272428 (RPL)BUILDING PERMIT
14
DEPARTMENT OF BUILDING & SAFETY
IIII, COUNTY OF RIVERSIDE i
CONSTRUCTION ESTIMATE
1 ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SOFT. @
WALL SO. FT. @
54'1 �jL! tap SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax voluation
MECHANICAL FEES
VENT SYSTEM O FAN Cl EVAP. COOL O HOOD
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
SIGN .
FIELD OFFICE
NO.I PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
jDST
f(
APPLIANCE
JOB ADDRESS SP NO
-� Ali 1;'
OWNER
74
u75
GARBAGE DISPOSAL
�F.?.0
USJ/E�'�l PERMIT I --T r
FURNACE Cl UNIT O WALL O FLOOR O SUSPENDED
DAT���/ + � �
PEFrj/r�11�02
76
LAUNDRY TRAY
AIR HANDLING UNIT I
CFM
IDLE METER
$
KITCHEN SINK
DST
UNITS
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
MICROFILM FEE
HEATING SYSTEM O FORCED O GRAVITY
AMPERES SERV ENT
LEGAL DESCRIPTION jj77// /
40
SHOWER
BOILER 0 B.T.U.
SQ FT @ ¢
DBL
$
BATHTUB
SET BACK
LOT SIZE ZOON7E
j
USE NO.
SQ FT @ ¢
TYPE
CK BY
WATER HEATER
jC Q G l
SQ FT RESID @ 1¢
l /FINAL
SEWAGE DISPOSAL
jj JL
PLAN CHECK FEE
SQ FT GARAGE @ 'h¢
$
HOUSESEWER
PLAN NO.
PLAN CHECKER
PERMIT FEE
INSPECTOR
`j Q
GAS PIPING
I OG
MOBILE HOME PERMIT FEE
Is
I
I I PERMIT FEE
PERMIT FEE
f Ov
P RN.j
TOTAL FEES
OB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
I DBL.
ELECT. FEE
DBL.
SMI FEE
I FEE
PLUMB. FEE
DBL.
J
J F M A M J A S Q N D
JOB ADDRESS SP NO
-� Ali 1;'
OWNER
74
u75
�F.?.0
USJ/E�'�l PERMIT I --T r
DAT���/ + � �
PEFrj/r�11�02
76
c f
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMITOFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION jj77// /
40
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZOON7E
j
USE NO.
GRP
TYPE
CK BY
/
l /FINAL
jj JL
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
DA
INSPECTOR
`j Q
cn
V3 V
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER NVOLVED
41 in
%o
G ---
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
/3
60
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR %
INSTRUMENTATION FEE
'y6,
A,6,1"/ C
$
ADDRESS
ADDRESS
FEE
! •'-�"f'
PLUMBING FEE
DBL
$
d
CITY ZIP CODE
CITY ZIP CODE
�itJli/� �•f-
G
+
TOTAL FEES
TEL. NO.
TEL. NO. ` LICENSE
CASH O CHECK M.O. O N.C. OA)"
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
SON OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
/
RECEIVED
!
TREES REQUIRED
BY
/
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
THE STATE CALIFORNIA, I ALSC
I
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND OF
SEWAGE SYSTEM
T
LL
ted
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I AUIC n TLIC CT ATC n r'AI IFIL DNIIA r nk/FDI NI r_ rn NIT D A r'Tn DC IC AI Cr) r.I IA DA NT FFh
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10 74) OP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.