272096 (SFD)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
I I UNITS
al
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAi SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
DST
VENT SYSTEM O FAN O EVAP. COOL AHOOD
CONSTRUCTION ESTIMATE
%o
ISTFL..>
PERMIT FEE
SQ.FT. @ /JI=-
WASHER (AUTOT ISH)
2ND FL.
4
SQ. FT. @ -77
E MIT O.
212096
POR.
%'e
SO. FT. @
DBL.
GAR.
CONST. FEE
��G�
SQ. FT. @�
_
` 1
CAR P.
SMI FEE
SO.FT. @
FEE
WALL
LAUNDRY TRAY
SO. FT. @
OFFICE
AIR HANDLING UNIT CFM
IDLE METER
SQ. FT. @
11
ESTIMATED CONSTRUCTION VALUATION $
a
NOTE: Not to be used os property tax valuation
ABSORPTION SYSTEM 0 B.T.U.
z
MFCHANIC_AL FEES
al
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAi SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
DST
VENT SYSTEM O FAN O EVAP. COOL AHOOD
Il
%o
SIGN
PERMIT FEE
/
WASHER (AUTOT ISH)
y
4
APPLIANCEJ--`
E MIT O.
212096
?
MOB. HM.FEE MICRO FEE
MECH. F E
� "
DBL.
GARBAGE DISPOSAL
CONST. FEE
��G�
DBL.
FURNACE O UNIT O WALL O FLOOR O SUSPENDED
DBL.
SMI FEE
DST
FEE
PLUMB F E
4
LAUNDRY TRAY
TO PERMIT
OFFICE
AIR HANDLING UNIT CFM
IDLE METER
,� .►,u JA/7_
11
KITCHEN SINK
a
OO
ABSORPTION SYSTEM 0 B.T.U.
z
MICROFILM FEE
TEMP USE PERM SVC
$
WATER CLOSET
MECHANICAL FEE
U�
COMPRESSOR ��w� HP
F
SET BACK
POLE, TEMP/PERM
USE NO.
LAVATORY
y
�Q
HEATING SYSTEM (FORCED Cl GRAVITY
,Q
10DI AMPERES SERV ENT
l)
SHOWER
O0
BOILER 0 B.T.U.
SQ FT @ a
PLAN CHECK FEE
BATH TUB.
/%a
PLAN NO.
PLAN CHECKER
FINAL DATE
SQ FT @ a
!
WATER HEATER
U
V t -"-:SQ FT RESID @ I
�,
DBL
SEWAGE DISPOSAL
/,9
l3
OFFICE
NO LENDER INVOLVED
FT GARAGE @
�S
HOUSE SEWER
PERMIT FEE
DBL
j%
ADDRESS
P,41m��-
GAS PIPING
MOBILE HOME PERMIT FEE
Is
JOWNER j
/?��l
74
PERMIT FEE
f" ".0 A/, l)
. G
USE OF PERMIT J
Da/ ����. G'�����*�- ���
PERMIT FEE
I � Q r/
E MIT O.
212096
TOTAL
19� =
MOB. HM.FEE MICRO FEE
MECH. F E
� "
DBL.
�L. CK. FEE
CONST. FEE
��G�
DBL.
ELECT. F E
�l `
DBL.
SMI FEE
DST
FEE
PLUMB F E
4
DBL.
TO PERMIT
OFFICE
,� .►,u JA/7_
11
a ��
J F M A M J J A S O N D
JUB ADDHESS f SP NO
�.3A Alzme,E/:
JOWNER j
/?��l
74
v.E A
f" ".0 A/, l)
75
USE OF PERMIT J
Da/ ����. G'�����*�- ���
F. C.
DATE
P M
272096
76
.:�-��-��
M H PERMIT FEE
$
COMMUNIT
DST
UNITS
ROOMS
VALUATION9,91SUPP.
TO PERMIT
OFFICE
,� .►,u JA/7_
11
a ��
z
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
j/th r� l �
/1f -"i -`I `D/�/ JA% /�- dY7S441'ACie JI-7/ir,Q ,•2-,
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONEJ
USE NO.
GRP
TYPE
C Ys
F i D S R//;I
PLAN CHECK FEE
$B
OND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
��
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
P,41m��-
Z"4,.'
�- 1`� 7 l
STRONG MOTION
INSTRUMENTATION
$
7
OWNER/AGENT'S SIGNATURE
CONTRACTOR Ir r I �'
FEEi
1
6,A t
FEE
$
ADDRESS
ADDRESS
J'-,
PLUMBING FEE
DBL
$
1�
CITY ZIP CODE
CITY // ZIP CODE
/A �T�1n1T/t, 6`
4
TOTAL
TOTAL FEES�ll�
$
/
�7
TEL. NO.
TEL. '0. LICENSE
.j!/ /' LICENSE
CASH O CHECK M.O. O N.C. O
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
li� OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY ,
TREES REQUIRED
O)
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
AGREE TO CARRY COMPENSATION INSURANCE MY EMPLOYEES. COMPLIANCE WITH THE
SEWAGE SYSTEM
I
r
T / ✓-V
LL
P (1
UPON
I A\A/C nC TUC CTATC nC r'AI Irn0KII A r'n\/CDIKI/- r'rlKITDAiTn DC IC AI Cn r_I IA DA KITrrn
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) Q► L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.