248217 (PLBG)BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 ST FL. SO.FT. @
2ND FL. SO. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SOFT. @
WALL SO. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENTSYSTEM O FAN O EVAP. COOL O HOOD
I APPI IAtirr
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER Lj B.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO, (DISH)
GARBAGE DISPOSAL
FURNACE ❑ UNIT O WALL O FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ a BATH TUB
SQ FT @ 4 WATER HEATER
SQ FT RESID @ 1 a SEWAGE DISPOSAL 0 4�;
SOFT GARAGE @ '/r¢ HOUSE SEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE Is
PERMIT FEE PERMIT FEE r�
PERMIT NO.
TOTAL FEESMOB.
HM. FEE
MICRO FEE
MECH. FEE
DBL
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
I SMI FEE
I FEE
PLUMB. FEE
f (•�Fj
DBL
J I F I M A I M I J I J A I S 1 O 1 N D
JOB ADDRESSL y /L7i SP NO
f ' ;i S % fid 6C (...if/u it
73
74
USE OF PE//RMIT r I /
1:—)
G .�zil'rr'Ls
F.C. JDATE
�{ / PF�MIT�NO+
7 �/ / ��G>,4
e}V(`
75
M H PERMIT FEE
$
CCiAMU/NNIITY
/jDST
UN 5
ROOMS
I VALUATION ISUPP.
TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
7 L,
LEGAL DESCRIPTION `� 641�,,v14
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
Ill—
f USE NO.
(FINAL
sPLAN
GRP
TYPE
CK BY
/3
F 5 R
CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
DATE
5— /—
JINSP
CTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
hO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
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.
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 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE'
OF THE STATE OF CALIFORNIA.-
FEE
$
PLUMBING FEE
DBL
$
t �l1
f�
t s
TOTAL FEES
/�
OWNER/AGENT'S SIGNATURE
CUNTRACTOW' f
.41V J
CASH ❑ CHECK M.O. ❑ N.C. ❑
ADDRESS
ADDRESS
.�J• l rU ' >�/
RECEIVED BY y,�,
TREES REQUIRED
41
SEWAGE SYSTEM
LL f��ltJJ�-�`
CITY ZIP CODE
'CITY
'A , ZIP CODE
Cif
INFORMATION
;fl/
ORM 284.208 (Rev. 9.731 @s
TEL. NO.
'TEL.. NO.
y !� LICENSE
.,�,+ 41 ys 7 I / G • ��� `+' / � /