280571 (RR)BUILDING PERMIT DEPARTMENT.OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES INO
1 ST FL.-,'SQ.FT. @ UNITS
2ND FL.. SQ. FT. @
POR. SO. FT. @ MOBILEHOME SVC.
GAR. POWER OUTLET -
CAR P. SO.FT. @ '
SQ. FT. @
i��SO.
FT.'@ oV.
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tox valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
APPLIANCE
SWIM POOL. PVT
SWIM POOL. COMM
SIGN
FIELD OFFICE
PLUMBING FEES
YARD SPKLR SYSTEM'
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISHI
GARRAGF DISPC)SAI
/! I
FURNACE ❑ UNIT •,❑ WALL ❑ FLOOR ❑ SUSPENDED
_ - - .
J F M A M J J A $ Q N D
JOB ADDRESS` l.�_ _ SP
7� 7?7 ` !/� l�t�
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
B. T.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
I AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ a
BATH TUB
UNITS
ROOMS
SQ FT @ a
WATER HEATER
SQ FT RESID @ 1 a
SEWAGE DISPOSAL
IikA
SQ FT GARAGE @ '/2a
HOUSE SEWER
PERMIT FEE
MICROFILM FEE
GAS PIPING
MOBILE HOME PERMIT FEE
$
LEGAL DESCRIPTION
PERMIT FEE
PERMIT FEE
2. _PERM Ij-jj 1
8057
�TOTAL65
5i.Jrj CJ
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. SEE
1y o
DBL.
ELECT. FEE
DBL.
SMI FEE
E
F:r
PLUMB. FEE
DBL.
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.
JOB ADDRESS` l.�_ _ SP
7� 7?7 ` !/� l�t�
- OWNER_,rt _ T
- DLL. J L
74
i�'�iCJQ<
lU IJ P
7j
U/fSE OF PERMIT. j }
.
((II)
F: C. JDATA
f ��
(I, N
PFgMN� 5 71'
L
76
/l�'roo .L/tt.)Cf
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION h
SUPP. TO PERMITFO FICE _
IikA
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
fiV LQ / /�- AL. ;16Y
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE / ZONE
USE NO.
GRP
TYPE
CQJY r\
FS IR
J/
PLAN CHECK FEE
$
BOND AMT.PLAN
NO.
PLAN CHECKER
FINAL DATE K�SR�ECT^OOR
t-a�'�� l
CONSTRUCTION FEE
DBL
$ /
(�
NAME OF CONST. LENDER BRANCH
OFFICE
NO LEND ANVOLVED
_
T
ELECTRICAL FEE
DBL
$
ADDRESS CITY
%
fj PATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
C6N.T (RF1R / i/rI t�
i f <j
. FEE
$
ADDRESS
ADDRESS (j
J`aF' 1.._a1' .�"/j,�!_•r,J (IC,� f,� %a" 1�
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
L
TOTAL FEES
$
j 4
Q
TEL. N0.
TEL. NO. ,�/� �, r c� S A LICENSE t/
.I f -3-) 7 � 6, *7/41 17 S
CASH CHECK ❑ M.O. O N.C. ❑('.�'��
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
PION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
J
RECEIVED BY
TREES REQUIREDi
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
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY. EMPLOYEES. COMPLIANCE WITH THE
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.