301833 (SATT)BUILDING DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
PER • .I
F M A M I J A S O.
PERMIT„NO.
1301m
JOB ADDRESS SP NO
"(-16 Ile I
COUNTY OF RIVERSIDE
76
DST
(1
�I
CONSTRUCTION ESTIMATE
P ,Azi
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL.
2ND FL.
FOR.
GAR. A61 2
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
21
UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
M H PERMIT FEE
SQ. FT. @ 'd POWER OUTLET ROOF DRAINS
$
SQ. FT. @ DRAINAGE PIPING
USE OF PERMIT F.C.
g �2
SQ. FT. @ DRINKING FOUNTAIN.
PE$MIT
3.
SQ. FT. @ URINAL
833-
VALUATION $ 7 O WATER PIPING
COPIES
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
EG/ L DESCRI TION / / j}�/ r
FLOOR DRAIN
DBL
$
MECHANICAL FEES
USE 90.
SWIM POOL, COMM
SET BACK
WATER SOFTENER
TV PE GK BV
VENT SYSTEM XFAN ❑ EVAP. COOL Sr HOOD
Qd
SIGN
WASH ER(AU TO ISH
APPLIANCE DRY R
VO
I's 19
/y
R �4r-
GARBAGE DISPOSAL
$
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
BOND AMT.
PLAN NO.
PLAN CHECKER
LAUNDRY TRAY
NSPECTOR
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
e"
_.6
ABSORPTION SYSTEM B.T.U.
CONSTRUCTION FEE
TEMP USE PERM SVC .
WATER CLOSET
4/14040
BRANCH OFFICE NO
COMPRESSOR ,�,.. HP
POLE, TEMP/PERM
LAVATORY
,DA
HEATING SYSTEM ORCED ❑ GRAVITY
QO
MPERES SERV ENT
$
SHOWER
ADDRESS
CITY STATE
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
4040
SQ.FT. @
j WATER HEATER
4040
tt
STRONG MOTION
Ll FT.RESID @ 11/4¢
6 $1.
SEWAGE DISPOSAL
'40)
CON17if'ACUf0
t•-
INSTRUMENTATION FEE
Zley SQ. FT. GAR @ 3/4¢
P
HOUSE SEWER
` Y
'SPECIAL ;NSP
DEMOLITION
FEE-
$
GAS PIPING
ADDRESS
Fy If'
PERMIT FEE
REGISTRATION
PERMIT FEE
00
j PERMIT FEE
L. /1
DBL.
I TOTAL FEES
fag �'
MOB.HM.FEE
MICRO FEE
MECH. FEE
PL. CK. FEE
CONST, FEE
�
ELECT. FEE
SMI FEE
FEE
PLUMB. FEE
F M A M I J A S O.
N D
JOB ADDRESS SP NO
"(-16 Ile I
OWNER,
l A
76
./1
P ,Azi
77
COMMMMUNNIITTY 0,(VALUATI
DATE
DSTJ OFFICE
78
M H PERMIT FEE
$
USE OF PERMIT F.C.
g �2
SUPP. TO PERMIT
PE$MIT
3.
NO
01
833-
MICROFILM FEE
COPIES
$
OOK PAGE P CFi
vtt Y/
EG/ L DESCRI TION / / j}�/ r
MECHANICAL FEE
DBL
$
USE 90.
ZON/yE/
SET BACK
LOT SIZE GRP
TV PE GK BV
rrRL�
5 V
ii
1
S
I's 19
/y
R �4r-
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
NSPECTOR
_.6
CONSTRUCTION FEE
DBL
NAME OF CONST. LENDER
BRANCH OFFICE NO
DER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY STATE
,37
tt
STRONG MOTION
$
pp �
OWNER/AGENTS SIGNATURE
CON17if'ACUf0
t•-
INSTRUMENTATION FEE
P
` Y
'SPECIAL ;NSP
DEMOLITION
FEE-
$
ADDRESS
ADDRESS
Fy If'
REGISTRATION
L. /1
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES $
#
TEL. NO. AREA
CODE
AREA CODE
TEL. NOS/.'
LICENSE
CASH ❑CHECK O.❑N.C.❑ d
�j
V X33,
��
RECEIVED BY TREES REQUIRED
�t
y11T SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
I� 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME, VOID.
AGREE THATALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
gas
SEWAGE SYSTEM
L Zj^ /BY
T
L
P G�f�
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
L"UMPt NSA I ION 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
FORM 284-208 (REV. 6-76) SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA.