258588 (PLBG)BUILDING PERMIT
CONSTRUCTION ESTIMATE
ST FL. SQ.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ.FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VFNT SYSTFM n FAN fI FVAP_ COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFE'
COUNTY OF RIVERSIDE
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER Lj B.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM J B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ a BATH TUB
SQ FT @ a WATER HEATER
SOFT RESID @ la SEWAGE DISPOSAL
SQ FT GARAGE @ 'ha HOUSE SEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE $
PERMIT FEE PERMIT FEE
5RR5,8
TOTAL FEES
MOB, HM. FEE MICRO
FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE PLUMB. FEE
DBL.
_ 7
F I M A I M I J I J A I S 1 Q 1 N D
,1013 ADDRESS �,T � SP NO
��"yd�G4 CCfJhj
OWNER �• y
Ip}I4r /(`��,4�l��% 3. C12
73
74OF
PERT �
USE MI
ZW r _s P,��c _;�,7-
F.C.
DATE
75
P� M
5 8 8
75
M H PERMIT FEE
$
CCO%OMMUNITTYY'
DST
r UNITS
ROOMS
I VALUATION JIUPP.
TO PERMIT
OFfFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
,1 47- /6 -1-5 --0-5e.e,r Cfv� ►E3 { 2.- PC 74 7 -/1'c --G o
MECHANICAL FEE
DBL
$
SET BACK
LOT S1ZE ZONE)
!FINAL
USE NO.
GRP
TYPE
CK BY
3.Cl43
F S R"''/
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
DATE
��7 rIPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLV
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
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.
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 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUA�TEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED T PLANS ANPECIFIC.ATIONS
HAS DONE SO IN ACCORDANCE WITH SECTIO RQFE-MONS CQDE
OF THE STATE OF CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
TOTAL FEES
$
OWNER/AGENT'S SIGNATURE
";elc&lc'Aj
CASH ❑ CHECK ,j M.O. ❑ N.C. ❑
ADDRESS
ADDRESS
GX
RECEIVED BY
TREES REQUIRED
SEWAGE SYSTEM
T
LL P
CITY ZIP CODE
CITY ZIP CODE
- -
1J/
INFORMATION
284.208 Rev. 9731 Os
L. NO.
TEL. NO.
`� LICENSEFORDk
7 4,,, •'f` 6-I