260012 (BLCK)BUILDING PERMIT DEPARTMENT OF BUILDING& SAFETY
` 'COUNTY OF RIVERSIDE.-
CONSTRUCTION
IVERSIDE-CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
1 ST FL. SO.FT.: @ UNITS
2ND FL. SO. FT. ,@ '
PORE SO. FT. @ MOBILEHOME SVC.
GAR. SO. FT. @ POWER OUTLET
f
CAR P. S0.F1. @
WALL �.�5?i SO 'FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM O FAN Cl EVAP. COOL ❑ HOOD
` SWIM POOL, PVT.
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. -PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
APPLIANCE •`
JOB ADDRESS % SP NO
e` —f +'� 1�
OWNFj�
�/t�T/QQti / ��ANi,
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL -0 FLOOR ❑ SUSPENDED
F.C.
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR 0
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED O GRAVITY
_ AMPERESSE_RV ENT
SHOWER
BOILER 0 B.T.U.
OFFICE
SQ FT . @ ¢
BATHTUB
SQ FT @ ¢
WATER HEATER '
I
SQ FT RESID @ ,T¢
SEWAGE DISPOSAL
MICROFILM FEE
SQ FT GARAGE @ '/x¢
HOUSESEWER .
PERMIT FEE
LEGAL DESCRIPTION
GAS PIPING
MOBILE HOME PERMIT FEE
$
%
teaAVT<
a'�i
PERMIT FEE
PERMIT.FEE
PERMIT N0.
600 2
TOTAL FEES
���--
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
/51.
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
17B7.
J I F I M A I M I J I J A I S 1 O 1N D
Ta
JOB ADDRESS % SP NO
e` —f +'� 1�
OWNFj�
�/t�T/QQti / ��ANi,
75
USE OF PERMIT
F.C.
DATE
P M N
0.12
76
JdA
M H PERMIT FEE
$
COMMUNITY
OST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
%
teaAVT<
a'�i
MECHANICAL FEE
DBL
$
SETBACK
LOTSIZE ZONEUSE
NO.
GRP
TYPE CK BY
—
-
F S RJA
PLAN -CHECK FEE
$
BOND AMT.PLAN
NO.
PLAN CHECKER
FINAL/DATE/
INSPECTOR
/y h
CONSTRUCTION FEE'
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
�Q
ELECTRICAL FEE
DBL -
$
ADDRESS 1 .errv-,,,
STATE
STRONG MOTION$
OWNER/AGENT'S SIGNATURE
-CONNTRACYR
O
INSTRUMENTATION FEE+'
FEE
4
$
ADDRESS -
ADDRESS
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
- TOTAL FEES
$
14PfJ
TEL. N0;
-
TEL. NO. p-�• LICENSE
�� -Y ✓ i "� ,- r%% C�
CASH O CHECK M.O. O- N.C. O
�THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
'''T N OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
•
RECEIVED BY
TREES REQUIRED
// I HEREBY AGREE THAT ALL WORK 'N CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
WITH THE LAWS OF RI4 2SIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEMCORDANCE
IT-'
LL
P
AGREE TO CARRY COMPENSATION I' -,URANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
.,C — T � CTATC —.-,. A .• —1—A T—C
I HEREBY CERTIFY THAT THE IND 'IDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284.208 (Rev. 10.74) QP L • HAS DONE SO IN ACCORDANCE WITt >ECTION 5541 OF T1HE BUSINESS AND PROFESSIONS CODE
I OF THE STATE OF CALIFORNIA.