303509 (SFD)FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY dbi
BUILDING PERMIT
J F M A M J J A S O N D
PERMIT NO,
30350 9
111W 'mur �'
UV V191 Vr RIYGR
OST/
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
SQ. FT. @ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. C. POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used os property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
M H PERMIT FEE
VENT SYSTEM [XFAN ❑ EVAP. COOL WHOOD AASIGN WASHER(AUTO)(
$
APPLIANCE WRYER GARBAGE DISPOSAL
USE OF PERMIT
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
SUPP. TO PERMITPE
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
NO.
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ ¢ BATH TUB tj
SQ.FT. @ a WATER HEATER
Q.FT.RESID @ 11/4¢ SEWAGE DISPOSAL f
SQ.FT.GAR @ 1/4a HOUSE SEWER
MICROFILM FEE
GAS PIPING
$
PERMIT FEE PERMIT FEE PERMIT FEE "
OOK PAAdE`� P RCE L
DBL.
I TOTA/Lj FEES
MOB.HM.FEE
MICRO FEE MEECH. FEE PL. CK. FEE
I 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
I
r
OWNER
76
77
C l UNITY
VALUATIO
$ d
DAT
/7 9
DST
!f
OFFICE
?r
78
>�>q' t
M H PERMIT FEE
$
USE OF PERMIT
F.C.
SUPP. TO PERMITPE
MIT
NO.
I
MICROFILM FEE
COPIES
$
OOK PAAdE`� P RCE L
LEGAL DESCRI ON
MECHANICAL FEE
DBL
$
USE NO.
ZONES
SET BACK
LOT SIZE
GRP TYPE CK BY
j
y �—
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.PLAN
CHECKER
FIN D`A E.) INS
ECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
�t
n�
ELECTRICAL FEE
DBL
$
ADDRESS CITY
v
STATE
STRONG MOTION
Qi
$
OWNER/AGENTS SIGNATURE
NTRA TOR t
INSTRUMENTATION FEE
LADRSS
SPECIAL INSP
$
ADDRESS
DEMOLITION
FEE
REGISTRATION
"
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
TEL. NO. AREA CODE TEL. NO. CODE LICENSE v
CASH❑CHECK O.❑N.C.
I��i
14
FREA
IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SRBAGREETHAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
RECEIVED BYTREES REQUIRED
SEWAGE SYSTEM
%%f
T
LL
P
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
.CUMrtNJA I IUN INaUKANC.t UPUN MY tMPLUYttS. 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 284-208 (REV. 6.76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.