268979 (AR)t
FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING $ SAFETY
+ COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
1 ST FL.
SQ.FT. @
2ND FL.
SO. FL" @
POR.
SO. FT. @
GAR.
SQ. FT. @
CAR P.
SO.FI. @
WALL
SO. FT. @
SQ. FT. @
WATER CLOSET
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not to be used os property tax valuation
MFCHANICAI FFFS
NO. ELECTRICAL FEES
UNITS `
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL COMM
NO. PLUMBING FEES
YARD SPKLR SYSTEM
YEAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATFR SnFTFNFR
L
•3O
VENT SYSTEM O FAN ❑ EVAP. COOL O HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
�R�/k/(TiLQ
GARBAGE DISPOSAL
FURNACE O UNIT O WALL ❑ FLOOR ❑ SUSPENDED
USE OF PERMIT
Ago
Ago i
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM T. U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED O GRAVITY
AMPERESSERV'ENT
SHOWER
BOILER B.T.U.
SQ FT @ ¢
BATHTUB
VALUATION
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
SOFT GARAGE @ '/z¢
HOUSE SEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE
PERMIT FEE
2 _PEgM1T fJQ -
6897
TO��EES
op
MOD. HM.FEE
MICRO FEE
MECH. FEE
DBL
PL. CK. FEE
CONST. FEE
DBL.
ELECT: FEE
DBL.
SMI FEE
1.DLO
FEE
PLUMB. FEE
IDBL.
J f M A M J J A $ O •N D
JOB ADDRESS SP NO
OWNE7R'
74
�R�/k/(TiLQ
Ci`a7V5 t
75
USE OF PERMIT
Ago
Ago i
F. C.
DATE
- ����,
P M N
9 7 9
76
.��-,res ;
M H PERMIT FEE
$'
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE Z.ONNES
USE NO.
GRP
TYPE CK BY
F 5 R
!
PLAN CHECK FEE
$
BOND AMT.PLAN
NO.
PLAN CHECKER
FINAL DATE INSPECTOR
11,
?G 'L,
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE NO LENDER I� D
r
ELECTRICAL FEE
DBL
$
ADDRESS CITY
+moi STATE
STRONG MOTION
$ -
OWNER/AGENT'S SIGNATURE�t.
C",
INSTRUMENTATION FEE
/t1 bAl �"vNsi
$
ADDRESS `.+./"
ADDRESS
FEE
115 e
PLUMBING FEE
DBL
$
CITY ZIP CODE
CIT ZIP CODE
toe
TOTAL FEES �
$
�
GD
TEL. NO.
TEL. NO.LICENSE
✓�6'�'j �-'}`��,/�/!
CASH CHECK ❑ M.O. O N.C. O
y/ 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.
RECEIVED BY,
TREES REQUIRED
O
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
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE Wi.TH THI
nic n crnrc �c gni i n r•rwrni r.r r
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 CODE
I OF THE STATE OF CALIFORNIA.