242848 (BLCK)I BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 ST FL.
SQ.FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ. FT. @
CAR P.
SQ.FT. @
WALL
SQ. FT. @
_ /
SQ. FT. @
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not to be used as property tax voluotion
MECHANICAL FEES
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
PLUMBING FEES
BOILER I 1 I
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
DST
f!
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHF) 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 @ C BATH TUB
SQ FT @ a WATER HEATER
SQ FT RESID @ 1 a SEWAGE DISPOSAL
SQ FT GARAGE @ 'h¢ HOUSESEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE. Is
I I PERMIT FEE PERMIT FEE
P R IT NO.
TOTAL FEES
/? Vi
MOB. HM. FEE
MICRO FEE
MECH. FEE
DBL
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
OBL.
SMI FEE
FEE PLUMB. FEE
JDBL.
J F I M A I M I J I J A I $ 1 O N I D I
JOB ADDRESS ?,4 CC i SP NO
OWNER1 c
74
USE OF PERMIT
d '� %G `oto• F� /�!C.�'
F.C.
DATE
° - _ 2
P�MIjJJ�
44��
48
75
M H PERMIT FEE
$
COMMUNITY�tPd p
DST
UNITS
ROOMS
VALUATION ISUPP.
TO PERMIT
OFFICEI
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
.0 4.,;r I-1 ,elf c -oCh o
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
tf—
i
USE NO.
GRP
TYPE CK BY
F S R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPE
/
ZOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO 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.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO INACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THJ STATE O CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
TOTAL FEES
$
OWNER/AGENT'S SIGNAT}1RE
/ IJ
)� J
CONTRACTOR
CASH 911,rCHECK ❑ M.O. ❑ N.C. ❑
ADDRESS
7j%
ADDRESS
RECEIVED BY .� i
TREES REQUIRED
SEWAGE SYSTEM
FTTLL
P
CITY ZIP CODE
44
CITY ZIP CODE
INFORMATION titf3 _
FORM 284.208 (Rev. 9.731 05
TEL. NO.
TEL. NO. LICENSE