290699 (SFD)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT a J-^6 ulTv ^e elveef l Me I
FIELD OFFICE
J F M A M 1 J A S O N D
PERMIT NO.
6
OWNER
%rUvry l 1 UP RI Y GR7IYC
DST
�f
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
DO
NO. PLUMBING FEES
I� 78
1ST FL. r SQ.
2ND FL. SQ.'
POR. d
GAR.
CAR P. SQ.
WALL" 50.
ESTIMATED CONSTRUCTION
FT. @ 40 $
U
UNITS
USE O PER Tpt
F.C.
FT. @ YARD SPKLR SYSTEM
1900'
SQ. FT. @ MOBILEHOME SVC. BAR SINK
5Q. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
t/�``� �)
50. FT.@ URINAL
VALUATION $ G WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
COPIES
FLOOR DRAIN
b
BOOK PAGE PARCEL
•MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM WAN ❑ EVAP. COOL qkTOOD
0,0
SIGN
WASHER (AUTO) (DIS44
ZONE I
SET BACK
APPLIANCE - WRYER
.00
TYPE
CK BY
GARBAGE DISPOSAL
do
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT r , CFM
IDLE METER
KITCHEN SINK
Y
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
dA
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
pc7
PLAN CHECK FEE
HEATING SYSTEM ORCED ❑ GRAVITY
I
AMPERES SERV ENT
BOND AMT.
SHOWER
AC7
FINAL DATE INSPECTOR
BOILER B.T.U.
00
SQ.FT. @ a
� BATH TUB
�
/mss
SQ. FT. @ ¢
r CONSTRUCTION FEE
WATER HEATER
$
NAME OF CONST. LENDER BRANCH
OFFICY
Q.FT.RESID @ 1l/4¢
a%�J
SEWAGE DISPOSAL>
SQ.FT.GAR @ 3/a¢
,�f
HOUSE SEWER
$
ADDRESS CITY
STATE
GAS PIPING
PERMIT FEE
PERMIT FEE
O C1
. PERMIT FEE
$
�jO
v
DBL•.
I TOTAL FEES
MOB.HM.FEE
MICRO FEE
M H. FEE PL. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
J F M A M 1 J A S O N D
JOB ADDRESS I SP NO
OWNER
77
COMMUNITY -
/4jt� . '
VALUATION
$.z
DATE
DO
I OFFICE
I� 78
•M H PERMIT FEE
$
USE O PER Tpt
F.C.
SUP . TO PERAT
1900'
t/�``� �)
6
' MICROFILM FEE
I
COPIES
$
b
BOOK PAGE PARCEL
LEGAL DESCRIPTION
!' MECHANICAL FEE
DBL
$
USE NO.
ZONE I
SET BACK
LOT SIZE
GRP +{�
TYPE
CK BY
�j
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
/mss
r CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICY
N LENDE INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
1 STRONG MOTION
$
�jO
v
OWNER/AGENT 'SIGNRE �' CONTRACTOR
S
;INSTRUMENTATION FEE
J
SPECIAL INSP
`DEMOLITION
FEE
$
ADDRESS
f�
DDRESS
REGISTRATION]
`
PLUMBING FEE
DBL
$
00
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES
,'RECEIVED BY
TREES REQUIRED
IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
`( RK 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
( AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
ESEWAGE SYSTEM
L'''"
��c, _
LL
P�%>/
h
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
"- LVMr[rvJAIIVry INJUKA NC.E UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS VY THE STATE Vr
_ CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
FORM 284-208 IREV. 8-76I SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.