280753 (AR) LD OFFICE
IE
BUILDING PERMIT DEPARTMENT OF BUILDING&SAFETY IIIIIIIIFIELD
IIIIIIIIIIIII
COUNTY OF RIVERSIDE 11
IE DST
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
I ST FL. SO.FT. @ �� UNITS
2ND FL. SQ.FT. @ YARD SPKLR SYSTEM
POR. SO.FT. @ MOBILEHOME SVC. BAR SINK
GAR. SQ.FT. @ POWER OUTLET ROOF DRAINS
CAR P. SO.FT. @ DRAINAGE PIPING
WALL SQ.FT. @ DRINKING FOUNTAIN
SQ.FT. @ URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax voluation SWIM POOL,PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL,COMM WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑UNIT ❑WALL ❑FLOOR ❑SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION,SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE,TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER 0 B.T.U. SQ FT @ C BATH TUB
SQ FT @ a WATER HEATER
D SQ FT RESID @j* SEWAGE DISPOSAL
SQ FT GARAGE @ '/za HOUSE SEWER
EPERMITFEE GAS PIPING
MOBILE HOME PERMIT FEE $ PERMIT FEE a PERMIT FEE
2 PERM�IT�Q.� TOTAL��S OB.HM.FEE MICRO FEE MECH.FEE DBL. PL.CK.FEE CONST.�E DBL. ELE�SEE DBL. SMI FEE FEE PLUMB.FEE JDBL.
8 7 9 1T� SV..�._e d
J F I M I A I M J I J I A I $ 1 O 1 N I D JOB ADDRESS SP NO OWNER
74 1A
75 USE OF PERMIT F.C. DATE PE IT O
76 uPa `'�'� a)/- ori 9- �-�G0753
M H PERMIT FEE $ COMMUNITY OSTJ UNITS I ROOMS I VALUATION SUPP.TO PERMIT OFFICE
/A 11 AIr a // �a a I
MICROFILM FEE COPIES $ LEGAL DESCRIPTION
to I7- 3a o - 4,11 /0 i- ;Z/ 6
MECHANICAL FEE DBL $ SETBACK LOT SIZEZC�/E'4 USE1JOO+�• GRP TYPE CK BY
F `e) S IR (ff!��'C� ".7 ti3
PLAN CHECK FEE $ BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE NS PECTOR
CONSTRUCTION FEE DBL $ / NAME OF CONST.LENDER BRANCH OFFICE NO LENDER INVOLVED
�O
'00 49r -.ELECTRICAL FEE DBL $ ADDRESS CITY STATE
t
STRONG MOTION $ ` OWNER/AGENT'S SIGNATURE �.r, -• •�d� ONTRACTOR
INSTRUMENTATION FEE S"Jk a.'Q mak/ 7e0 f
$ ADDRESS �» A ADDRESS
FEE A d j li�
PLUMBING FEE DBL $ CITY ZIP CODE CITY ZIP CODE
Af A 4)/.A 45 14
TEL. TEL.NO. LICENSE
TOTAL FEES $ //z
CASH ❑ HECK M.O. ❑ N.C. ❑ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.CESSA,
RECEIVED BY TREES REQUIREDON OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC-
SEWAGESYSTEM CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
T LL p AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284.208 (Rev. 10-74)@L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.