290587 (ELEC)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT / /�I ulry �r nl lr r—e
J F M A M J J A S O N D
PERMIT NO, 71
9058
OWNER
Lwwry 1 1 Vr RI Y GRJIIJG
lqmw
COMMUNITY
ALUATION
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
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[MH PERMIT FEE
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
F.C.
SQ. FT. @ POWER OUTLET ROOF DRAINS
IEZIT
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
EMICROFILM FEE
WASHER (AUTO) (DISH)
$
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
FSyAGGEE�
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
DAL
$
LAUNDRY TRAY
USE NO. zok-a SET BACK LOT SIZE GRP TYPE BY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
s
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
� I 5 S R
WATER CLOSET
$
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
150AMPERES SERV ENT
DBL
SHOWER
NAME OF CONST. LENDER
BOILER B.T.U.
SQ.FT. @ ¢
BATH TUB
SQ.FT. @ ¢
WATER HEATER
DBL
$
SQ.FT.RESID @ 11/4¢
CITY
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢
HOUSE SEWER
,
GAS PIPING
STRONG MOTION
PERMIT FEE
$
PERMIT FEE
✓
PERMIT FEE
! INSTRUMENTATION FEE
DBL.
I TOTAL FEES
rM.FEE
MICRO FEE
MEC H. FEE L. 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
I
`
OWNER
(76
1-, 77
COMMUNITY
ALUATION
DATE
DST/
OFFICE
i
11.7 8
[MH PERMIT FEE
$
USE F ER 1
F.C.
suPPOTO PER IT
IEZIT
NO
90587
EMICROFILM FEE
COPIES
$
BO/OK PARCEL LEG}A"LL DESCRIPTION34C>e
FSyAGGEE�
I. MECHANICAL FEE
DAL
$
USE NO. zok-a SET BACK LOT SIZE GRP TYPE BY
ICI
I I
s
� I 5 S R
PLAN CHECK FEE
$
BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE I PB -TOP
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
!ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
QQ
,
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONTRACTOR t e tf '
vT
! INSTRUMENTATION FEE
�- PECIAL INSP
$
ADDRESS
ADDRESS
DEMOLITION
I
�✓ ' �I } Ale X11
'7�
�l
REGISTRATION
I
IFEE
�7S !
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
ell,
TOTAL FEES
$
TEL. NO.
AREA CODE
TEL. NO....q�r�//,,,,
AREA COD/E
LICENSE u
.CASH❑CHECK .0.0N.C.❑d071—JC�tJ
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RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK 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
ITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
'COMPENSATION 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. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.