268977 (ELEC)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
COUNTY OFAIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
I ST FL SO FT @ UNITS,
2ND FL.
SO. FT. @
OWNER
POR.
SO. FT. @ :
MOBILEHOME SVC.
GAR.
SO. FT. @
POWER OUTLET
CAR P.
SO.F1. @
AIR HANDLING UNIT
SO. FT. @
r -� 7
• WALL
KITCHEN SINK
SO. FT. @
0 B.T.U.
ESTIMATED CONSTRUCTION VALUATION $
TEMP USE PERM,&K
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
MECHANICAL FEES
SWIM POOL, COMM
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
I SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHFR (At ITCH HwRw
DST
APPLIANCE
JOB ADDRESS - _.' SP NO
OWNER
74
'e�� f "mJ"�' :^ i ,;;1 Y` :tiF � �'�
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
USE OF PERMIT
t
.7p
F. C.
DATE PE MIT NO.
6 8 9 7
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
r -� 7
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
0 B.T.U.
¢t
TEMP USE PERM,&K
' fi
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
MICROFILM FEE
SQ FT @ C
$
BATH TUB
LEGAL DESCRIPTION
SQ FT @ C
WATER HEATER
MECHANICAL FEE
DBL
$
SQ FT RESID @ 1 ¢
SET BACK
SEWAGE DISPOSAL
USE NO.
GRP
SQ FT GARAGE @ '/za
CK BY
HOUSESEWER.
PERMIT FEE
�
GAS PIPING
MOBILE HOME PERMIT FEE
$
A/
PERMIT FEE
;
PERMIT FEE
PERMIT N0.
268977
TOTAL FEES=
1 �v
HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
1
DBL.
SMI FEE
-FEE
PL4FEE
J I F I M I A I M I J J I A I S 1 O 1N D
JOB ADDRESS - _.' SP NO
OWNER
74
'e�� f "mJ"�' :^ i ,;;1 Y` :tiF � �'�
�`7'.•.�"( /1J.s�� `�% Y` - .' R
75
USE OF PERMIT
t
.7p
F. C.
DATE PE MIT NO.
6 8 9 7
76'_
'% l°1
r -� 7
M H PERMIT FEE
$
C MMUNITY
DSTf
UNITS
ROOMS
VALUATION
TO PERMIT
OFFICE�
�
LS.UPP.
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
PLAN CHECK FEE
$
BOND AMT.
PLAN NO. -
PLAN CHECKER
FINAL DATE
CONSTRUCTION FEE
DBL
$.
NAME OF CONST. LENDER. BRANCH
OFFICE
NO LENDER IoLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$ -
OWNER/AGENT'S SIGNATURE
CONTR CjFQR / {j J 1�✓� in_�.-� �L .:'
INSTRUMENTATION FEE
j uZ)f_,i\
d
"
$
ADDRESS
ADDRESS .r
FEE
-CODE
PLUMBI NGFEE
DBL
$
CITY ZIP
ZIP CODE
pCIITY
TOTAL FEES �
$
� �
TEL. NO.
"�,+^•=
TEL. NO. LICENSE
x ` � -'y `�%
7
! G ! /
CASH ❑ CHECK (2( M.O. ❑ N.C. ❑
,{� THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAY . CESSA
ON OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
Ar
RECEIVED BY °
TREES REQUIRED
il'� 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
SEwAGESYSTEM
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) (DL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OFTHE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.