272211 (AR) Ell
BUILDING PERMIT DEPARTMENT OF BUILDING&SAFETY VIII
COUNTY OF RIVERSIDE IIIIIIIIIIIIIIIIIIII 80
IE 1-m
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL. 1 SOFT. @ UNITS
2ND FL. SQ.FT. @ YARD SPKLR SYSTEM
POR. SQ.FT. @ MOBILEHOME SVC. BAR SINK
-GAR. SQ.FT. @ POWER OUTLET ROOF DRAINS
CAR P. SQ.FT. @ DRAINAGE PIPING
WALL SQ.FT. @ DRINKING FOUNTAIN
SQ.FT. @ n URINAL
ESTIMATED CONSTRUCTION VALUATION $ �� �fJ p WATER PIPING ,1 p
NOTE:Not to be used as property tax valuation SWIM POOL,PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL,COMM WATER SOFTENER
VENT SYSTEMfi(FAN ❑ EVAP. COOL ❑HOOD 04D SIGN WASHER(AUTO)(DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑UNIT O WALL ❑FLOOR ❑SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE,TEMP/PERM LAVATORY rfJl�
HEATING SYSTEM ❑FORCED ❑ GRAVITY AMPERES SERV ENT l SHOWER a C,
BOILER�B.T.U. SQ FT @ a BATH TUB
SQ FT @ a WATER HEATER
17 SQ FT RESID @ Ir SEWAGE DISPOSAL
SQ FT GARAGE @ 1/2¢ HOUSE SEWER {�
PERMIT FEE �n GAS PIPING
T,FFE
MOBILE HOME PERMIT FEE $ / PERMIT FEE GG, r , PERMIT FEE 3
PERMIT NO. � TOTAL FEES OD.HM.fEE MICRO FEE MECH.FSE DBL PL. K�� CT(�NSDBL. ELECT�Fejr DBL. SMS FEE �� FE
B. E JDBL.27221
2J F M A M J J A S Q N D JOB ADDRESS SP NO, OWNER y(
74 4411 14
75 USE OF PERMIT //,�� F.C. DATE PE MIz�O.
76 JQDI� (y�lL"s%fIl B<r ". 4-47W a.2d 'J��{ `/ . 1221.
M H PERMIT FEE $ COMMUNITY DST I UNITS I ROOMS I VALUATION SUPP.TO PERMIT OFFICE
MICROFILM FEE COPIES $ LEGAL DESCRIPTION
MECHANICAL FEE DBL $ } ) SETBACK /} LOT SIZE ZONE USE NO. GRP TYPE BY
F o S R !J 4?
PLAN CHECK FEE $ BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE INSPECTOR
/y oo It,- aqC
CONSTRUCTION FEE DBL $ NAME OF CONST.LENDER BRANCH OFFICE NO LENDER INVOLVED
ELECTRICAL FEE DBL $ ADDRESS CITY STATE
S` s ' - ( ,
STRONG MOTION $ OWNER/AGEJJT'S SICyVtTUF;F-; .4:ONTRACTOR
INSTRUMENTATION FEE s - ✓ � u � !
$ ADDRESS ADDRESS
FEE P
PLUMBING FEE DBL $ CITY PCODE CITY ZIP CODE
TEL!,NO. TEL.NO. LICENSE
TOTAL FEES $
CASH O CHECK M.O. O N C ❑ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS.CESSA-
RECEIVED BY TREES REQUIRED t3 TION OF HEREBYRK AGREEAGROR 120 EE THATDAYS SHALL ALL WORK IALSO CAUSE PERMIT TO N CONNECTION WITHH TBECME VOID.
H SOPERMITT WILL BE DONE IN AC-
SEWAGE SYSTEM CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
T LL p CY 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)Or L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA. _ ,