272491 (SFD)BUILDING PERMIT :DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE '
,.CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
I ST FL. F �'� " SQ:FT. @ r C� �� Q, Q O UNITS
2ND FL. SO. FT. @
POR. / SQ. FT. @ MOBILEHOME SVC.
(--AD j0 SQ. FT. @ .�} ?T5 d>� POWER OUTLET
CAR P. SOFT. ;@
WALL SQ. FT.. @
SQ. FT. 9
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM X FAN ❑ EVAP. COOL X HOOD_ 0L
SWIM POOL. PVT
SWIM POOL. COMM
SIGN
NO.
FIELD OFFICE
PLUMBING FEES
DST
74;70
Z 7 (�
]j
YARD SPKLR SYSTEM
F.C.
�
DATE
15" fir
BAR SINK
76
•ii-
ROOF DRAINS
DRAINAGE PIPING
$
DRINKING FOUNTAIN
CFM
DST
URINAL
IDLE METER
I VALUATION
WATER PIPING
y S�
FLOOR DRAIN
� B.T.U.
WATER SOFTENER
TEMP USE PERM SVC_
%
WASHER (AUTO) (NeH1
Qt:
APPLIANCE
71,_2
ft `
3
74;70
Z 7 (�
]j
GARBAGE DISPOSAL
F.C.
�
DATE
15" fir
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
76
•ii-
LAUNDRY TRAY
$
AIR HANDLING UNIT
CFM
DST
r UNITS
IDLE METER
I VALUATION
f
KITCHEN SINK
ABSORPTION SYSTEM
� B.T.U.
TEMP USE PERM SVC_
WATER CLOSET
COMPRESSOR 3 r 0
HP
f>!)
POLE, TEMP/PERM
LAVATORY
z
HEATING SYSTEM FORCED ❑ GRAVITY
90 200
AMPERES SERV ENT
MICROFILM FEE
SHOWER
0,-
CBOILER
BOILERB.T.U.
LEGAL DESCRIPTION
SQ FT @ C
J
BATH TUB
y` 11 C)
$
SETBACK�^
LOT SIZE ZONE
SQ FT @ C
USE NO.
GRP
WATER HEATER
Q 4
/
FCI
/ 00' SQ•FT RESID @/ ff
0,017 0
rF
SEWAGE DISPOSAL
d(J 04
QFT ARAGE @ '/,a
3U
HOUSE SEWER
!
PERMIT FEE
00
.5.
1911-10X1
�r '^��
$
F�
GAS PIPING
BOND AMT.
PLAN NO.
MOBILE HOME PERMIT FEE
j, $
INSP CTOR
LQ0
PERMIT FEE
PERMIT FEE
d r
PER IT NO.
.27 49
TOTAL FEES
/� 6'2
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL K. FEE
Pr
CONST. FEE
1vT'
DBL.
ELECT. FE _
,���
DBL.
SMI FEE
� ��-
FEE
PLUMB. FEE'
j �
DBL
JF.__ .. _.A._ __., J_. -.A_ S �- N D
JOB ADDRESS SP NO
t
- A
OWNER
74;70
Z 7 (�
]j
USE OF PERMIT _f
J/9 flJ, rA �.
F.C.
�
DATE
15" fir
PE I O.
2492,
76
•ii-
M H PERMIT FEE
$
COMMUNITY
DST
r UNITS
ROOMS
I VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
,/
MECHANICAL FEE
DBL
$
SETBACK�^
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK B_ Y
/
FCI
0,017 0
rF
%
F/
!
.5.
PLAN CHECK FEE
$
F�
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSP CTOR
LQ0
11-,f - � G
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
XD e
'0 z'
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
�--
OWNER/AGENT'S SIGNATURE
CONTRACTOR
_?4a/
INSTRUMENTATION FEE
g
Al— evA�44�1
$
,ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
�1
A �; t
TOTAL FEES * Is
/ �
l�+
L CJ
TEL. NO.
TEL. NO. LICENSE
CASH ❑ CHECK M.O. ❑ N'.C. ❑
It THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
t 1VTION OF WORK FOR 120 -DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
E
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
G�ail�/
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
Alf/LCT CET ATC LICI AIS A!'ll\iLMnl!`!-
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATION;
FORM 284-208 (Rev. 10-7'4) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND RROFESSIONS CODI
I OF THE STATE OF CALIFORNIA.