272352 (SFD) Revision 1FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
Allook. COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE
I ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SO. FT. @ 1.
CAR P. SQ.FT. @ L
WALL SQ. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM O FAN ❑ EVAP. COOL O HOOD
APPLIANCE
FURNACE Cl UNIT O WALL O FLOOR O SUSPENDED
AIR HANDLING UNIT I I CFM'
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
IDI F MFTFR
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
GARBAGE DISPOSAL
LAUNDRY TRAY
KlTrWPNI CINIV
ABSORPTION SYSTEM
� B.T.U.
OWNER
?i16
TEMP USE PERM SVC
WATER CLOSET
/ 1 16.4 ()rc 3 T'�= /?.A
COMPRESSOR
HP
F.C.
POLE, TEMP/PERM
LAVATORY
M H PERMIT FEE
HEATING SYSTEM O FORCED ❑ GRAVITY
$
AMPERES SERV ENT
SHOWER
DST
BOILER � B.T.U.
ROOMS
VALUATION
SQ FT @ ¢
BATH TUB
SQ FT @ ¢
WATER HEATER
L/s9(�
SQ FT RESID @ 1 ¢
SEWAGE DISPOSAL
COPIES
$
LEGAL DESCRIPTION
SQ FT GARAGE @ I/2¢
HOUSE SEWER
PERMIT FEE
MECHANICAL FEE
DBL
GAS PIPING
MOBILE HOME PERMIT FEE
$
USE NO.
PERMIT FEE
PERMIT FEE
CK BY
PERMIT NO.
272352
TOTALFE,
/�,Y
MOB. H:]FEE
FEE
MECH. FEE
��.
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE.
DBL.
SMI FEE
FEE
PLUMB. F
3.,
DBL.
J I F I M A I M I J I J q I 5 1 Q 1 N I D
]4
JOB ADORESSP NO
- I7 S" 40r
OWNER
?i16
r R k E R A
/ 1 16.4 ()rc 3 T'�= /?.A
]rj
76
USE OF PERMIT
kA t -)P)170 IT _A_ �°'�'
F.C.
DATE
-�-�
PE MIT 0.
��2352
M H PERMIT FEE
$
COMMUNITY
DST
NITS
ROOMS
VALUATION
SUPP. TO PERMITFICE
OF
4/4 1N
. v A
i/
L/s9(�
IT
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOTSIZ ZONE
USE NO.
GRP
TYPE
CK BY
4`
�,,4/�
{�fl
R �+
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSIPEC OR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLV D
/
ELECTRICAL FEE
DBL
$
ADDRESS / ttF, CITY
STATE
,s j
STRONG MOTION
$
OWNER GEN'S SIGNATURE 1 e r
``
CONTRACTOR
INSTRUMENTATION FEE
FEE
$
ADDRE_ `. `� �1
,,jj V
ut P30x
ADDRESS
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY 21P CODE
TOTAL FEES �
$
�/T
TEL. NO.
TEL. NO. LICENSE
CASH ❑ CHECK M.O. O N.C. ❑
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.
RECEIVED
t '
BY ��,
TREES REQUIRED
AAA"��,t1
yy I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
t,(\
SEWAGE SYSTEM
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
T
LL
P li
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I �••••.. .+,, �vr,, ,. vVIM 1-1 LRIIVV I. l I I RMI, I UKJ I J MLJU VUMKMINICCU.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) OP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.