302022 (SFD)DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
BUILDING PERMIT rni iwirV AC DIVCDCllnC I
PERMIT NO. ���• v. .... �...•.rr
DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. i�
SO. FT. @
SO. FT, @
SQ. FT. @=
SQ. FT. @
SO. FT. @
SQ. FT. @
VALUATION
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
D�
f
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$ °
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM6k FAN ❑ EVAP. COOL >eHOOD
OU
SIGN
WASHER (AUTOH)
APPLIANCE RYER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
-2
gal
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERM SVC
WATER CLOSET
ga4l>
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
00
HEATING SYSTEM ORCED ❑ GRAVITY
AMPERES SERV ENT
f'
SHOWER
Z)g
BOILER E:== B.T.U.
SQ.FT. @ ¢
BATH TUB
�4
SQ. FT. @
FWATER HEATER
!Jd
,I %&MI'T.RESID @ 11/4¢
SEWAGE DISPOSAL
Q.FT.GAR @ 3/4¢
HOUSE SEWER
GAS PIPING
PERMIT FEE
d!
PERMIT FEE
(PERMIT FEE
O�
DBL.
TOTAL PEE'W
MOB.HM.FEE
MICRO FEE
MECH. F�EEEEr�
PL. C FEE
CONrS�T./FEE
ELEChTT. FEEEEE
SMI FEE(/� FEE
PLUMB. FpVEy.E�/•��
154
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OWNER
44
76
77
COMMUNITY
VALUATION
DATE
bse I OFFICE
78-=F--
M H PERMIT FEE
$
USE OF='PERMfr
F.C.
SUPP. O PERMIT
P KNIT NO.
<e
_,A
MICROFILM FEE
COPIES
$
BOOK AGE PARCEL
LEGAL DESCRI !aN
MECHANICAL FEE
DBL
$
USE'No
20NE
SET
LOT SIZEn GRP
TYPE
CK BY
39
.7G.Jy
^BACK
PLAN CHECK FEE
$
BOND AMT. PLAN NO.p
PLAN CHECKER
FINALk.7 i `, y
INSPEC.TOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LEN f BRANCH
OFFICE NO LEN ER INVOLVED
d
O
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
=TRONG MOTION
C
d
per►
OWNER/AGENTS SIGNATURE CONTRACT
INSTRUMENTATION FEE
3
�7�I
SPECIALINSP
DEMOLITON
FEE
ADDRESS AODRESW
pti
REGISTRATION
0,
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
3 %
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TOTAL FEES $
j4
TEL NO AREA
CODE TEL
NO,
AREA EO DE
I. C2E NSE #
CASH❑CHEC O.❑N.C.❑ _3,J 7/
3g4, XF 6
RECEIVED BY TREES REQUIRED
SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATIOIIJ OF
F DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID,
E REE THATALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
SEWAGE SYSTEM r
T/i LL
P�
L S OF RIVE R5iDE.COUNTY AND THE STATE OF CALIFORNIA, !,ALSO AGREE TO CARRY
CkAICA Tlnkl l"CI
I .. •" •' •• �'.� •.I444 IIrL e++•*Vtil I14� J,nll-ul
CnLIFORNIA 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
FORM 284-208 (REV 6-761 OF CALIFORNIA.