242962 (RPL)BUILDING PERMIT
CONSTRUCTION ESTIMATE
IST -FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ.FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMA ED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax voluotion
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFE'
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
BOILER O B.T.U.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) IDISHt
DST
I•
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APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM Cl FORCED ❑GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ a BATH TUB
SQ FT @ ¢ WATER HEATER
SQ FT RESID @ 1 a SEWAGE DISPOSAL
SQ FT GARAGE @ 'ha HOUSE SEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE "M A PERMIT FEE D�
24RAT IT NO, 6
TOTAL FEES
J 77
MOB. HM. FEE MICRO
FEE
MECH. FEE
DBL.
PL. CK. FEE
/ ! �y
CONST. FEE
U ��14
DBLf
ELECT. FEE
I DBL.
SMI E
•.
FEE
PLUMB. FEE
V�
DBL.
JI F I M A I M I J IJI A I S O 1N D
JOB ADDRESS ` SP NO
OWNER
73
74
USE OF PERMIT
F.C.
DATE,
m
P MI NO
75
M H PERMIT FEE
$
COMMUNITY
t�lz A,�v�
DST
UNITS
ROOMS
VALUATION g
t-
S PP. TO PERMIT OFFICE
J
MICROFILM FEE
COPIES
$
LEGAL D CRIPTION 1%
MECHANICAL FEE
DBL
$
SETBACK
LOT SIE ZONE
USE NO.
GRP TYPE CK BY
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATEr p 1 e
q _
INS CTOR
�,t.i.ke,
CONSTRUCTION FEE
DBL
$
e
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
$
�j
•
TOTAL FEES
$
✓
%
OWNER/AGENT'S SIGNATURE
CONTRACTOR
�'%c ��,+7e�
ft r oar'''
��`�`�''�/f
CASH ❑ CHECKw M.O. ❑ N.C. ❑
ADDRESS t
S ADDRES` 1
71- ? r%i '1
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
a
LL P
CITY ZIP CODE
CITY .,'.-.� r3 ZIP CODE
INFORMATION
FORM 284.2081Rev.9.731 Os
TEL. NO,
TELL. NO. j� LICENSE ^�
ate` i' :J• j � /1r9 -e ,
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