272161 (SFD)BUIiDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE
CARP. SOFT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used CIS property tax voluotion
,{' MECHANICAL FEES
pL
VENT SYSTEM FAN ❑ EVAP. COOL 9 HOOD
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN �+
WATER SOFTENER
WGSHFR IDI ITCHI �.
APPLIANCE
CONSTRUCTION ESTIMATE
^e) NO. ELECTRICAL FEES
1 ST FL.
1q,3V
SQ.FT.
UNITS
2ND FL.
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
SQ. FT. @
�.�
POR.
�r
,� r
'i
r'�°J
SQ. FT. @ .-�
!� �MOBILEHOMESVC.
GAR
�
.'J 04Y
SQ FT @ u
alI iy iE- POWER OUTLET
VIP
CARP. SOFT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used CIS property tax voluotion
,{' MECHANICAL FEES
pL
VENT SYSTEM FAN ❑ EVAP. COOL 9 HOOD
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN �+
WATER SOFTENER
WGSHFR IDI ITCHI �.
APPLIANCE
L'K 44
l
74
w
GARBAGE DISPOSAL
75
USE OF PERMIT
A'j �n 1 a
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
DATE fI
��
PE O.
27 2161
76
LAUNDRY TRAY
o,
_ �f
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U.
ROOMS
TEMP USE PERM SVC
p
WATER CLOSET
COMPRESSOR g—
HP
J'�
POLE, TEMP/PERM
kyr
LAVATORY
HEATING SYSTEM WORCED ❑ GRAVITY
to
;Lett AMPERES SERV ENT
MICROFILM FEE
SHOWER
$
BOILER � B.T.U.
SQ FT @ ¢
BATH TUB
Q�
DBL
$
SQ FT @ ¢
/
WATER HEATER
USE NO,
l
GRP
TYPE
I
CK, BY
f' .:� '7 SQ FT RESID @
SEWAGE DISPOSAL
)
41 SQ FT GARAGE @ _�
a 7
HOUSE SEWER
PLAN CHECK FEE
PERMIT FEE
BOND AMT.
PLAN NO.
PLAN CHECKER
GAS PIPING
INSPECTOR
MOBILE HOME PERMIT FEE
$
PERMIT FEE`
j}
PERMIT FEE
u
fQO.6
21"H6
TOTAL FEES�
MOB. HM.FEE
MICRO FEE
MECH. '�F�E
JDBL.
PL��,FEE
COCONST,FEE�
DBL.
'LECT. FF�fij
DBL.
SMI FEE
FEE
iLUMB�
108L.
J I F I M A I M I J I J "A I S 1 Q 1 N I D
JOB ADDRESSSP NO
OWNER
74
w
75
USE OF PERMIT
A'j �n 1 a
F.C.
DATE fI
��
PE O.
27 2161
76
o,
_ �f
M H PERMIT FEE
$
COMMMUNITY�;;
UNITS
ROOMS
VALUATION
'
SUPP. TO PERMIT
OFFICE
1� t �,vj AIT,r
1.
%
-?fi/ .Sd
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
/ {/
Bn r f 6,- C ✓ (i%� - i % ri'�r e�. !� eC '!j!7 j� -C,4 /V7A �i! tY1 �i 7-,1
MECHANICAL FEE
DBL
$
SET BACKS//�
LOT SIZE ZONE
USE NO,
l
GRP
TYPE
I
CK, BY
1 C/
)
/ eelld�
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSPECTOR
t
"�3 T,
u
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
11.E
00
ELECTRICAL FEE
DBL
$
ADDRESS CIT
STA E
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRA/CTO f
INSTRUMENTATION FEE
t
! („
$
ADDRESS
ADDRESS
FEE
''7 �.
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$
;
�C3��`
TEL. NO,
TEL". NO. LICENSE
CASH CHECK ❑ M.O. ❑ N.C. ❑
Auti"YHIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
N 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
RECEIVED BY �
TREES REQUIRED
SEWAGE SYSTEM
f�
lyx jt! (i
I/�•
T CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I •ALSO
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) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.