280618 (AR)BUILDING PERMIT / DEPARTMENT OF BUILDING & SAFETY
t COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL -FEES y
I ST FL SQ FT UNITS
MOBILEHOME SVC.
POWER OUTLET
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
IAincuaD lel ITnI IMC
APPLIANCE
JOBAD09Er z" -- _ SP -NO
OWNER
2ND FL.
FURNACE ❑ UNIT O WALL O FLOOR O SUSPENDED
SO. FT. @
POR.
AIR HANDLING UNIT
SQ. FT. @
GAR.
KITCHEN SINK
SQ. FT. @
CARP.
TEMP USE PERM SVC
SO.FT. @
WALL
HP
SQ. FT. @
OwhtAele
�^
SO. FT. @ 3�U
ESTIMATED CONSTRUCTION VALUATION $ a.
NOTE: Not to be used CIS property tax voluotion
BOILER � B.T.U.
MECHANICAL FEES
SQ FT @ ¢
VENT SYSTEM
❑ FAN O EVAP. COOL O HOOD
MOBILEHOME SVC.
POWER OUTLET
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
IAincuaD lel ITnI IMC
APPLIANCE
JOBAD09Er z" -- _ SP -NO
OWNER
GARBAGE DISPOSAL
FURNACE ❑ UNIT O WALL O FLOOR O SUSPENDED
keL
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY i
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T.U.
ROOMS
SQ FT @ ¢
BATH TUB
OFFICE
SQ FT @ c
WATER HEATER
SQ FT RESID @ I a
SEWAGE DISPOSAL
SQ FT GARAGE @ 'h¢
HOUSESEWER
PERMIT FEE
COPIES
$
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
PERMIT FEE
ER IT 0.
1
TOTAL FEES
5; °='
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
S, �°-JDBL.TS��_
DBL.
ELECT. FEE
TYPE
E
.
FEE
PLUMB. FEE29N
-
J F M A M J J A S ^O N D
JOBAD09Er z" -- _ SP -NO
OWNER
74
--
7S .:Z3.3 S/a,v/%71y!�C�
keL
75
76
USE OF PERMITF.C.
Fu.V Roo x2�i8 � @A�
JDATE
9tLU
PE IT 0n
90618
cc ry, 411
76
MH PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
I VALUATION
SUPP. TO PERMIT
OFFICE
30.
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
?A)#"417 -330 -®N 4k /q GA, OU10�,� . 66)F
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
C BY
-
/ Q
SR,3_XPLAN
CHECK FEE
$
AMT.
PLAN NO.
PLAN CHECKER
FINAppL DATE
INSPECTOR,
J
� (�
CONSTRUCTIbN FEE
_I
DBL
$
Q
.�+
NAME OP CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR Ge Y " j
G
$
ADDRESS
ADDRESS
FEE
_
7 j3
y+ (- l tt
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITYZIPCOOE
TOTAL FEES
�.
TEL. NO.
TEL. NO. LICENSE
CASH ❑ _ CHECK,f M.O. ❑ N.C. O
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 122'0 DAYS. CESSA
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. '
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN'AC
CORDANC€ WITH THE LAWS OF RIVERSIDE COUNTY. AND THE STATE OF CALIFORNIA, I ALSC
RECEIVED BY %a.��
TREES REQUIRED 4
f
SEWAGE SYSTEM
T
LL
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES COMPLIANCE WITH THE
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev. -10-74) OP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.