268095 (SPIN)BUILDING PERMIT
CONSTRUCTION, ESTIMATE
IST FL. SQ.FT. @..
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SQ. FT. @
CAR P. SQ.FT. @
WALL SO. FT. O
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION. $
NOTE: Not to be used os property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑
DEPARTMENT OF BUILDING St SAFETY
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
FIELD OFFICE
NO. PLUMBING FEES
ST
OWNER
GARBAGE DISPOSAL
YARD SPKL R SYSTEM
BAR SINK
AIR HANDLING UNIT
ROOF DRAINS'
IDLE METER
DRAINAGE PIPING
ABSORPTION SYSTEM,
DRINKING FOUNTAIN, -
TEMP USE PERM SVC
URINAL
COMPRESSOR
WATER PIPING'
POLE, TEMP/PERM
FLOOR DRAIN
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
WATERSOFTENER
SHOWER
WASHER (AUTO) (DISH)
ROOMS
APPLIANCE
J F'�M A M' J J A S O N D
'JOB ADDRESS 5P'No
qFql
OWNER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM,
0 B.LU.
TEMP USE PERM SVC
WATER CLOSET ?
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT,
SHOWER
BOILER B.T.Ui
ROOMS
SQ FT @ ¢
BATHTUB
OFFICE
SQ FT @ ¢
WATER HEATER
(4val �✓T
SQ FT RESID @ 1 ¢
SEWAGE DISPOSAL
SQ FT GARAGE @ 'h¢
HOUSE SEWER
PERMIT FEE
COPIES
$
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
PERMIT FEE
PERMIT NO.
268095
TOTAL FEES
1��
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE DBL. SMI FEE -
,A�IJ-Qa
FEE
PLUMB. FEE
DBL.
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED vTHE `PLANS AND SPECIFICATIONS
FORM •284-208 (Rev. 10.74) (DIL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
'JOB ADDRESS 5P'No
qFql
OWNER
74
75
USE OF PERMIT
S 7557-
F.C.
DATE
:1py,608095
.
76
,,�. ,� .�
IA -.5-175
M H PERMIT FEE
$
C019MUNAITY
�A
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
(4val �✓T
.�
MICROFILM FEE
•
COPIES
$
LEGAL DESCRIPTION
�� =fel,% 6 /� - �o j J
%'�� 0 T- 5� - - �/`/�'
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE NO.
GRP
TYPECK B
111
F S
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
I PECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
n
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR wi`-' s 1+j•< ri
INSTRUMENTATION FEE
ldhl7F
x
$
ADDRESS.
ADDRESS
E? •� P rS7' FEE'
/
1
�/ t
�. ..- 7,90 Aj
PLUMBING FEE
DBL
$
CITY ZIP CODE
CIT ZIP CODE
TOTAL FEES �
$ "
�
TEL. NO.
TEL. NO. _ LICENSE
j>`71 � lOC)02� �^'. � - � 4 • �>
CASH ❑ CHECK M.O. Cl N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN•l20 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
CORDANCE WITH THEAAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
T
LL
p-•
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED vTHE `PLANS AND SPECIFICATIONS
FORM •284-208 (Rev. 10.74) (DIL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.