260564 (SFD)BUILDING PERMIT DEPARTMENT OF: BUILDING & SAFETY
-COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
1 ST FL, —2 < SQ.FT. � UNITS
2ND FL. SO. FT. @
MOBILEHOME SVC.
POR. 50. FT. @ _ '
i GAR.' � SO."'"'"
POWER OUTLET
CAR P.' SQ.FI. @+
WALL SQ. FT. @
SQ. FT. @ `
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used as property tax voluotion
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SWIM POOL, PVT
SWIM POOL; COMM
SIGN
FIELD OFFICE
NO. PLUMBING. FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
DST
1�
APPLIANCE
JOB ADD ESS SP NO
�%
13
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR Cl SUSPENDED ..
3"-%S/ ` 41v t3f o
LAUNDRY TRAY'
AIR HANDLING UNIT CFM
IDLE METER
w KITCHEN SINK
ABSORPTION SYSTEM O;B.T.U.
TEMP'USE PERM SVC
WATER CLOSET
COMPRESSOR. HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY '
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ FT @ a
BATH TUB
DST
SQ FT @ a
WATER HEATER
VALUATION
SQ FT,RESID @ 1 a
SEWAGE DISPOSAL
SQ FT GARAGE @ '/7a
HOUSESEWER
PERMIT FEE
,UNITY
f 01NJ�
GAS PIPING
.MOBILE HOME PERMIT FEE Is
IPERMIT
FEE
PERMIT FEE
PERMIT NO.
26-0564
TOTAL FEESMOB,
a 4a-=
HM.FEE
MICRO FEE
MECH, FEE
DBL.
PL. CK. FEE
"
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J F M A " MJ J A S O N D
JOB ADD ESS SP NO
�%
13
OWNER
j f
74.
3"-%S/ ` 41v t3f o
75
USE OF PERMIT .
F.C.
J
DATE
P M N
MH PERMIT, FEE
$
COM
DST
UNITS
ROOMS
VALUATION
TO PERMIT
OFFICE
,UNITY
f 01NJ�
ISUPP.
'MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
F
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE.
USE NO.
GRP
TYPE K BYQ_
)
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
J
o f�
ci 0 7`S
7 .
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNERJAGENT.'S SIGNATURE
CONTRACTOR
INSTRUMENTATION FEE
$
ADDRESS •
ADDRESS
FEE,
PLUMBINGFEE
DBL
$
CITY ," ZIP CODE
CITY ZIP CODE
/1 ?1,5 Il .¢Al
-
TOTAL FEES �
$
/;�
���
TEL. NO.
'" _ �• �, � � .��
TEL. NO. LICENSE
CASH CrECK ❑ 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 BY
TREES REQUIREDTION
yv
L' 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
SEWAGESYS7EM
1p
T
LL
(n
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
,C—r EcrnrC --n— — iC A --
I'HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS 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.