245749 (BLCK)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COO " yr R! v r.Rawr.
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO,j PLUMBING FEES
DST
1 ST FL.
2ND FL.
POR.
SQ.FT. @
SQ. FT. @
SO. FT. @
UNITS
BOILER O B T U
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
CAR P. Sq.F7_ :@
WALL / �3eJA SQ. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
s
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER IAUTOI (DISH)
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 U HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED []GRAVITY
AMPERESSERV ENT
SHOWER
SQ FT @ ¢
BATH TUB
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 11
SEWAGE DISPOSAL
SQ FT GARAGE @ 'h
HOUSESEWER
PERfv11T FEE
TEMP ELEC SVC
GAS PIPING
MOBILE HOME PERMIT FEE Is
PERMIT FEE
PERMIT FEE
PERMIT NO-
TOTAL FEES
n
1415U. HM FEE
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FEE
I DBL PL CN. FEE
CONST- FEE
Y�?
DBL
ELECT. FEE
DBL
SMI FEE
FEE
PLUMB. FEE
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74
USE OF PERMIT
F C DATE PF/PrM1 N
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUAl 10'r
TO PERMIT
OFFICE
ISUPP.
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
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MECHANICAL FEE
DBL
$
SET BACK,
LOT SIZE ZONE
USE NO.
GRP
TYPE
I C
F S __ R ��
)
vr-
PLAN CHECK FEE
$
BOND AMT. PLAN NO
PLAN CHECKER
FINAL DATE
/
r r
JINSPECTOR
H,4'
CONSTRUCTION FEE
DEL
$
NAME OF CONST- LENDER BRANCH
O FICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY
STATE
SMI FEE
1
$
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-
COP,DANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
$
FEE
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
PLUMBING FEE
DBL
$
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
$
O%VNE.§1 AGENT'S SIGNATURE
CONTRACTOR '
t
J�1
TOTAL FEES
��
f`f7�
CASH ❑ CHECK Ey M.O. ❑ N.C. ❑
ADDRFSS
AD RESS
l� •'� a Lf r� ��
~
RECEIVED BY f
TREES REQUIRED
SEWAGE SYSTEM
T
ILLIF
CITY ZIP CODE
C11CODE
[
41 � J C
INFORMATION
TEL No
TEL NO. LICENSE
FORM?B42UB IRev- 9-731 (phi
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