272793 (SFD)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
" COUNTY OF RIVERSIDE
CONSTRUCTION / O ESTIMATE NO. ELECTRICAL FEES
IST FL. SOFT. @I Z UNITS
2ND FL. -SO. SO. FT.
POR. / 7 e� SO. FT. @- �' % Gi MOBILEHOME SVC.
GAR. _ SO. FT. Q. POWER OUTLET
CARP. �C1� SOFT. @
WALL SO. FT. @
SO. F.T. @
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used as property tax voluation
MECHANICAL FEES
VENT SYSTEM ' ❑ FAN ❑ EVAP. COOL J9 HOOD
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.
PLUMBING FEES
OWNER
GARBAGE DISPOSAL
YARD SPKLR SYSTEM
FURNACE ❑ UNIT ❑WALL ❑ FLOQh ❑ SUSPENDED
BAR SINK
✓ L Y." .�
ROOF DRAINS
LAUNDRY TRAY
DRAINAGE PIPING
DATEPE
DRINKING FOUNTAIN
76
URINAL
1
WATER PIPING
272793
FLOOR DRAIN
WATER SOFTENER
WASHFR (At ITniffni SHI
4.1 .I r/7
APPLIANCE j. 7 ten. y- _3
JOB ADDRESS SP NO
OWNER
GARBAGE DISPOSAL
��"
FURNACE ❑ UNIT ❑WALL ❑ FLOQh ❑ SUSPENDED
✓ L Y." .�
75
LAUNDRY TRAY
F. C.
DATEPE
AIR HANDLING'UNIT CFM
76
IDLE METER
KITCHEN SINK
272793
ABSORPTION SYSTEM O B.T.V.
TEMP USE PERM SVC
WATER CLOSET
D,SiT
14)
COMPRESSOR 0 HP
VALUATION
POLE, TEMP/PERM
OFFICE
LAVATORYLj
HEATING SYSTEM FORCEO ❑ GRAVITY
{ / ` AMPERES SERV ENT'
!�c
SHOWER
BOILER B.T.U.
/ �
�
SO FT @ ¢
%
BATHTUB"?
1
SO FT @ ¢
WATER HEATER
•^ *j (i
(�
�*` •� eY
/,?;r/ SO FT RESID (C -301'c
�/
SEWAGE DISPOSAL
COPIES
$
SO FT GARAGE @°jt/'✓
LEGAL DESCRIPTION
HOUSESEWER
PERMIT FEE
MECHANICAL FEE
GAS PIPING
$
MOBILE HOME PERMIT FEE $
NO.
PERMIT FEE',>!a
`
PERMIT FEE[
PERMIT NO,
TOTAL FEE$
MOB. HM.FEE
MICRO FEE
,.
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
I FEE
PLUMB. FEE
DBL.
J I F I M A I M I J I J A 1 S 1 O 1 N I D
JOB ADDRESS SP NO
OWNER
74
��"
✓ L Y." .�
75
USE OF PERMIT
F. C.
DATEPE
MIT NO.
76
-f� car �
- _
272793
M H PERMIT FEE
$
COMMUNITY'
D,SiT
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
/!
/ �
�
,
(�
�*` •� eY
_�
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK LOT SIZE ZONEUSE
NO.
GRP
TYPE
CK BY
J ✓ AST
�!
PLAN CHECK FEE
$
RONO AMT.
PLAN NO.. PLAN CHECKER
FINAL DATE JnPEITnR
CONSTRUCTION FEE
DBL
$
OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
/NAME
/
wo
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR,
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE 1
DBL
$
CITY ZIP CODE
CITY ZIP CODE
-ell
L
TOTAL FEES �
$ � t�
Cr%�
TEL. NO.
�.
TEL. NO. LICENSE
t�
CASH CHECK bd M.O. ❑ N.C. Cl
tTHIS PERMIT SHALL BECOME VOID IF WORK IS NOT,COMMENCED WITHIN 120 DAYS. CESSA
/ i6V4ION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
tf' 1 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
RECEIVED BY _
TREES REQUIRED
SEWAGE SYSTEM
T1"(7 LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
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.