268779 (PLBG)BUILDING PERMIT
DEPARTMENT OF, BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATENO. ELECTRICAL FEES
UNITS
131 FL.
111..%ADDRESS SP NO
SQ.FT. @
2ND FL.
J
SQ. FT. @
POR.
LAUNDRY TRAY
SQ. FT. @
GAR.
CFM
SO. FT. @
CAR P.
SO.FI. @
WALL
TEMP USE PERM SVC
SO. FT. @ F
$
COMPRESSOR
HP
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tox valuation
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
MECHANICAL FEES
SHOWER
VENT SYSTEM
❑ FAN ❑ EVAP. COOL ❑ HOOD
MOBILE410ME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
DST
/7
APPLIANCE
111..%ADDRESS SP NO
OWNER
J
GARBAGE DISPOSAL
J
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
75
LAUNDRY TRAY
F. C.
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
$
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
ROOMS
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 0 B.T.U.
SQ FT @ ¢
BATH TUB
SQ FT @ ¢
WATER HEATER
MICROFILM FEE
COPIES
SOFT RESID @ I¢
SEWAGE DISPOSAL
LEGAL DESCRIPTION
SQ FT GARAGE @ 1/2¢
HOUSE SEWER
Pe- 4-17-y90 _00 _ �o7- VIAlr* (ry X75
PERMIT FEE
DBL
$
GAS PIPING
a {�
MOBILE HOME PERMIT FEE
is
NO.
PERMIT FEE
PERMIT FEE
!1e
PERMIT NO,
TOTAL FEES
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J F M A M J J A S Q N D
111..%ADDRESS SP NO
OWNER
J
J
75
USSEEi OF PERMIT
F. C.
DATE
P f IT NO
268 779
76
!lG%�/sflLtl�. (,-45 £!1f/r14,
•�—A7"
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
Pe- 4-17-y90 _00 _ �o7- VIAlr* (ry X75
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONEUSE
NO.
GRP
TYPE
CK BY
F S R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INRTOR
CONSTRUCTION FEE
DBL
$
NAME OF COUST. LENDER BRANCH
OFFICE
NO LENDER INVOLV
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR
""e,J
INSTRUMENTATION FEE
�//�f�% ��UN�}jA/1,
FEE
$
ADDRESS
ADDRESS
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
L3
TOTAL FEES
$
TEL. NO.
TEL. NO.
CASH CNC M.O. ❑ N.C. ❑'�Tl
HIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
OFWORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
f
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
ILL
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
T
p
I ALAK! ETUC CT A TC/ C/ AI ICn DAIIA lY k/CDIAIC IY KITDArT(lDC IC A I CYl/^I IA DA IJTCCr%
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.
7
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