272152 (RPL)BUILDING PERMIT
DEPARTMENT OF -BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL. �'
2ND FL:
POR.
GAR.
CAR P.
WALL
SQ.FT. @
UNITS
LAUNDRY TRAY
SO. FT. @
YARD•SPKLR SYSTEM
SO. FT. @ MOBILEHOME SVC.
BARSINK
SO. FT. @ POWER OUTLET
ROOF DRAINS
SOFT. @
DRAINAGE PIPING
SQ. FT. @'
DRINKING FOUNTAIN
UNITS
SQ. FT. @
VALUATION
URINAL
ESTIMATED CONSTRUCTION VALUATION $
POLE, TEMP/PERM
WATER PIPING
NOTE: Not to be used as property tQx valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
I
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN
WASHPP IAI ITC)) rnitHl
APPLIANCE
.JOB ADDRESS SP NO
OWNER
74
GARBAGE DISPOSAL
/
7Y%i,'1R :�,L'� Y �f7fs
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
USE OF PERMIT—/?
1
F.C. DATE
LAUNDRY TRAY
76
AIR HANDLING UNIT
CFM
IDLE METER
M H PERMIT FEE
KITCHEN SINK
$
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERM SVC
UNITS
WATER CLOSET
VALUATION
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
I
BOILER 0 B.T.U.
SQ FT @ ¢
COPIES
BATH TUB
LEGALDESCRIPTION we `
SQ FT @ ¢
WATER HEATER
MECHANICAL FEE
DBL
SQ FT RESID @ la
SEWAGE DISPOSAL
LOT SIZE ZONE
USE NO.
SQ FT GARAGE @ 'ha
TYPE
HOUSE SEWER
PERMIT FEE
7 '''+
GAS PIPING
MOBILE HOME PERMIT FEE
S
"'�Z ',
PERMIT FEE
PLAN CHECK FEE
PERMIT FEE
$
R IT O.
2 H 5
TOTAL FEES
,2i
MOB. HMTEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
,�t �
_
ELECT. fEE
� zz'-.
DSL.
SMI FEE
FEE
PLUMB. FE _
D`,9V
,
J I F I M I A I M I J IJ A S Q N D
.JOB ADDRESS SP NO
OWNER
74
�zr�""'�l�.tJ! ' �l •;�_
/
7Y%i,'1R :�,L'� Y �f7fs
75
USE OF PERMIT—/?
1
F.C. DATE
PE I O.
76
_-
,� r-
2.15 2
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
_ A!
I
MICROFILM FEE
COPIES
$
LEGALDESCRIPTION we `
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
7 '''+
1
l
"'�Z ',
F/ f/ S / Q R /�}
f iJ`
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINw IT
INSPECTOR
CONSTRUCTION FEE
'DB'L
$
NAME OF CONST. LENDER - BRANCH
OFFICE
NO LENDER INVOLV D
ELECTRICAL FEE
f)
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
/
CONTRACTOR
+'� r , ' . 1.
�...
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
`-r•
•.
CASH ❑ CHECK [ M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BYTREES
REQUIREDf'fION
t; I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AG
i 'COR 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 THi
I I HEREBY CERTIFY THAT THE NDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284.208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
I OF THE STATE OF CALIFORNIA.