286331 (RPL). A. DEPARTMENT OF BUILDING FIELD OFFICE
BUILDING PERMIT �„�„�,�„ ,,
J F M A M J J A S O N D
PERMIT NO.
86 331
'ROW CVVIVIT Vi RIYCR3IVC
76
77
COMM�yUNITY `�
I�
VALUATION /�
$ !r'C/:ds' oe
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
M H PERMIT FEE
1ST FL. SQ.
2ND FL.
POR.
GAR.
CAR P. SQ.
WALL SQ.
i�7lkJf
ESTIMATED CONSTRUCTION
FT. @ $
UNITS
USEF PERMIT
�{��
F.Cq.
SUPP, TO PERMIT
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ . URINAL
86331-
VALUATION Is efap +w WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
COPIES
FLOOR DRAIN
BOOK PAGE PARCEL
MECHANICAL FEES
ISWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM [J FAN ❑ EVAP. COOL ❑ HOOD
SIGN
DBL
WASHER (AUTO) (DISH)
USE NO.
APPLIANCE ❑ DRYER
SET BACK
LOT SIZE
GARBAGE DISPOSAL
TYPE
C/rKB�Y)/
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
1
1
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
I
S
ABSORPTION SYSTEM . B.T.U.
TEMP USE PERM SVC
PLAN CHECK FEE
WATER CLOSET
$
COMPRESSOR HP
POLE, TEMP/PERM
PLAN CHECKER
LAVATORY
TOR
HEATING SYSTEM ❑ FORCED [:)GRAVITY
AMPERES SERV ENT
liteW
SHOWER
BOILER B.T.U.
SQ.FT. @ a
CONSTRUCTION FEE
BATH TUB
$
NAME OF CONST. LENDER BRANCH
SQ.FT. @ a
NO LENDIR INVOLVED
WATER HEATER
d�
SQ.FT.RESID @ 111/4a
SEWAGE DISPOSAL
ELECTRICAL FEE
DBL
$
SQ.FT.GAR @ 3/44
ADDRESS CITY
HOUSE SEWER
STATE
/
A/ GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
TOTAL FEES
.r -
MOB.HM.FEE
MICRO FEE MECH. FEE
PL. GK. FEE
A0 �`�
,�
CONST. FEE
32 �__
ELECT. FEE
/
SMI FEE
,�
FEE
PLUMB. FEE
r Cies
J F M A M J J A S O N D
JOB ADDRESS SP NO
77”
OWNER L
76
77
COMM�yUNITY `�
I�
VALUATION /�
$ !r'C/:ds' oe
DATE...
DST` OFFICE
A/
78
M H PERMIT FEE
$
USEF PERMIT
�{��
F.Cq.
SUPP, TO PERMIT
PE MIT NO
4
86331-
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
i - �q
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP
TYPE
C/rKB�Y)/
1
1
%�
I
S
S
.,3
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
NAL Q T) 1 ` INSP
TOR
7�/.1
liteW
1:
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFI E
NO LENDIR INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
/
STRONG MOTION
$
�
OWNER/AGENTS SIGNATURE CONTR
- O ./LOX4
�krew
INSTRUMENTATION FEE
2�.7� w
SPECIAL INSP
$
ADDRESS ADDRESS
DEMOLITION
REGISTRATION
FEE
PLUMBING FEE
DBL
,$
CITY ZIP CODE CITY
ZIP CODE
% f J
G
TOTAL FEES $
TEL. NO. AREA
CODE TEL.
NO. f
AREA COD,/
-7
LICENSE a
CASH❑CHECK .O.❑N.C.❑ /Z)
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i .6-
5 '3
RECEIVED BY TREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK ISNOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
,SEWAGE SYSTEMI
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL
P��t
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO -AGREE TO CARRY "
r• w, CVMPtNSAIIUN INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 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.