303513 (SFD)DEPARTMENT OF BUILDING & SAFETY
BUILDING PERMIT J-^1 u1Tv ^e mvese�ne I
FIELD OFFICE
S O
J F M A M J J A N D
PERMIT NO.
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OWNER
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1
DST
�
CONSTRUCTION ESTIMATE
VALUATION
NO. ELECTRICAL FEES
DST
NO. PLUMBING FEES
1 ST FL. SQ.
2ND FL.
POR. 4A
GAR.
CAR P.
WALL SQ.
ESTIMATED CONSTRUCTION
FT. @—, S
+.,
UNITS
I
78
SQ. FT. @ YARD SPKLR SYSTEM
ca.�
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
M H PERMIT FEE
SQ. FT. @ DRAINAGE PIPING
$
FT. @ DRINKING FOUNTAIN
USE OF PERMIT
SQ. FT. @ URINAL
SUPP, TO PERMIT
VALUATION $ WATER PIPING
MIT
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM 5eFAN ❑ EVAP. COOL HOOD
MICROFILM FEE
SIGN
$
WASHER (AUTO)(DISN)
Aw—
LEGA DESCRIPTION
APPLIANCE RYER
GARBAGE DISPOSAL
4�4 40'x✓/ i
MECHANICAL FEE
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
$
USE NO.ZONE
LAUNDRY TRAY
SET ACK LO SIZE
GRP TY�P/E
AIR HANDLING UNIT- CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U.
/..
TEMP USE PERM SVC
PLAN CHECK FEE
WATER CLOSET
$
COMPRESSOR HP
NO._
PLAN NO.
POLE, TEMP/PERM
FINAL DATE INSPEGrTOR
JLJ
LAVATORY
HEATING SYSTEM FORCED ❑ GRAVITY
AMPERES SERV ENT
V—
SHOWER
CONSTRUCTION FEE
DBL
BOILER B.T.U.
SQ.FT. @ a
BRANCH OFFICE
BATH TUB
SQ. FT. @ a
WATER HEATER
ELECTRICAL FEE
DBL
$
Q.FT.RESID @ 11/4a
1
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4a
IHOUSE SEWER
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONT R
GAS PIPING
�r
PERMIT FEE
PERMIT FEE
SPECIALINSP
PERMIT FEE
DBL.
TOTAL FEES
MOB.HM.FEE
MICRO FEE
MEC14. FEE
-2•Z'
PL. CK. FEE
CONST. FEE
�'
ELECT. FEE
PiJ�
SMI FE�Ei `�
- Pair
FEE
PLUMB. FEE
3-7 `0
S O
J F M A M J J A N D
JOB ADDRESS SP NO
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"� '7 41.1aE I
OWNER
76
c
1
77
COMMUNITY
VALUATION
DATE
DST
OFFICE
-pot
p
7 //
I
78
rtia
ca.�
�7
.
M H PERMIT FEE
$
USE OF PERMIT
F.C.
SUPP, TO PERMIT
PE
MIT
NO.
z
00
Lj-
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGA DESCRIPTION
7 .� .�D
4�4 40'x✓/ i
MECHANICAL FEE
DBL
$
USE NO.ZONE
SET ACK LO SIZE
GRP TY�P/E
CK BY
4
y`
-I1� S S R V ���
/..
PLAN CHECK FEE
$
BOND AMT.
NO._
PLAN NO.
PLAN CHECKER
FINAL DATE INSPEGrTOR
JLJ
V—
i✓ - IQ - ? -7
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER/ NVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONT R
INSTRUMENTATION FEE
r
SPECIALINSP
$
ADDRESS
DEMOLITION
FEE
REGISTRATION
,, L
.REGISTRATION
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
�d
TOTAL FEES All. $
TEL. NO. AREA
CODE
TEL, NO,
KREA CODECE
SE
CASH ❑CHECK .O.❑N.C. + CJ'
�4
�,�i"3
%
'-2-4 W
RECEIVED BY TREES REQUIRED
ISIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
�X/
E Y AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL
ffklftH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
FORM 284-208 IREV, 6-761
COMPENSATION INSURANCE UPON MY EMPLOYEES. C OMPUANC.t WITH IHE LAWS OF THE SIA E OF
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.