206067 (PLBG)BUILDING PERMIT
CONSTRUCTION ESTIMAT
1ST FL.
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. LM
GAR.
SQ. FT.
CAR P.
SQ. FT. @
WALL
SQ. FT.
CONST. SERV. ENTRANCE
SQ. FT. @
ESTIMATED VALUATION Is
MECHANICAL FEES
DEPARTMENT OF BUILDING & SAFETY
I&
COUNTY OF RIVERSIDE
E ELECTRICAL FEES
NO. I I I I NO.
MOTOR 1 OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W.
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
+' - WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER K.W.
GARBAGE DISPOSAL
FURNACE❑UNIT❑WALL❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM B.T.U.
SQ. FT.@ q
BATH TUB
INCINERATOR ❑ DOMESTIC E) INDUS. OR COMM.
SQ.FT.-- (r
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 q
SEWAGE DISPOSAL
BOILER EZ� B.T.U.
SQ. FT. GAR AGE @ I q
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I 1 (PERMIT FEE I aq --- I PERMIT FEE I A v
PERMIT NUMBER FM MEAT & VENT FEE DBL PI. CK. FEE C EE DBL EL DBL FEE PLUMBING FEE DBL
S&�
J
J F M A M J J
A
S O
N D
JOB ADDRESS �.1
OWNER
All?
/J.Z. N4i:?,72
-F7k
73O
USE.F BUrLDING
F.C.
DATE
PER IT
NO
74
WA/ ���n<��,��Ed�
.
X06067
75
COMMUNITY
DST
I UNITS
rOOMI
VALUATION 4
SUPP. TO PERMIT
I OFFICE
76
MOBILEHOME
$
LEGAL
HOOKUP FEE
�SCRIPTION
ra I� /j7.
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
ZO�N7E
`
USE NO.
GRP
TYPE
CK BY
A
F S R
7 1
0 /—T
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSP
CTOR
PLAN CHECK FEE
$
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVO VED
CONSTRUCTION FEE
DBL
ADDRESS
CITY STATE
ELECTRICAL FEE
$
d
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
FEE
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF -
DBL
PLUMBING FEE
$
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
/
Q
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
�s]
IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
TOTAL FEES $
CATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND
gQ
PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
CASH Zr, CHECK LlP� M.O. ❑
N.C. Q
OWNER
CONTR C OR
Received By n
ADDRESS
ADDRESS
7 �` �rt� fel Alli&
Sewage System
T ��
LL
P
CITY
CITY
Trees Required
Yes
No��G--
INFORMATION
TEL. NO.
TEL. NO. 1� LICENSE
FORM 284,209 (REV. 4/71) Lo
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