290381 (ELEC)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY •
I
_ J F I M A M J J A S O -N D
PERMIT No.
OWNt
ij(✓/'w(j
COUNTY OF RIVERSIDE
77'COME
RrUNITY VALUATION
DATE .y
DST
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
M H PERMIT FEE
NO. PLUMBING FEES
$
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ $
UNITS
SUP . TOP PERMIT
PE MIT
NO.
SQ. FT. I I YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
SQ. FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
MICROFILM FEE
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
LEGAAALL D SCRIPTION
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
.�
MECHANICAL FEE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO)(DISH)
ZONE
SET BACK
APPLIANCE ❑ DRYER
GRP
TYPE
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDEDlJG
LAUNDRY TRAY
JI
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
I
ABSORPTION SYSTEM � B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
S
LAVATORY
HEATING SYSTEM [IFORCED- ❑ GRAVITY
AMPERES SERV ENT
PLAN CHECK FEE
SHOWER
$
'
BOILER B.T.U.
SQ.FT. @ rt
PLAN CHECKER
BATH TUB
SQ.FT. @ rt
WATER HEATER
1-7. �j
SQ.FT.RESID @ 11/ort
CONSTRUCTION FEE
SEWAGE DISPOSAL
$
NAME OF CONST. LENDER BRANCH
SQ.FT.GAR @ 1/4¢
NO LENDER INVOLVED
HOUSE SEWER
GAS PIPING
DBL
$
PERMIT FEE
ADDRESS CITY
PERMIT FEE
0.
PERMIT FEE
DBL.
TOTAL FEES
IMOB.HM.FEEI
MICRO FEE
MECH. FEE PL. CK. FEE
CONST. FEE
ELE. FFEEE
SMI FEE
FEE
PLUMB. FEE
_ J F I M A M J J A S O -N D
JOB ADDRESS SP NO
I
( e
OWNt
ij(✓/'w(j
76
77'COME
RrUNITY VALUATION
DATE .y
DST`
OFFICE
78
M H PERMIT FEE
$
USE O PER IT j�j
�,fi`r�fr !�✓
F1414
SUP . TOP PERMIT
PE MIT
NO.
-1.C.
0381
MICROFILM FEE
COPIES
$
BOOK PArGEjf PARCEL
LEGAAALL D SCRIPTION
.�
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET BACK
ILOTSIZE
GRP
TYPE
BY
JI
�CK
I
1
S
S
R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECT
1-7. �j
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
h
STRONG MOTION
$
OWNER/AGENTS SIGNATURE CONTRACTOR
ty
'��.�K.,,,"'
INSTRUMENTATION FEE
! l
f
SPECIAL INSP
$
ADDRESS ADDRESS
DEMOLITION
�]
FEE
REGISTRATION
��
PLUMBING FEE-
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES $
TEL. NO.
AREA CODE TEL.
NO.
AREA CODE
LICENSE tt
00j®
CASH ❑CHECK O.❑N.C.❑
7/1,/
RECEIVED BY TREES REQUIRE
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
4
SEWAGE SYSTEMI
HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL
P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
L,OMFtrNSA 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.