272395 (RER)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
kk COUNTY OF RIVERSIDE A
CONSTRUCTION ESTIMATE
I ST FL.
SOFT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ. FT. @
CAR P.
SQ.FT. @
(WALL
SQ.7,ET. @
L l4 C L NTl
C.T
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
SO. FT. @
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not to be used os property tox valuation
MECHANICAL FEES
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING :4
FLOOR DRAIN
WATER SOFTENER
DST
VENT SYSTEM FAN ❑ EVAP. COOL ❑ HOOD
<� Qv
SIGN
OWNER
{
74
WASHER [AUTO) (DISH)
0Utl.{
APPLIANCE
75
USE OF PERMIT 4 nP J'/x7-Ufi E.5
F.C.
GARBAGE DISPOSAL
PE I O.
76
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
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LAUNDRY TRAY
$
AIR HANDLING UNIT CFM
COMMUNITY
IDLE METER
UNITS
ROOMS
KITCHEN SINK
SUPP. TO PERMIT
OFFICE
ABSORPTION SYSTEM j B.T.U.
TEMP USE PERM SVC
`
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
COPIES
$
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
LEGAL DESCRIPTION
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ ¢
BATH TUB
MECHANICAL FEE
DBL
$�-y
SQ FT @ ¢
SET BACK
LOT SIZE ZONE
WATER HEATER
USE NO.
GRP
TYPE
CK BY
SQ FT RESID @ la
SEWAGE DISPOSAL
�, I
Ili
SQ FT GARAGE @ I/7¢
f
HOUSE SEWER 1
O
PERMIT FEE
ri
BOND AMT.TNNO.
GAS PIPING
FIIN%AL T�
IrySP CTOR
MOBILE HOME PERMIT FEE S
PERMIT FEE
oc `
PERMIT FEE21
C
O.
21
TOTAL FEES
MOB. HM.FEE
MICRO FE!',11
MECH. FEE
DBL.
PL. CK. FEE
I CONST. FEE
DBL,
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J
J f M A M
J J A S Q N D
.JOB ADDRESS SP NO
f �l
OWNER
{
74
0Utl.{
rF%f/
75
USE OF PERMIT 4 nP J'/x7-Ufi E.5
F.C.
DATE
PE I O.
76
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M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
A (rVv/ALTA�-
I
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
F
MECHANICAL FEE
DBL
$�-y
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
!!
011)
�, I
Ili
F S R
PLAN CHECK FEE
$
BOND AMT.TNNO.
PLAN CHECKER
FIIN%AL T�
IrySP CTOR
�i !! f
/
/ �"'/ , , )G
/
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
.'/Q
Co
-
ELECTRICAL FEE
DBL
$
ADDRESS CITY
/
STATE
`
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
y(
p�/,%1l)Z�+(J/I/�T
FEE
$
ADDRESS
ADDRESS / /
f3D iE/. // -/e'
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
i 'q
/A11910, L4 1
TOTAL FEES
$
TEL. NO.
TEL. NO. / LICENSE
CASH ❑ CHECK M.O. ❑ N.C. ❑
S 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 `
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
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
1A—C!CTUC CTATC!C!Al A/'!l\/CDIAI(_ r-TDAr`rl DC IC Al rn(-1 IA DA AITCCh
SEWAGE SYSTEM
T
LL
y
P tlYt�
I 1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) Qr L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.