286075 (SFD)BUILDING PERMIT A
DEPARTMENT OF BUILDING & SAFETY - FIELD OFFICE
J F M AIM J 1 A S O N D
PERMIT NO.
1
�_%J%p v l L Vr RI V CICJIL7L2.86075
COMMUNITY
t
VALUATION
$ � S6 ? cscs
DST
CONSTRUCTION ESTIMATE
�'
-:
NO. ELECTRICAL FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
1 ST FL. SQ.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $�
ffi.�
UNITS
PE MI NO
SO. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
G f6075
FT. @ 41_4* DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
ow_ URINAL
VALUATION $ - Lr WATER PIPING
�.
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MICROFILM FEE
MECHANICAL FEES
$
SWIM POOL, COMM
BOOK AGE PARCEL
WATER SOFTENER
VENT SYSTEM AFAN ❑ EVAP. COOL Dk2lOOD
SIGN
,
WASHER (AUTO) (QU)
QQ
$
APPLIANCE [XDRYER
S
ZONE
SET BACK
GARBAGE DISPOSAL
GRP
TYPE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK.
I ID
S /
ABSORPTION SYSTEM B.T.U.
R�
TEMP USE PERM SVC
WATER CLOSET
4kp
PLAN CHECK FEE
COMPRESSOR HP
Q
POLE, TEMP/PERM
BOND AMT.
LAVATORY
PLAN CHECKER
FINAL DATE INSP
HEATING SYSTEM D<FORCED ❑ GRAVITY
>
MPERES SERV ENT
SHOWER
/ �
BOILER B.T.U.
a-�
SOFT. @ a
CONSTRUCTION FEE
BATH TUB
d
NAME OF CONST. LENDER BRANCH
OFFICE
SQ.FT. @ a
WATER HEATER„
d
FT.RESID @ 11A4
�Ls�
SEWAGE DISPOSAL
du
ADDRESSJ�` CITY
SQ.FT.GAR @ 3/aa
HOUSE SEWER
STRONG MOTION
GAS PIPING
$
1�
PERMIT FEE
O••,b
PERMIT FEE
PERMIT FEE
4
DBL.
TOTAL FEES �pj•]MOB.HM.FEEI
MICRO FEE
ME H. FEE
PL. CK. FEE
CONST. FEE
EL FEE
SMI FEE
FEE
FEE
PLUMB. FEE
J F M AIM J 1 A S O N D
JOB ADDRESS SP NO
71 Aye I
OWNER
^t r
0 1\•.'
76
77
COMMUNITY
t
VALUATION
$ � S6 ? cscs
DATE ��//
f 76
DST OFFICE
�'
-:
78
M H PERMIT FEE
$
USE PERMIT
F.C.
SUPP. O PE IT
PE MI NO
1 /�' 0
G f6075
.f !fie
MICROFILM FEE
COPIES
$
BOOK AGE PARCEL
LEGAL DESCRIPTION
-0l4
,
MECHANICAL FEE
DBL
$
USE NO,
ZONE
SET BACK
LOT SIZE
GRP
TYPE
CK BY
~�
I ID
S /
I�
S jI'
R�
S,
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSP
CTOR
P4�
/ �
, se
a-�
� ,
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
d
ELECTRICAL FEE
DBL
$
ADDRESSJ�` CITY
STATE
STRONG MOTION
$
1�
OWNER/AGENTS SIGNATURE CONTRACTOR
INSTRUMENTATION FEE
SPECIAL INSP
$
ADDRESS ADDRESS
DEMOLITION
FEE
�-^ 1
&Ij®X
REGISTRATION
RS �.7 !
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
33
TOTAL FEES
$
TEL NO. AREA
TEL.
NO.
AREA CODE17'
CASH ❑CHECK .O.❑N.C.❑
`
-.
RECEIVED BY
TREES REQUIRED.
ERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME. VOID.
SEWAGE SYSTEM
T(p/�TV
r LL
P / y�//x
AITH'OR
REBY AGREE THATALLWORK IN CONNECTION WITH THIS PERMITWILLBE DONE INACCORDANCE
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
o W L.UMrr"aAmDN INJUKANi-r UFON MT CMYLOTEES.C0N%rLIANLt WIltl INt LAWJ Uh INt JIAIt Ur
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.