290428 (BLCK)T
FIELD OFFICE
BUILDING PERMIT DEPARTMENT , OF BUILDING & SAFETY
J F M AIM J J A S O N D
PERMIT NO. 2 81
11 Vr RIYCR7IYC
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL. SQ.
• POR.
GAR. SQ.
CAR P. SQ.
WALL SQ.
,eao,ot
ESTIMATED CONSTRUCTION
FT. @ $ UNITS
FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
FT. @ POWER OUTLET ROOF DRAINS
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 WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
:M H PERMIT FEE
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
$
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
USE OF PERMIT
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
SUPF. TO PERMIT
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
NO290421.
BOILER B.T.U. SQ.FT. @ a BATH TUB
SQ.FT. @ a WATER HEATER
'
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a HOUSE SEWER
'
GAS PIPING
PERMIT FEE
PERMIT FEE PERMIT FEE dd
MICROFILM FEE
DBL.TOTAL
FEES
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FEE MECH. FEE PL. CK. FEE I
CONST. FEE ELECT. FEE SMI FEE
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JOB ADDRESS SP NO
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COMMUNITY VALU�ATTIO''N
DATE
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OFFICE
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:M H PERMIT FEE
$
USE OF PERMIT
F.C.
SUPF. TO PERMIT
PERMIT
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MICROFILM FEE
COPIES
$
BOOK PARCEL
LEGAL DESCRIPTION
>>PAGE
:MECHANICAL FEE
DBL$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP TYPE
ICK B(Y\+
I
S
S
R
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PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE VIr SPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENGE INVOLVED
04C>
.ELECTRICAL FEE
DBL
$
ADDRESS CITY
-- -^
STATE
STRONG MOTION
$
OWNER/AGENTSSSIGNATURE CONTRACTOR
INSTRUMENTATION FEE.
SPECIAL INSP
$
ADD S J ADDRESS
DEMOLITION
FEE
EGISTRATION
PlV+r-i�
PLUMBING FEE
DBL
$
CIS ZIP CODE CITY
ZIP CODE
NO. AREA CODE LICENSE tt
TOTAL FEES $
TEL. NO
AREA CODE TEL.
ASH ❑CHECK O.❑N.C.❑
RECEIVED BY TREES REQUIREDTHIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
1
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM
�4 T LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, 1 ALSO AGREE TO CARRY
r r)AAPFNCATin&i IwICI IDAw1/ 1
...ter v� v�. ,..� r...� •v�.�v.�. ...„. ... vr..�., v� ��,-------.
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
FORM 284.208 (REV. 6-761 OF CALIFORNIA.