268485 (PLBG)I BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
1 CONSTRUCTION ESTIMATENO. ELECTRICAL FEES
! 1 ST Cl FT UNITS
.
SO. . @
2ND FL.
SQ. FT. @
POR.
SO. FT. @
GAR.
SO. FT. @
CAR P.
SO.FI. @
WALL
SO. FT. @
SO. FT. @
JDATE'flT
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not to be used as property tox voluot ion
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOBILEHOME 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 (AUTO) IDISHI
DST
&0
APPLIANCE
SP NO
.IOB ADDRES�S>
OWNER
GARBAGE DISPOSAL
) /f
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
75
LAUNDRY TRAY
F.C.
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
JDATE'flT
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
$
COMPRESSOR 0
HP
POLE, TEMP/PERM
LAVATORY
ROOMS
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 0 B.T.U.
SQ FT @ a
BATH TUB
SQ FT @ a
WATER HEATER
MICROFILM FEE
COPIES
SQ FT RESID @ 1 a
SEWAGE DISPOSAL
LEGAL DESCRIPTION
SQ FT GARAGE @ '/aa
HOUSESEWER
,-/- G� --!I' -//- / ..-,5�
PERMIT FEE
DBL
$
GAS PIPING
SET BACK
MOBILE HOME PERMIT FEE
$
USE NO.
PERMIT FEE
PERMIT FEE
� �
PERMIT NO.TOTAL
268485
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 I FM A M J J A S O N D
SP NO
.IOB ADDRES�S>
OWNER
) /f
75
USE OF PERMIT
F.C.
76
r % P
JDATE'flT
/-- r�'' iGi
8 4 8 5
M H PERMIT FEE
$
O MUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
,-/- G� --!I' -//- / ..-,5�
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
/
F 5 R�
fel
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
r
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
�=
STATE
r fI
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR ♦ N,�_ o ., s l
$
ADDRESS
ADDRESS
'FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
TEL. NO.
TEL. NO. LICENSE
CASH CHECK CHECK ❑ M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
ON OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BYR/'
TREES REQUIRED
,41 11I
D
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
ICORDANCE
,
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
r �A1. Air 1-1—A IT -1 it A.-- Trrn
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.