260527 (BLCK)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING I& SAFETY
COUNTY OF RIVERSIDE AdlbL
CONSTRUCTION ESTIMATE
I ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SQ. FT. @
CAR P. SQ.FT. @
> }WALL SO. FT. @
L,64r%N1°%w SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM O FAN ❑ EVAP. COOL ❑ HOOD
�O
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
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)
APPLIANCE
JOB ADORLSS SP NO
JOWNER
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
WATERCLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ a
BATHTUB
OFFICE
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
l�t7
I
SQ FT GARAGE @ Ih¢
HOUSE SEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE
Is
I
PERMIT FEE
PERMIT FEE
PERMIT NO.
26052
TOTAL FEES
°SFE
Oe. HM.FFE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
JDBL.
J I F I M A I M I J I J A I S 1 O 1 N D
JOB ADORLSS SP NO
JOWNER
74
755
USE OF PERMITF.C.
�
DATE
�- 7!;-1'260527_
ERMIT NO
76
&x /o Z' &)aa /=a Ne..�
- �
M H PERMIT FEE
$
COMMUNITY
DST
MR11M1
VALUATION
SUPP. TO PERMIT
OFFICE
l�t7
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE NO.
GRP
TYPE,CK BY
/I�
v
- /
F S R
PLAN CHECK FEE
$
BOND AMT,
PLAN N0.
PLAN CHECKER
FINAL DATE
INS CTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST, LENDER BRANCH
OFFICE
NO LENDER INVOLVED
400
of
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
FEE
$
ADDRESS
ADDRESS
,(
PLUMBING FEE
DBL
$
CITY ZIP CODE
C/IT��1 t / ZIP CODE
ui,4 �'T
G° fi/!T /
TOTAL FEES
$
00
TEL. NO,
3109
TEL. NO. LICENS`E
CASH Q CHECK M.O. p 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 BY
TREES REQUIRED
t
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 ALSO
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I A%AICl CTUC CTATC( C!'AI IC(\DNIIA ('(1\/CDINIl-('lINITDAiTf_1Df IC Al C(1(_I IA DANITCFrI
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rem. 10-74) Qr L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.