302227 (SFD)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY d
T NO.
.. PERMI22
JOB ADDRESS SP NO
r. I
\.VVIV 1 i Vr RI V cKwtiC
76
i'..d L7% O
DST
CONSTRUCTION ESTIMATE
COMMUNITY
NO. ELECTRICAL FEES
DATE.
NO. 'PLUMBING FEES
OFFICE
IST FL. 062 SQ. FT. @ $
Z2
UNITS
$
USE -o PER IT
TO
2ND FL. SO., FT. @
SUPP. TO PERMI PE$
IIT
NO.
YARD SPKLR SYSTEM
FOR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
t?'
POWER OUTLET
$
ROOF DRAINS
BOOK ISAGE PAR;�LEGAL
CAR P. SQ. FT. @
DRAINAGE PIPING
WALL SQ. FT. @
MECHANICAL FEE
DBL
$
DRINKING FOUNTAIN
USE NO.ZO(NEEj
SQ. FT. @
SET" BACK LLOO'T�SSIIZZE.�,.�
GRP TYPE CK BY/
URINAL
ESTIMATED CONSTRUCTION VALUATION is
00
.01
I� l
WATER PIPING
d0
NOTE: Not to be used as property tax Valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
PLAN CHECK FEE$
SWIM POOL; COMM
WATER .SOFTENER
BOND AMT.
VENT SYSTEM ❑ FAN ❑ EVAP. COOL &MOOD
PLAN CHECKER
SIGN
WASHER (AUTO) (Q&5W
G�
APPLIANCE R' R
e>o
GARBAGE DISPOSAL
C7�3
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑ SUSPENDED
CONSTRUCTION FEE
DBL
$
LAUNDRY TRAY
NAME OF CONST. LENDER .
AIR HANDLING UNITCFM
I
NO L DER INVOLVED
IDLE METER '
KITCHEN SINK
G
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERM SVC
ELECTRICAL FEE
WATER CLOSET
CXi
COMPRESSORHP'
�.
:?0-2
PO TEMP/PERM
STATE
LAVATORY
C1C3
HEATING SYSTEM ORCED ❑ GRAVITY
CO.
AMPERES SERV ENT
SHOWER
Ao
BOILER B.T.U.
$
SQ.FT. @ a
OWNER/AGENTS SIGNATURE
BATH TUB
pC3
SQ.FT. @ a
WATER HEATER
X70
SQ.FT.RESID @ 11/4a
$
JSEWAGE DISPOSAL
ADDRESS
ADDRESS
DEMOLITION
REGISTRATION
SQ.FT.GAR @ 1/4a
3�
HOUSE SEWER
S � n
IT-
'
GAS PIPING
•
DBL
PERMIT FEE
IPERMIT FEE
,I;yQ
PERMIT FEE
DBL.
TOTAL FEES
MOB.HM.FEE
MICRO FEE
M . FEE
L. CK. FEE
TEL. NO. AREA
EL T. FEE
SMI FLut
FEE
P—!%8. FEE
CASH ❑CHECK .O.❑�❑
I 2
J --;/- 44
y.rr.w�
1:]�T.'FEE
RECEIVED B)I TREES REQUIRED
r . �"
FEEE
'"
H GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
/
ii`
J F M A M J J A S O N D
JOB ADDRESS SP NO
r. I
OWNER
76
i'..d L7% O
77
COMMUNITY
VALUATION
$
®/M
DATE.
DyST
OFFICE
78
H PERMIT FEE
$
USE -o PER IT
TO
.C.
SUPP. TO PERMI PE$
IIT
NO.
02227
MICROFILM FEE
COPIES
$
BOOK ISAGE PAR;�LEGAL
DESCRIPTTON
MECHANICAL FEE
DBL
$
USE NO.ZO(NEEj
SET" BACK LLOO'T�SSIIZZE.�,.�
GRP TYPE CK BY/
00
1
.01
I� l
PLAN CHECK FEE$
BOND AMT.
PLAN NO.
PLAN CHECKER
FIN
FINAL DATE INSPECTOR,
j[
ci
J
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER .
BRANCH OFFICE
NO L DER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
^r
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
193.
'SPECIALINSP
$
ADDRESS
ADDRESS
DEMOLITION
REGISTRATION
FEE
~
S � n
IT-
'
PLUMBING FEE
•
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES $
TEL. NO. AREA
CODE a
TEL. NO.
AREA CODE
LICENSE 4
CASH ❑CHECK .O.❑�❑
Z
J --;/- 44
RECEIVED B)I TREES REQUIRED
r . �"
T SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF,
F 20 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
SEWAGE SYSTEM
H GREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
P
THE LAWS OF RIVERSIDE:000NTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
LV/w �i�Jh IIVI`I 11 •IJV KHIV I•.0 111111 mT .M11.11TtCJ. 11M1LIHINI.tVVI III Inc u+wa-11 Int JIAIt 1Y
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.