290360 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT • �.�„&ITv 0%r vie rime I
J F A S O
M M J J A N D
PERMIT NO.
OWNER fr e
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CONSTRUCTION ESTIMATE
VALUATION
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND FL.
POR. S
GAR.
CAR P.
STIALITO
ESTIMATED CONSTRUCTION
SQ. FT. @ $
2,Aa
UNITS
'M H PERMIT FEE
SQ. FT. &— YARD SPKLR SYSTEM
$
SQ. FT. @ MOBILEHOME SVC. BAR SINK
USEOFPERMIT
M
SQ. FT. @ .S" POWER OUTLET ROOF DRAINS
SUPP. O PERMIT
SQ. FT. @ DRAINAGE PIPING
NO.
SQ. FT. @_4Yr 3 DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ C!4 WATER PIPING
00
' NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
COPIES
WATER SOFTENER
BOOKPAGEPARCEL
VENT SYSTEM JWAN ❑ EVAP. COOL WHOOD
00
SIGN
WASHER (AUTO ISH)
ice/ �' ESL
APPLIANCE WRYER
tSCI
$
GARBAGE DISPOSAL
tX�
SET BACK
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
GRP TYPE
C/Kj�B�Y
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
4p
POLE, TEMP/PERM_:?LAVATORYjCy
Q
I
S 0 IS
HEATING SYSTEM ORCED ❑ GRAVITY
QFi.
AMPERES SERV ENT
SHOWER
tJCi
BOILER B.T.U.
SQ.FT. @ a
PLAN NO.PLAN
BATHTUB
FINAL ATE INSPE
SQ. FT. @ a
WATER HEATER
t
CHECKER
Q.FT.RESID @ 1 V
DBL
SEWAGE DISPOSAL
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NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
",q-SQ.FT.GAR @ 3/aa
%
HOUSE SEWER
.ELECTRICAL FEE
DBL
GAS PIPING
fX�
ADDRESS CITY
PERMIT FEE
AO:?
I PERMIT FEE
j PERMIT FEE
OWNER/AGENTS SIGNATURE CONTRACT
DBL.
I TOTAL FEES MOB.H M.FEE
MICRO FEE
MEC H. FEE
PL. CK. F E
CONST. FEE
ELECT, FEF
SMI FEE
FEE
PLUMB, FEE
J F A S O
M M J J A N D
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OWNER fr e
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COMMUNITY .
VALUATION
DATEDjST
OFFICE
'M H PERMIT FEE
$
USEOFPERMIT
M
F.C.
SUPP. O PERMIT
PERMIT
NO.
'MICROFILM FEE
COPIES
$
BOOKPAGEPARCEL
LEGAALL DESCRIPMN
ice/ �' ESL
MECHANICAL FEE
..
DBL
$
USE NO.
ZONE
SET BACK
LOT SIIZZtE�
GRP TYPE
C/Kj�B�Y
4p
Q
I
S 0 IS
01)R
:PLAN CHECK FEE
$
BOND AMT.
PLAN NO.PLAN
FINAL ATE INSPE
CHECKER
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
/
.ELECTRICAL FEE
DBL
$
ADDRESS CITY
•
STATE
'STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENTS SIGNATURE CONTRACT
R
5r'!.I'i�'�r''R� E
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LF.b
'SPECIALINSP
DEMOLITION
FEE
$
ADDRESS ADDRESS
:REGISTRATION/
�i
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'PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
CODE
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rZIP
)
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
AREACODELICENSE
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e
F
CASH❑CHEC .O.❑N.C.❑
-72
�.
'RECEIVED BY r TR ES REQUIRED
RMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
OR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Y AGREE THATALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
gffHE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
SATION —Cl
SEWAGE SYSTEM T �� LL
P
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.