280056 (SPIN)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
L ' COUNTY OF RIVERSIDEAk
r�
CONSTRUCTION ESTIMATE
1 ST FL. SQ.FT. @
2ND FL. SO. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ.FI. @
WALLSO. FT. @
---dSO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
APPLIANCE \
FURNACE ❑ UNIT ❑ WALL O FLOOR ❑ SUSPENDED
AIR HANDLING UNIT CFM
ABSORPTION SYSTEM 0 B.T.U.
COMPRESSOR 0 HP
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL. PVT
SWIM POOL, COMM
SIGN
IDLE METER
TEMP USE PERM SVC
POLE, TEMP/PERM
NO. I PLUMBING FEES I t
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
HEATING SYSTEM ❑FORCED ❑GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ ¢
BATH TUB
755
SQ FT @ ¢
WATER HEATER
DATE
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
se Gf,o-
�
SQ FT GARAGE @ '/r¢ j
HOUSE SEWER
PERMIT FEE
M H PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE
PERMIT FEE
PERMIT NO.
280056
TOTAL FEES
/� �;
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
t�F
PL CK. FEE
CONST. FEE
��.;
DBL.
ELECT. FEE
rr �/
DBL.
SMI FEE
•• PLUMB. FEE
�a
JDBL.
1 F M A M 1 J A S Q N D,.
-JOB ADDRESS 5P NO
OWNER
755
USE OF PERMITF.C.
DATE
PE MIT NO.
76
se Gf,o-
�
8 0 056
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATIONSUPP.
TO PERMIT
OFFICE
a //N r`�
I
I
72 7v
�
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
/
pxi(3
F S R
!
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
15 )L-
PPECTOR
,
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS,�-^-""'�^•� CITY
STATE
STRONG MOTION
$
/OWNER/AGENT'S SLGM6T1Aii'E.--r •ti t Z .f
9900TRACTOR
INSTRUMENTATION FEE
FEE
$
Cs
ADORE �
ADDRESS
�
�.
7 l f
PLUMBING FEE
DBL
$
CITY ,-
�f ZIP CODE
CITY ZIP CODE
TOTAL FEES 0
$
�
TEL. NO.
r/ %'` , i('i
TEL. NO. LICENSE
CASH ❑ CHECK ❑ M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
jTREES
RECEIVED
REG UIREDTION
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
A\A/C IIC TL E CTATC nc rAI IC(IDAIIA rn%ICDIAI(_ (nAITDAiTn DC IC AI Cn ( I IADANTCCh
I `^ I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) O► L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.