268935 (SFD) i FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING St SAFETY IIIIIIIIIII I II VIII
COUNTY OF RIVERSIDE 02
IE DST
CONSTRUCTION ESTIMATE NO ELECTRICAL FEES P MBING FEES
1 ST FL. ..oZIAIF6 SQ.FT. @/J � µ UNITS
2ND FL. SO.FT. @ YARD SPKLR SYSTEM
POR. i? SQ.FT. @-- 0 ,,,,r MOBILEHOME SVC. BAR SINK
GAR. t SQ.FT. @ .i►T- POWER OUTLET ROOF DRAINS
CAR P. SQ.FT. @ DRAINAGE PIPING
WALL, SQ.FT. @ DRINKING FOUNTAIN
SO.FT. @ URINAL
ESTIMATED CONSTRUCTION VALUATION $'K/ 76 f WATER PIPING
NOTE:Not to be used as property tox valuation SWIM POOL.PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL,COMM WATER SOFTENER
VENT SYSTE2d,V FAN ❑ EVAP. COOL Z HOOD (J SIGN WASHER IAUTOftISH1 nU
APPLIANCE / y GARBAGE DISPOSAL
FURNACE ❑UNIT ❑WALL ❑FLO R ❑SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC 'WATER CLOSET. (ss2
COMPRESSOR ® HP POLE,TEMPAPERM LAVATORY Qaj
HEATING SYSTEM FORCED ❑ GRAVITY , ' AMPERES SERV ENT SHOWER f?L1
BOILER B.T.U. SQ FT @ ¢ BATH TUB
SQ FT @ ¢ WATER HEATER �/ 400
az r6
0
6 SQ FT RESID @ 1¢ SEWAGE DISPOSAL
rSQFTGARAGE @ 'h¢ HOUSE SEWER
PERMIT FEE ! GAS PIPING
MOBILE HOME PERMIT FEE Is PERMIT FEE PERMIT FEE Q,� v
PERMIT NO. TOTAL FEE$ MOR.HM.FEE=ECH.FEE DBL. PL.CK.FEE CONST.FEE DBL. ELECT.FEE DBL. SMIFE FEE PLUMB.FEE DBL.
268935 � =° � , -
1~ J F M A M J 1 A $ O N D JOB ADDRESS _ - SP NO OWNER
�/+s
74
Iv
75 USE OF PERMIT F.C. DATEPE MIT NO.
76 ., - yr �� E ;�.. ;� X68935
M H PERMIT FEE $ COMMUNITY DST ITS I ROOMS I VALUATION SUPP.TO PERMIT OFFICE
MICROFILM FEE COPIES $ LEGAL DESCRIPTION
MECHANICAL FEE DBL $ SETBACK LOT SIZE ZONE USE NO. GRP TYPE CKRY
PLAN CHECK FEE $ / BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE �ECTOR
CLCONSTRUCTION FEE DBL $ NAME OF CONST.LENDER BRANCH OFFICE NO LENDER INVOLVED
ELECTRICAL FEE DBL $ ADDRESS CITY STATE
STRONG MOTION $ OWNER/AGENT'S SIGNATURE CQNTf(AO�Ft
INSTRUMENTATION FEEXY
$ ADDRESS ADDRESS
FEEy.-
PLUMBING FEE DBL $ CITY ZIP CODE CITY ZIP CODE
w C .U 113/La
TEL.NO. TEL.NO. LICENSE
TOTAL FEES $
CASH ❑ CHECK JN M.O. ❑ N C ❑ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.CESSA-
RECEIVED BY � / TREES REQUIREDQACORDANCE
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTIONWITH THIS PERMIT WILL BE DONE IN AC-
SEWAGE SYSTEM 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)QL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.