290673 (AR)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY .
BUILDING PERMIT ,.,.,,
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S O
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PERMIT NO.
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DST
1
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
FOR.
GAR.
CAR P. SQ.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET IROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION Is 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 )
F.C.
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT IDLE METER KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
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COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER OB.T.U. SQ. FT. @ a BATH TUB
COPIES
SQ.FT. @ a WATER HEATER
SQ.FT.RESID @ 11/4a SEWAGE DISPOSAL
LEGAL DESCRIPTION
SQ.FT.GAR @ 1/4a HOUSE SEWER
GAS PIPING
00,
PERMIT FEE
PERMIT FEE PERMIT FEE
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$
TOTAL 17EEL
MOB.H M.FEE
MICRO FEE MEG H. FEE PL. CK. FEE
I CONST. FEE,C.pq ELECT. FEE I SMI FEE
FEE PLUMB. FEE
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S O
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JOB ADDRESS SP NO
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- 3
OWNER
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COMMUNITY..
A
VALUATION
DATE
DST
OZ
78 11
-1
M H PERMIT FEE$
USE O RMS'
F.C.
SUPP. TO PERMIT�
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0673
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
00,
MECHANICAL FEE
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$
USE NO.
ZONE
SET BACK
LOT SIZE GRP
TYPE CK BY
y
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I
/
I
S
S R
:PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
IN ECTOR
1
,CONSTRUCTION FEE
ABL-
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DCLr
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTO
r
INSTRUMENTATION FEE
"'�'�.
r'SPECIALINSP
$
ADDRESS ADDRESS
DEMOLITION
FEE
REGISTRATION
.. ve
+PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
i{+ D u 1
TOTAL FEES
$
TEL. NO, AREA
CODE TEL.
NO..
AREA CODE
LICENSE u
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RECEIVED BY f TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
LV/�\rCIVJH I1Vry IIVJVRAIV LC Llr LJIV MT CMrLLJTCCJ. L.VMYLIAIN,-E YViTH THE LAYV5 OF THE STATE LJr
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
OF CALIFORNIA.