296508 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PER081 MIT a 9-nl IKITV nE Dweoelnc A.
J F M A M J J A S O N D
PERMIT NO.
OWNER
/ f
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77
COMM.MUNITY
VALUATION
f j
CONSTRUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
1ST FL. SQ.
2ND FL. SQ.
POR.
GAR. rL7e2
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ i $
SUP . TO PER IT PERMIT
UNITS
FT. @ YARD SPKLR SYSTEM
SQ. FT. @ e MOBILEHOME SVC. BAR SINK
Cs
SQ. FT. @ S10 r > POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
COPIES
VALUATION $ WATER PIPING
100
NOTE: Not to be used as property tax valuation
LE AL DESCRIP/O/N f1
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
MECHANICAL FEE
SWIM POOL, COMM
$
WATER SOFTENER
USE NO.
ZONE
VENT SYSTEM KFAN ❑ EVAP. COOL OOD
Q?
SIGN
TYPE CK BY
WASHER (AUT ISH)
900
APPLIANCE RYER
00
3
GARBAGE DISPOSAL
00
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
S (!
KITCHEN SINK
?C7
/' f
ABSORPTION SYSTEM B.T.U.
I
TEMP USE PERM SVC
i
WATER CLOSET
Oc>
BOND AMT.
COMPRESSOR C� HP
�d
POLE, TEMP/PERM
ECTOR
�' r
LAVATORY
OC3
HEATING SYSTEM XFORCED ❑ GRAVITY
(TQ
AMPERES SERV ENT
4)n
SHOWER
4A 00
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
tf
CONSTRUCTION FEE
SQ.FT. @ a
WATER HEATER
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
;205' Q.FT.RESID @ l'Aa
SEWAGE DISPOSAL
L?0
ELECTRICAL FEE
SQ.FT.GAR @ 3/aa
$
HOUSE SEWER
AODRE5S
CITY
STATE
jj
GAS PIPING
OC+
PERMIT FEE
le
PERMIT FEE
$
PERMIT FEEDBL.
OWNER/AGENTS SIGNATURE
CONTRACTOif
INSTRUMENTATION FEE
TOTAL FEESS
9 I `irvV
MOB.HM.FEE
MICRO FEE
;-*g*"��
M H.FEES
:�.r�
L. CK. FEE
.r'�wr
CONST. FEE}E0ELE
/ ~ , may,
T.
SMI �F}EE
1*7
.
FEE
I
PLUMB. FEE
7r
J F M A M J J A S O N D
JOB ADDRESS SP NO
e " 0.2 -5/ %G I
OWNER
/ f
76
77
COMM.MUNITY
VALUATION
DATE �j -y�-y
DST/
OFFICE
78
M H PERMIT FEE
$
USE OF PERMIT F.C.
SUP . TO PER IT PERMIT
NO.
I
MICROFILM FEE
COPIES
$
BOOK AGE PARCEL
LE AL DESCRIP/O/N f1
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT
G/'RRP�
TYPE CK BY
3
��_
/SIZE
�
��/
1
S (!
5
R
/' f
7
I
PLAN CHECK FEE
i
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE I S
ECTOR
�' r
/0'I�
tf
CONSTRUCTION FEE
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
qtf
AODRE5S
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONTRACTOif
INSTRUMENTATION FEE
3
_ r
4!2e 14
SPECIALINSP$
DEMOLITION
FEE
ADDRESS
ADDRESS
REGISTRATION
> 6' ~ �
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
CIO
TOTAL FEES
$
TEL, NO. AREA
CODE
TEL. N
AREA CODE
LICENSE a
CASH❑CHEC M.O.❑N.C.❑
J
W
/', --0 jam
RECEIVED BY
EES REQUIRED
SHALL BECOME VOID IF WORK IS 11t�OT COMMENCED WITHIN 120 DAYS. CESSATION OF
>KF120 DAYS SHALL ALSO CAUSE PERMTfTO BECOME VOID.
I GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
LAWS OF RIVERSIDE COUNTY AND THE. STATE OF I AGREE TO CARRY
SEWAGE SYSTEM
LL
p
CALIFORNIA, ALSO
AAPFNCA TI(lIJ I,JGI Lon All -C I10llw� . oCc
cca. 1-111-1ry [ Yvnn I— -- yl Inc olr.lc yr
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 IREV. 6-761 SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.