BLCK (248565)BUILDING PERMIT
CONSTRUCTION ESTIMATE
IST FL. SO.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT: @
GAR. SQ. FT. @
CAR P. + SO.FT. @
WALL6:/, '2 SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM' ❑ FAN ❑ EVAP. COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFETY
1 COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
'POWER OUTLET
SWIM POOL, PVT '
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER I I B.T.U.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) tDISH1
DST
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ 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 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ C BATH TUB
SQ FT @ a WATER HEATER .
SQ FT RESID @ 1 ¢ SEWAGE DISPOSAL
SO FT GARAGE @ Vvr HOUSESEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE PERMIT FEE
PERMIT NO.TOTAL
2iaU
FEES
- i
MOB. HM. FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL,
ELECT. FEE
DBL.
SMI FEE
FEE PLUMB. FEE
DBI.
J F M A I M I J I i I A I S O N D
jOB ADDRESS
j SP NO
"' 7 ✓1�� /1/�3fLS I� /.F? I
OW`Nf-R, _
C f� Ll Ait .
737
74
USE OE PE(I�
F.C.
DATE
P MI NO
M H PERMIT FEE
$
COMMUNITY
-A Ai tib'
DST
UNITS
ROOMS
VALUATIONSUPP.
TO PERMIT OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
rQJ'
5-
—MECHANICAL
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
"
R•JIVY
PLAN CHECK FEE
$
rqOND
PLAN NO.
PLAN CHECKER
FINAL/DA�TE�y INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE •
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA-
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
LHEREBY 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 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS -IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
TOTAL FEES *
/P
'OWNER/AGENT'S
SIGNATURE
CONTRACTOR `I
. r//,r
CASH ❑ iCHECK�3/ M.O. ❑ N.C. ❑
ADDRESS
ADDRESS
,- & A' —r,
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
T
-
LL
CITY ZIP CODE
CIT 1 21P CODE
INFORMATIONtf�'���}A�"�
FORf,n 284-2081Re, 9.731 05 a6
TEL. NO.
TEL. NO. '210ENSE
,•,e 6C / % f ,� { :3
111