272495 (SATT)BUILDING PERMIT
� r
CONSTRUCTION ESTIMATE
IST FL. SQ.FT. @ % e'
2ND FL. SO. FT. @
POR. SO. FT. @
GAR.SQ. FT. @
CAR P.SOFT. @
WALL SO. FT. @ N
SQ. FT.- @
ESTIMATED CONSTRUCTION VALUATION
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ,X FAN ❑ EVAP. COOL (2(
DEPARTMENT OF BUILDING & SAFETY
kk • COUNTY OF RIVERSIDE •A
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
6 t POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
(] SIGN
FIELD OFFICE
NO.
PLUMBING FEES
I
74
o f
YARD SPKLR SYSTEM
USE OF PERMIT
0,0j
BAR SINK
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR Cl SUSPENDED
ROOF DRAINS
76
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
f
WATER PIPING f
FLOOR DRAIN
DST
WATER SOFTENER
KITCHEN SINK
WASHER (AUTO) IDCRWt ';..
APPLIANCE
x'.._
,'� e4,
74
o f
GARBAGE DISPOSAL
USE OF PERMIT
0,0j
F. C.
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR Cl SUSPENDED
P M
76
LAUNDRY TRAY ..
M H PERMIT FEE
AIR HANDLING UNIT
CFM
IDLE METER
DST
UNITS
KITCHEN SINK
VALUATION
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET '
.ry/ o
COMPRESSOR 0
HP
POLE, TEMP/PERM
Ik-
LAVATORY
[:C}
HEATING SYSTEM 9.FORCED ❑ GRAVITY
A/ 120
_9 IT, AMPERES SERV ENT
G(J
%
SHOWER
BOILER 0 B.T.U.
LOT SIZE ZONE
SQ FT @ a
GRP
TYPE
BATH TUB
7343
{
P!
!
UJ
SQ FT @ a
WATER HEATER
211r-4.9-
F .dt� s✓ �-�
R
SQ FT RESID @/ >r�{
$
Of,
SEWAGE DISPOSAL
0c
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
11-I, G cam.
SOFT GARAGE @Pe�e
:�r y•' w
$
HOUSE SEWER
NAME OF CONST. LENDER BRANCH
OF=ICE
PERMIT FEE
Oli
GAS PIPING
ELECTRICAL FEE
MOBILE HONJE PERMIT FEE
$
ADDRESS CITY
PERMIT FEE.
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f
PERMIT FEE
Z --e�
E MIT On 5
29
TOTAL FE S�
MOB. HMSEE
i
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST, FEE
/I, �`'
DBL.
ELECT."FEE_
4A
DBL.
SM�7I FEE
FEE
PLUMB. FEE
D BL.
J F M A M J 1 A 5 O N D
.JOB ADDRESS SP NO
ow� #
74
o f
]rj
USE OF PERMIT
0,0j
F. C.
DATE
P M
76
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
'14
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION rj l
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
{
P!
!
UJ
211r-4.9-
F .dt� s✓ �-�
R
PLAN CHECK FEE
$
Of,
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
11-I, G cam.
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OF=ICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
r/
OWNER/AGENT'S SIGNATURE
CONTRACTOR'S - • "r i
!
$
�
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE''
CIT ZIP CODE
+
TOTAL FEES
$ f J✓
�r
TEL. NO.
TEL. NO. _ .LICENSE
�* ,� . • �!� 7/"
CASH ❑ CHECK,® M.O. p N.C. ❑
ts r THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
v� ION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY rt,r�s,.
TREES REQUIRED
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 ALSC
TO
SEWAGE SYSTEM
1C' -'-V
x f
T
LL
P�
AGREE CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
c4.
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
L OF THE STATE OF CALIFORNIA.