286261 (ELEC)BUILDING PERMIT FIELD OFFICE
DEPARTMENT OF BUILDING & SAFETY •
I
F
J F M A M J J A S O N D
PERMIT NO.
R
V
OWNER -
y'
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COUNTY OF RIVERSIDE
77
COMMUNITY
/ ,
VALUATION
$
DST
J/
�7
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
78
NO. PLUMBING FEES
1 ST FL.
2ND FL.
' POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
F.C.
SUPP. O PER IT
M06261
SQ. FT. @ YARD SPKLR SYSTEM
MICROFILM FEE
SQ. FT. @ MOBILEHOME SVC: BAR SINK
$
SQ. FT. @ POWER OUTLET ROOF DRAINS
PAGE PA
PARCEL
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL '
/BO1OK
— . 3A
VALUATION $ WATER PIPING
MECHANICALFEE
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
ZONE
SET BACK
MECHANICAL FEES
SWIM POOL, COMM
TYPE
WATER SOFTENER
VENT SYSTEM [J FAN ❑ EVAP. COOL ❑ HOOD
SIGN -
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
PLAN CHECK FEE
WATER CLOSET
$
COMPRESSOR HP
POLE, TEMP/PERM
PLAN CHECKER
LAVATORY
IN SECTOR
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
„
BOILER B.T.U.
SQ.FT. @ a
,CONSTRUCTION FEE
BATH TUB
$
NAME OF CONST. LENDER BRANCH
SQ.FT. @ ¢
NO LENDER INVOLVED
WATER HEATER
SQ.FT.RESID @' 11/aa '
SEWAGE DISPOSAL
ELECTRICAL FEE
DBL
$
SQ.FT.GAR. @ 3/4a
ADDRESS CITY
HOUSE SEWER
STATE
GAS PIPING
STRONG MOTION
PERMIT FEE
$
PERMIT FEE
OWNER/AGENTS SIGNATURE
PERMIT FEE
,INSTRUMENTATION FEE
OBL.
I TOTAL FEES
IMOB.HM.FEEI
MICRO FEE
MECH. FEE P . CK. FEE
.CONST. FEE
ELECT.FEE
SMI FEE I
FEE
PLUMB. FEE
F
J F M A M J J A S O N D
JOB ADDRESS I SP NO
s+� �{ jt —�-
/ S'riJ T 4 ) - /'/Yl !
OWNER -
y'
�%t�I /iuh ergl '
`76
77
COMMUNITY
/ ,
VALUATION
$
DATE//
i �, f�
DST
OFFICE
78
-M H PERMIT FEE
$
USE'OF PERMIT
F.C.
SUPP. O PER IT
M06261
MICROFILM FEE
COPIES
$
PAGE PA
PARCEL
LEGAL DESCRIPTION
/BO1OK
— . 3A
E r j.
MECHANICALFEE
DBL
$
USE NO.
ZONE
SET BACK
LOT S ZEGRP
TYPE
CK BY
I
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
IN SECTOR
,CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENTS SIGNATURE
f1T A
,INSTRUMENTATION FEE
:SPECIALINSP
$
ADDRESS ADDRESS
DEMOLITION
FEE
REGISTRATION
,r',
49,
PLUMBING FEE
DBL
$
CITY ZIP CODE CITYY
ZIP CODE
" TOTAL FEES $
00
TEL. NO. AREA
CODE TEL.
NO.
AREA CODE
LICENSE u
CASH ❑CHECK .O.❑N.C.❑
,RECEIVED.BY TREES REQUIR
or
THIS PERMIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE'PERMIT TO BECOME VOID:
,SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMITWILL BE DONE INACCORDANCE
,: T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
LVMPtNJAIIUN INJUKANCt UPUN MY LMPLOYEES. 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 HAS DONE
FORM 264-206 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.