
SUPP. TO PERMIT
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.,FT. @ ¢ BATH TUB
SQ.FT. @ ¢ WATER HEATER
.�>Ro
SQ.FT.RESID @ 1%4t SEWAGE DISPOSAL
-SQ.FT.GAR @ 3/4¢ HOUSE SEWER
GAS PIPING
'
PERMIT FEE PERMIT FEE PERMIT FEE
$
DBL.
I TOTAL FEES �MOB.HM.FEEJ
zw
LEGAL DESCRIPTION
MICRO FEE MECH. FEE PL. CK. FEE
CONST. FEE _ EL CT. FEE SMI FEE
FEE PLUMB, FEE'
J f M A M J J A S O N D
JOB ADDRESS - - SP NO
Ltsi�I✓/!tom
OWNER
�
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e
76
�/� ,'J QA1
h/ e( /r,ck
77
COMMUNITY VALUATION
14 • ' ' tit. -rJ, 4-.4 $
DATE !
/�/,/ % iP
DST/
f/
OFFICE
.�
78
M H PERMIT FEE
$
USE OF PERMIT s
F.C.
SUPP. TO PERMIT
PE MI NO.'
.�>Ro
°MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
X17-1-17 0/
.MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TV PE - GK BY
}L
1
PLAN CHECK FEE -
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE IN
ECTOR
1'
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
9
_..^
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONT��tr''
INSTRUMENTATION FEE
'SPECIAL INSP
-
$.
ADDRESS ADDRESS
DEMOLITION
,REGISTRATION
FEE
I'
PLUMBING FEE
DBL
$
CITY . ZIPGODE CITY
r ZIP CODE
TOTAL FEES N)O.- $TEL.
�
NO.
AREA CODE TEL,
.-
AREA CODE
LICENSEE 9
CASH❑CHECK-O.❑N.C.❑ %a,
3W4
/NO.
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71
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RECEIVED BY TREES REQUIREDTHIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME. VOID.
t
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, I ALSO AGREE TO CARRY
FORM 284-208 (REV. 6-76) .
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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.