280049 (ADD)BUILDING, PERMIT
CONSTRUCTION ESTIMATE'
I ST FL. SQ.FT. @
2ND FL. SO. FT. @ ! �`
POR. SO. FT. @
GAR. SQ. FT. @
CAR P. SO.FT. @
WALL SQ. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation'
mr-rHANH-AI FF -FC
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
r
NO. .` ELECTRICAL FEES
UNITS `
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL. PVT
CWIM Dnnl fr1MM
FIELD OFFICE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
NO. PLUMBING FEES`
APPLIANCE
PERMIT FEE
YARD.SPKLR SYSTEM
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
BARSINK
i.
ROOF DRAINS
IDLE METER
DRAINAGE PIPING
ABSORPTION SYSTEM B.T.U.
DRINKING FOUNTAIN
WATER CLOSET .
URINAL
POLE, TEMP/PERM
WATER PIPING
.,S
FLOOR DRAIN
SHOWER
%A/ATFD ln9T9:NIFD
SQ FT @ a
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
PERMIT FEE
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
jIJ
�� FEES
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET .
COMPRESSOR HP /
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 0 B.T.U.
SQ FT @ a
BATH TUB
OFFICE
SQ FT @ a
WATER HEATER
SQ FT RESID @ 1 a
SEWAGE DISPOSAL
//
SQ FT GARAGE @ '/]a
HOUSE SEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE $
JOB ADDRESS �%� SP NO
�
PERMIT FEE''
74
PERMIT FEE
/
o p Ci
2 _PE$MI®O._
8 4
jIJ
�� FEES
MOB. HM.FEE MICRO FEE
MECH. E� DBL.
VWy^f
L. CK.FEE
11
�T�IE�
,DBL.
DBL.
5 E
$
FEE
PL
DBI.
UNITS
ROOMS
SUPP. TO PERMIT
OFFICE
/_A4)«i c,
//
t
�UATION
/ s
J I F I M A I M I J I J A 1 S 1 O 1 N D
JOB ADDRESS �%� SP NO
�
OWNER
74
� I /0 !yk
/
o p Ci
75lS
E OF PERMIT
` /
DATE
%—�3-7G
P M N
' 049
]b
vpr as
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
SUPP. TO PERMIT
OFFICE
/_A4)«i c,
//
�UATION
/ s
�
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK I
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
/
/
/
f
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
j/
ADDRESS"- CITY
STATE
STRONG MOTION
$
OW, 'R/AGENT SIGNATUR'
`"rte.
CONTRACTOR t
INSTRUMENTATION FEE
£ 3!; {r tel
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITt ZIP CODE
CITY ZIP CODE
TOTAL FEES
$ /
TEL. NO.
TEL. NO. LICENSE
CASH ❑ CHECK M.O. p N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
ION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEI
TREES REQUIRED
t
I HE
BREBY 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
j;
T
LL
P �J
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
.FORM 284-208 (Rev. 10-74) @L dl HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.