268273 (PLBG)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
AML COUNTY OF RIVERSIDE Amikk
CONSTRUCTION ESTIMATE
I ST FL. SO.FT. @
2ND FL. SO. FT. @
POR. SO. FT. @
GAR. -SO.FT. @
CAR P. SO.FT. @
WALLSO. FT. @
---dSO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax voluation
MECHANICAL FEES
VENT SYSTEM O FAN ❑ EVAP. COOL O HOOD
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 ADDRESS SP NO
3'i -y95' �// coh
GARBAGE DISPOSAL
74
FURNACE O UNIT O WALL O FLOOR O SUSPENDED
LAUNDRY TRAY
USE OF.PERMITF.C.
� w,El/ F.A- Sr d.��lr v,
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
76
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED (:1 GRAVITY
AMPERES SERV ENT
SHOWER
ROOMS
BOILER 0 B.T.U. -
SO FT @ a
BATH TUB
SO FT @ ¢
WATER HEATER
t ulmra
SO FT RESID @ 1 ¢
SEWAGE DISPOSAL
SO FT GARAGE @ 'h¢
HOUSES47M / 7`
PERMIT FEE
$
GAS PIPING
LEGAL DESCRIPTION
MOBILE HOME PERMIT FEE Is
PERMIT FEE
PERMIT FEE
0
2 pERIYIIT fj0.�
TOTTALFEES
F10
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMBB.FEE I11111., Po
fy�/�
/
J T M A M J J A S O N D
JOB ADDRESS SP NO
3'i -y95' �// coh
OWNER
�3�1I H".)gs
74
"41
75
USE OF.PERMITF.C.
� w,El/ F.A- Sr d.��lr v,
DATE
—6 -��
PE IT 0.
2 7 3-
76
,
M H PERMIT FEE
$
COMMUNITY
DST
I UNITS
ROOMS
I VALUATION dd
SUPP. TO PERMIT
OFFICE
t ulmra
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACKLOT
SIZE ZO1,0
NE
USE NO.
GRP
TYPE CK BY
fy�/�
/
,,
(
F 5 R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
L
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
/7
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR r i2 �• ,I
;" �N
PL/Nc
FEE
$
ADDRESS
ADDRESS fJ
)2,y q w�-/Q I��U
PLUMBING FEE
DBL
$ �f
CITY ZIP CODE
CITY / ZIP CODE
TOTAL FEES
$
dD
TEL. NO.
T . N0. LICENSE
CASH CHECK ❑ M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
if, ONOF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
�i
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`'��C���
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
1A\AICt C TUC CTATC r C! -A1 ICIIDAII A r- %/CDI1.1t'_r' KITDArTnDC IC A I Cn(�I IA DA AITCCn
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.