260615 (SFD)O
FIELD OFFICE
BUILDING PERMIT -�' DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES INO
I ST FL. A♦ SOFT- @ ✓ Q9W7 UNITS
2ND FL. SQ. FT. @
POR.,- SO. FT. @ ¢ - O MOBILEHOME SVC.
GAR. I POWER OUTLET
CAR P. SQ.FT.
WALL SQ. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used os property tax voluotion
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL XHOOD
SWIM POOL, PVT
i SWIM POOL, COMM
SIGN
PLUMBING FEES
YARD SPKLR.SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER __
WASHER IAUTOI,-AI SHl -
APPLIANCE �r fK f�
ULOB Ay�D/QRE55 /}7 ht � I4� SP NO
OWNER
74
GARBAGE DISPOSAL
OF PERMIT
%�ir3
F.C.
FURNACE ❑ UNIT ❑ WALL Cl FLOOR ❑ tUSPENDED
P76 615
T% , � r 4"91J2W/
LAUNDRY TRAY
MH PERMIT FEE
AIR HANDLING UNIT CFM
IDLE -METER
DST
UNITS
ROOM$
KITCHEN SINK
SUPP. TO PERMIT
OFFICE
ABSORPTION SYSTEM O B.T.U.
TEMP USE PERM SVC
•WATER CLOSET
COMPRESSOR l HP
POLE, TEMP/PERM
MICROFILM FEE
LAVATORY
$
lJ
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
Q V!)
AMPERES SERV ENT
Q
i rA
SHOWER
DBL
$
BOILER 0 B.T.U.
SETBACK
SQ FT @ a
USE NO-
GRP
BATH TUB
3�
SQ FT @ a
J
WATER HEATERi
G
I�
PLAN CHECK FEE
SQ FT RESID @ 1 a
- !��
BOND AMT.
SEWAGE DISPOSAL
PLAN CHECKER
FIIh
SQ FT GARAGE @ 'ha
HOUSE SEWER
PERMIT FEE
Q
(�
CONSTRUCTION FEE
DBL
GAS PIPING
NAME OF CONST. LENDER BRANCH
MOBILE HOME PERMIT FEE $
NO LENDER INVOLVED
PERMIT FEE
3 7
!J
PERMIT FEE
PERMIT NO.
?606 5
TOTAL FEE
MOB. HM.rEE
MICRO FEE
MECH. FEE
Lisp
DBL.
PL. CK. FEE
vD"�'
CONST. FEE
DBL.
ELECT. FEE
DBL.
IMI FEE
FEE
PLUMB. FEE
DBL.
J F M A M J J A S Q N D
ULOB Ay�D/QRE55 /}7 ht � I4� SP NO
OWNER
74
75USE
OF PERMIT
%�ir3
F.C.
DATE
--�b
P76 615
T% , � r 4"91J2W/
MH PERMIT FEE
$
coMMum
DST
UNITS
ROOM$
VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES.
$
LEGALD SC RIPTION
3 /'A Qtj
i rA
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE NO-
GRP
TYPE CK BY
I�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FIIh
INSPECTOR
/D�-TE
(�
CONSTRUCTION FEE
DBL
$ -
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
3 7
010
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
°�
OWNEL/AGENT-,S SIGNATUREr,
CONTRACTOR
y
$ -
ADDRESS
ADDRESS
FEE
/�^•�
PLUMBING FEE
DBL
$
CITY_ t ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
TEL. NO'
TEL. NO. - LICENSE
CASH CHECK ❑ M.O. ❑.: N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. �ESSA
At" TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
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
TO CARRY THI
SEWAGE SYSTEM
6- ,
T
LL
p
AGREE COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) OL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS -AND PROFESSIONS COD_ E
I OF THE STATE OF CALIFORNIA.