276764 (RPL)FIELD OFFICE
BUILDING.PERMIT ' DEPARTMENT OF -BUILDING & SAFETY
COUNTY OF RIVERSIDE
' CONSTRUCTION ESTIMATE
1 ST FL.
SQ.FT. @
2ND FL.
SO. FT. @
POR.
SO. FT. @
GAR.
SO. FT. @
CARP.
SOFT. @
KITCHEN SINK
SQ. FT. @
1ALS �
4ApC'[f
SQ. FT. @
ESTIMA CONSTRUCTION
VALUATION $
NOTE: Not to be used as property tax valuation
MFCHANIC'AI FFFC
NO. ELECTRICAL FEES
UNITS
MOBItEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
D/S�T'/y
/
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
rUF PERMIT
a 'r �o�� F.C. JDA = l�- P 78 7 6 4
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 Cl FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ ¢
BATHTUB
USE NO.
SQ FT @ ¢
WATER HEATER
CK BY'
SQ FT RESID @ I ¢
SEWAGE DISPOSAL
SQ FT GARAGE @ Ih¢
HOUSE SEWER
PERMIT FEE y
GAS PIPING
MOBILE HOME PERMIT FEE Is I I I PERMIT FEE PERMIT FEE
2 16706 4 TOTAL FEE MOB. HM.FEE MICRO FEE MECH. FEE I DBL. I P�C ,�f �T��Eb DBL. ELECT F DBL. , FEE
FEE PLUMW' DBL.
J
J I F I M A I M I J I J A I S 1 O 1 N D
JOB ADukESSSP NO
OWWR
75
rUF PERMIT
a 'r �o�� F.C. JDA = l�- P 78 7 6 4
76
M H PERMIT FEE $
SA
C MMUNITV DSTF1111S. ROOMS VALUATION OFFICE
ISUPP.TOPERMIT
!1f /Y fG� !-�
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION r" ?
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE I
ZOyE
USE NO.
GRP
TYPE
CK BY'
I
PLAN CHECK FEE
$ `,BOND
A.T.
PLAN CHECKER
FINAL D
INSPE OR
IPLANNO.
R •/(o. L
I
CONSTRUCTION FEE
DBL
$ H p.
f�f'3
c��
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER /INVOLVED
ELECTRICAL FEE
DBL
$
J�
�v
ADDRESS
CITY
-
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
i.
OWNER/,A13 _' SI NATURE / r-
%f �
CONTRAt-T9R
`^
ley
}/ jv(>
(Y
•
FEE
$
ADDRESS
ADDRESS
PLUMBING FEE
DBL
$ �.-
r'r--)
CITY ZIP CODE
CITY Ir/' ZIP CODE
TOTAL FEES
$
G T
TEL. NO, T
L. NJJ / LICENSE
CASH p CHECK M.O. ❑ N.C. ❑
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.
RECEIVED BYE �,
TREES REQUIRED
C' f'�r{�L"
I 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
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I A\A/C l CTIJC CTATCl C! AI ICAO).))A l'/1\/CDI A.I(_rIITDArT! DC IC A I rn rI IA DA AITCCh
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 264-208 (Rev. 10-74) OIL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.