290614 (SATT)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT
FIELD OFFICE
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F
PERMIT NO.
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'77
COMMUNITY
DST
'
CONSTOUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
'
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t
1ST FL:
2ND FL.
POR.. -
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
F.C.
UNITS
PERMIT
NO.
SQ. FT. @ YARD SPKLR• SYSTEM'
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @_&a! POWER OUTLET: ROOF DRAINS "
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN.
SQ. FT. @ URINAL
VALUATION $ G+t9 WATER PIPING -
MICROFILM FEE
COPIES
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
ISWIM POOL, COMM
WATER SOFTENER
'MECHANICAL FEE
D L
VENT SYSTEM ❑ FAN ❑ EVAP. COOL OOD
Q,Q,
SIGN
WASHER (AUTO H)
SET BACK
LOT SIZE
APPLIANCE RYERv
TV PE C�yKj BY
GARBAGE DISPOSAL
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FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
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LAUNDRY TRAY
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AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
CIO
'
ABSORPTION SYSTEM 0 B.T.U.
FINAL DATE INSPECTOR
l
TEMP USE PERM SVC
''" WATER CLOSET
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L
COMPRESSOR ,. tJ HP
IPOLE, TEMP/PERM-
LAVATORY
HEATING SYSTEM JLXORCED ❑ GRAVITY
t GrJ
AMPERES SERV ENT
00 SHOWER
.
'
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
a:
SQ.FT. @ a
WATER HEATER
$
ADDRESS
CITY
Q.FT.RESID @ .1 1/4a
SEWAGE DISPOSAL
V�MER/AGENT
SQ.FT.GAR @ 3/4¢
HOUSE SEWER
STRONG MOTION
$
IGNATURE
GAS PIPING
INSTRUMENTATION FEE
PERMIT FEE
PERMIT FEEPERMIT
FEE
-271
y'
DBL.TOTAL
FEESMIRO
]MOB.H..FEE1
FEE
.
. .
CONST. FEE
ELECT.FEE SMIFEE
FEE
PLUMB. FEE
J F I M A M J J A S O N D.
JOB.ADDRESS I SP NO
r/ I
OWNER
'77
COMMUNITY
VALUATION C
DATE f �q
DST
OFFICE
,78
M H PERMIT FEE
$
SE OF ER IT
F.C.
SU P. TO PE MIT
PERMIT
NO.
-
�290614
MICROFILM FEE
COPIES
$•
fFAGE ' PARCEL
DESCRIPTION
�BOOK
[LEGAL
'MECHANICAL FEE
D L
$
USE NO. •
ZONE
SET BACK
LOT SIZE
GRP
TV PE C�yKj BY
%
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PLAN CHECK FEE
$
-
BOND AMT,
PLAN NO.
PLAN CHECKER .,
FINAL DATE INSPECTOR
l
,CONSTRUCTION FEE
DBL'
Q I
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
V�MER/AGENT
STRONG MOTION
$
IGNATURE
CONTRACTOR
INSTRUMENTATION FEE
"^': ^'
SPECIAL INSP
!DEMOLITION '
FEE�-
$
ADORES
ADDRESS
,REGISTRATION
•
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITU - ZIP CODE
'•. TOTAL FEES $
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AREEAAjCOODE
TEL. NO.
AREA CODE
LICENSE tt
CASH❑CHECK .O.❑N. C:❑,�
eVQ
1/J�
'RECEIVED.BY TREES REQUIRED
THIS IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WOR R 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I Y AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
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LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE. TO CARRY ,
• A T.-
__... .. __ �. �......�.vr..r wre„�vL •�rrr '111 Ln♦�J VI- IIIL JIMIL VI '
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.
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NOTICE: f THIS IS NOTA BUILDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
i
DISTRICT
Permit No �.
_ Contractor_ --
Architect_----- —
Owner
ldlAddress___ —
Addres City----
/ d %� _, , V City--
City-h+Y[= ti+l / _ Phone_ --
-� Phone .
d 41
Phone
- have read the application and agree that if Curb and Gutter; ety
artnent of'Buildin9 sand -Safety
(we) the undersigned, hereby certify and acknowledge that I y of o
�. the County of Riverside, the Riverside County Dep
W _
paving, and/or Dedication of right of way is required by
_ rZ shall not make a,Final Inspection until.said requirements have been' met. I am also aware that no `'r okis ef to toe&eooccupied until ne within the Cl (we) have, 1
without an encroachment .permit. w will not occupy said property and will not. cause said p p y :
NOW, therefore, it is agreed that I (we)
complied with. all laws of the County of Riverside and :he State of California governing. said property.
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SIGNATURE OF OWNER AGENT AND/OR J
DATE---
Approval by Signature from the Following `Departments Listed Below
Must Be Obtained Prior to the Issuing�of a Cruction Permit.
onst
_ I SPACE NO. USE OF STRUCTURE
r_ f/�/_'-tom I — SINGLE FAMILY ❑ DUPLEX El.
JOB ADDRESS �a—�a'� ` APARTMENTS ❑ AGRIC. ❑'
LEGAL DESCRIPTION OF PROPERTY L- —�L= y , 5::04.4 IV �� COMMERCIAL ❑ INDUSTRIAL ❑
{ L vT -7 J -=-�
Z - -
O LL ` LTERATIONS
LA COMMUNITY
USE OF PERMIT
-- ,
p Z N0. OF SUBMITTED PLANS
W a .. CASE N0.
v+ NO. OF BUILDINGS -NOW XISTING
Z NO.'OF PARKING SPACES REQUIRED - a� f SIDE. READ
sETBACfKS: FRONT,-----
.4
RONT,
Z ZONE 2 ^� - y
_+ s NO Q LOT. SIZE
'j c GRADING PERMIT REQUIRED? YES ❑ a STREET i
m FEET REQUIRED ON x
SETBACK ORDI. ANC
OF
"SIGNATURE OF LAND USE OFFICIAL _
DATE % x
:P1 NO ❑ NO. OF FEET_ STREETf "
r
DEDICATION•REQUIRED: YES
'❑ T,
F= •NO •❑
Z. CURB AND GUTTER REQUIRED: YES ❑
Q-� Y BE °INSTALLED?
CAN CURB AND GUTTER FEASIBL� .YES ❑ ,NO ❑ .h
o " HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT,PERMIT fQR DRIVEWAY AND STREET
�..r �..7 •YES •❑ NO ❑
Q IMPROVEMENT.
'SIGNATURE,.OF ROAD4 DEPT. OFFICIAL-
0
FFICIAL x
A,t� o0C
DATE—
POOLS
ATE ,
SWIMMING POOLS PUBLIC
j' a SEWAGE!DISpOSAL
W 'ul
C L FOOD ESTABLISHMENT
REMARKS t
WATER POLLUTION eta+
NµFLOOD CONTROL 1
P` Z AIR POLLUTION
DIV OF HW.Y"� YOUR PROPERTY MAY BE SUBJECT•T.O.
~
FLOOD. RIVERSIDE COUNTY,ASSUMES
O a
^`' ""• ' "'"` -�t *NO'BILITY-IN E
.RESPONSIVENT OF fL00D:._
.;,
w r 1 APPLICANT' 1
,,.} CANARY FILE: `PINK
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