258847 (BLCK)I BUILDING PERMIT
CONSTRUCTION ESTIMATE
I ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. ,Q.FT. @
WALL SQ. FT. @
W;!! -J) Z SQ. FT. @ "
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not !o be used as property tax vol;iotion
MECHANICAL FEES
DEPARTMENT OF BUILDING & SAF
COUNTY OF RIVERSIDE
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
PLUMBING FEES
BOILER I I I
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
VENT SYSTEM Cl FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO iDISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR (3 SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHF= SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ ¢ BATH TUB
SQ FT @ ¢ WATER HEATER
SOFT RESID @ 14 SEWAGE DISPOSAL
SQ FT GARAGE @ '/z¢ HOUSE SEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE PERMIT FEE
PERMIT NO.
BR4
TOTAL FEESMOB.
HM. FEE
i
MICRO FEE
MECH. FEE
DBL
PL. CK. FEE
/CONST. FEE
I
DBL.
ELECT. FEE
DBL.
I SMI FEE
FEE PLUMB. FEE
DBL
F I M I A M I J J Ii A I S Q 1 N I D
JQB ADDRESS_ I SP NO
.�G t1���7j
I OWNER
7'� i�.Lifi' f - �f
73 Ir`o�-}1K
74
USE OF PERMIT ,%
i rVL)� � i
F.C.
DATE
�
PS8 4 '
75
M H PERMIT FEE
$
COMMUNITY {
2.} j%
DST
I UNITS
ROOMS
I VALUATION v c
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
zzl _r
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
e�4
F +....- S — Rte...,-.
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
9 3 •`)!S
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA-
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
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 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
is
TOTAL FEES--
WNER/AGENT'SSI I `
e k
CONTRACTOR
CASH ] CHECK ❑ M.O. Cl N.C. ❑,�
ADD SS
ADDRESS
RECEIV BY,. , . r
yy"y'x. -'�"• .
TRFES REQUIRED
SEWAGE SYSTEM ,.�-r—
T
LL P
ZIP CODE
/ }} i !ry,�
A6 �'i ALL
CITY ZIP CODE
INFORMATION
FO;Rn 284.2U8 tRe, 9.73 ®s
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TEL. NO. LICEI!SL