268980 (AR)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE i
CONSTRUCTION ESTIMATE
1 ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SO. FT. @
CAR P. SOFT. @
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM O FAN O EVAP. COOL O HOOD
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL. PVT
SWIM POOL. COMM
SIGN
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
/1
APPLIANCE
JOB ADDRESS SP NO
OWNER
GARBAGE DISPOSAL
/
`7-4oGT C�[jt4� �/�
FURNACE O UNIT O WALL O FLOOR O 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 O FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ a
BATH TUB
%
SQ FT @ ¢
WATER HEATER
Ir
MICROFILM FEE
COPIES
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
LEGAL DESCRIPTION
SQ FT GARAGE @ 'ha
HOUSE SEWER
�-�
�- �fl -//- r
PERMIT FEE
GAS PIPING
% / � ara
MOBILE HOME PERMIT FEE
Is
I
I PERMIT FEE
PERMIT FEE
e D
PERMIT NO.
268980
TOTAL FEES
57°0'17E
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
DBL.
ELECT. FEE
DBL.
.SMI FEE
FEE
PLUMB. FEE
9o0
JOBL.
J F M A M J J A S O N D
JOB ADDRESS SP NO
OWNER
74
/
`7-4oGT C�[jt4� �/�
1/4 T///JT �i
75
USE OF PERMITG4 r &C &ye 5C t 1
F.C.
DATE
PE MIT NO.
X68980
76
Ani (s�.X� �15�t:�G;�1-
M H PERMIT FEE
$
COMMUNITY
DSTUNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
o44 00 /,k/ Tit
%
, B ri
I
Ir
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
�-�
�- �fl -//- r
% / � ara
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE NO.
GRPTYPE
XfY
f?.,,
7
"�i/"
F S R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
NSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INV ED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
Z
i !
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR/
INSTRUMENTATION FEE
��
F NU, -/C kS 0/t/ Q, IAS t
FEE
_
.ADDRESS -
ADDRESS /�
!✓ // �'{
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY✓ ZIP DE
.
TOTAL FEES
$
�U
TEL. NO.
TEL. NO. LICENSE
CASH FHECK O M.O. O N.C. O p
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 12(00 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
SEWAGESYS7E
T
LL
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I A%A/C / CTUC CTA TCl C! AI IEl DkllA l' %JCOI 1.1!` /' KITDA rT/lDC IC AI Cnf lIA DA AITCCII
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) O► L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.