268960 (SATT)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE `:, . NO_ ELECTRICAL FEES
,'I ST FL. SQ.FT. @� ".. �' •,:.:�. . UNITS
2ND FL. SQ. FT. @ .
POR. ' �M" ~ ' SQ. FT. C91�e� MOBILEHOME SVC.
GAR. SO. FT. CEJ / fu D POWER OUTLET.
CARP. SQ.FT: @
WrQll SQ. -FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $,
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL A HOOD
SWIM POOL, PVT
SWIM POOL, COMM
r' O SIGN
FIELa OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
I DRAINAGE PIPING
i DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI(MSM
rr
01
APPLIANCE}'
y
U
74
< �o 9jArF4e I VX�
GARBAGE DISPOSAL
75
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR [Z SUSPENDED
F.C.DATE
0
J
76
PE IT O.
8960
LAUNDRY TRAY
AIR HANDLING UNIT
I CFM
IDLE METER
KITCHEN SINK
L3
ABSORPTION SYSTEM l
B.T.U.
UNITS
TEMP USE PERM -SVC
VALUA-ION SUPP, TO PERMIT
WATER CLOSET
COMPRESSOR I
HP
''U
POLE, TEMP/PERM
LAVATORY
2. �$
HEATING SYSTEM FORCED ❑ GRAVITY
AMPERES SERV ENT
- �'
SHOWER
BOILER B.T.U.
SQ FT @ C
BATH TUB
sem,
DBL
$'
SQ FT @ ¢
LOT SIZE ZONE
WATER HEATER
USE NO.
GRP
TYPE ICK BY
SQ FT RESID @ la .0�✓ rp
SEWAGE DISPOSAL
%r✓
p} SQ FT GARAGE @ 'ha
HOUSE SEWER
PLAN CHECK FEE
PERMIT FEE
$
0
BOND AMT.
PLAN NO.
GAS PIPING
MOBILE HOME PERMIT FEE
$
1 1
PERMIT FEE
Q /
PERMIT FEE
Iry Pv
ER IT O.
TOTAL FEE
�'�
MOB. HM.fEE
MICRECH.
O FEE
M FEE DBL.
PL. CK. FEE
�;NST�&_
DBL.
ELECTL F B
SMI FE
FEE
PLU MB.
DBL.
J f M A M J J A S O N D
108 ADORFS� SP NO
OWNER
74
< �o 9jArF4e I VX�
t !. A`: � 7A'7 t i' /
75
USE OF PERMIT
F.C.DATE
0
J
76
PE IT O.
8960
76
M H PERMIT FEE
$
COMMUNIT
DST
UNITS
ROOMS
VALUA-ION SUPP, TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$'
SETBACK
LOT SIZE ZONE
USE NO.
GRP
TYPE ICK BY
17l
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
INOCTOR
I
IFINA-DATE
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OIFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
/
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CON RA OR,r:%^�.-+ .-
INSTRUMENTATION FEE
(JYClF%11"
�
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
r�
Y
~�! �f .L.r" _• _ II� J c
TOTAL FEES/�
$ y
TEL. NO.
TEL. NO, K',' ^' Y LICENSE,
�1 < c'. �' .
�
c
"CGS f1 dE •L-
CASH CHECK ❑ M.O. ❑ N.C. ❑~
-
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCE WITHIN 1CESSA-
20 DAYS.
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE P- RMIT TO BECOME VOID.
RECEIVED B
TREES REQUIRED o
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC -
CORDANCE WITH THE LAWS OF RIVERSIDE COUNT-( AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPCN MY EMPLOYEES. COMPLIANCE WITH THE
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO'REPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rem. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 554- OF THE BUSINESS AND PROFESSIONS CODE
I OF THE STATE OF CALIFORNIA.