290179 (SFD)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a COUNTY OF RIVERSIDE
FIELD OFFICE
J F. M A M J J A S O N D
PERMIT NO.
OWNER
'76✓`
-
" f c,4*,;U1 +� +�
VA.OATfION
$O'` Is'i
DST
7
CONSTRUCTION ESTIMATE
OFFICE
NO. ELECTRICAL FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
' 1ST FL. l SQ.
2ND FL. SQ.
POR. SQ.
GAR. SQ.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @ $ ' ++�
•1
UNITS
PE MIT
N O.
FT. @ YARD SPKLR SYSTEM
FT. @ ' 3 MOBILEHOME SVC. BAR SINK
FT. @ POWER OUTLET ROOF DRAINS
6,
FT. @ f DRAINAGE PIPING
9
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
COPIES
VALUATION $ r—+" WATER PIPING
; Y
NOTE: Not to be used as property tax valuation
ISWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
DBL
$
VENT SYSTEM [I FAN ❑ EVAP. COOL OOD
USE NO.
SIGN
SET BACK
WASHER(AUTO H)
GRP
TYPE CK BY
APPLIANCE DRYER
r
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
Is
LAUNDRY TRAY
�Y
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ry ty
-j
ABSORPTION SYSTEM O B.T.U.
R-21.
TEMP USE PERM SVC
o WATER CLOSET
PLAN CHECK FEE
COMPRESSOR � HP
p
POLE, TEMP/PERM
PLAN NO.
r LAVATORY
FINAL DATE I
ECTOR
HEATING SYSTEM : FORCED ❑ GRAVITY
MPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ.FT.
DBL
BATH TUB
NAME OF CONST. LENDER BRANCH
OFFICE NO LENDER INVOLVED
SQ.FT. @ a
WATER HEATER
J o
`ELECTRICAL FEE
DBL
SQ.FT.RESID @ 11/4a
r, '
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4¢
1
HOUSE SEWER
`
GAS PIPING
C U
$
PERMIT FEE
OWNER/AGENTS SIGNATURE CONTRACTO
PERMIT FEE
INSTRUMENTATION FEE
PERMIT FEE
�%
DBL.
I TOTAL FEES
/
.:moi)*+
MOB.HM.FEEJ
MICRO FEE
J -
M .FEE
L
P. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
J F. M A M J J A S O N D
JOB ADDRESS SP NO
J I
�i"�jr f q% I.�•i�'
OWNER
'76✓`
77COMMUNITY
`
—lt
" f c,4*,;U1 +� +�
VA.OATfION
$O'` Is'i
DATE
"% r� r?-�
DST
OFFICE
76
Et
M H PERMIT FEE
$
USE OF PERMIT
F.C.
SUPP. TO PERMIT
PE MIT
N O.
r
6,
9
0179
;MICROFILM FEE
COPIES
$
OK PA%E PARCEL LEG DESCRIPTION
:MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE CK BY
Is
571
�Y
-j
S
R-21.
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE I
ECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE NO LENDER INVOLVED
`ELECTRICAL FEE
DBL
$
ADDRESS CITY
STAT
w
`
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTO
INSTRUMENTATION FEE
�%
'SPECIALINSP
'DEMOLITION
$
ADDRESS ADDRESS
`REGISTRATIONAbW
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
J
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
NO.
ARE CODE
LICENSE u
CASH ❑CHECK .O.❑N.C.❑
RECEIVED BY TREES REQUIRED
S P SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK 0 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I H AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
EWAGE SYSTEM
Q
T rr`j`i LL
P �- ?t «'
TH LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
'-CUMrLNSAIION INSURANCE 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 2e4-208 (REV. 6-76) 50 IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.