290069 (ELEC)DEPARTMENT OF BUILDING&SAFETY •
FIELD OFFICE
BUILDING PERMIT
1 F M A M J
PERMIT No. -
JOB ADDRESS SP NO
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COUNTY OF RIVERSIDE
76
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
DATE
��
NO. I PLUMBING FEES
1 ST Fl.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
_MH
SQ. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC.
BAR SINK
SQ. FT. @ POWER OUTLET
ROOF DRAINS
SQ. FT. @
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
VALUATION $
WATER PIPING
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM [J FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE ❑ DRYER
COPIES
$
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED!;7
LEGAL DESCRIPTION
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
SET B CK
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT,
ICK BY
SHOWER
BOILER B.T.U.
SQ.FT. @ ¢
R
BATH TUB
SQ. FT. @ ¢
WATER HEATER
4
SQ.FT.RESID @ 11/4a
SEWAGE DISPOSAL
�
SQ.FT.GAR @ 3/a¢
HOUSE SEWER
BOND AMT.
PLAN NO.
PLAN CHECKER
GAS PIPING
PERMIT FEE _
DBL. I TOTA FEES MOB.HM.FEE MICAO'FEL-
J
PERMIT FEE
MECH. FEE PL. CK. FEE CONST. FEE/T.
FEE -
PERMIT FEE
SMI FEE FEE PLUMB. FEE
1 F M A M J
J A S O N D
JOB ADDRESS SP NO
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OWNER
76
77
COMMUNITY VALUATION
$
DATE
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ST
OFFICE
78
_MH
PERMIT FEE
$
SE R
F.C.
SUPP O P�E}RMIT
PE MIT
NO.
L
90069
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
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MECHANICAL FEE
DBL
$
USE NO.
ZON
SET B CK
LOT SIZE
GRP TYPE
ICK BY
S.
S
R
4
�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE I
ECT R
. ,�-7_?I
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
V
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
w
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOR
., j':.
INSTRUMENTATION FEE
SPECIAL
$
ADDRESS
SSS'
INSP
DEMOLITION
FEE
�l
REGISTRATION
I ti ;
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
r ZIP CODE
TOTAL FEES$
TEL, NO,
AREA CODE TEL.
NO.
AREA CODE
LICENSE 0
CASH❑CHECK O.❑N.C.❑
RECEIVED BYTREES REQUIRED
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
ORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME, VOID.
SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P
WITH THE LAWS, OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
COMPENSATION INSURANCE UPON MY EMPLOYEES.. 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 IREV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.