244678 (CPWU)BUILDING PERMIT
CONSTRUCTION ESTIMATE
I ST FL.
SQ.FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ. FT. @
CAR P.
SQ.FT. @
WALL
SQ. FT. @
HEATING SYSTEM ❑ FORCED ❑GRAVITY AMPERES SERV ENT SHOWER
SQ. FT. @
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
DEPARTMENT OF r `"WING & SAFE'
COUrJTY #''RIVERSIDE
NO. I ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
FIELD OFFICE
NO.I PLUMBING FEES
BOILER L I E
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
G
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED 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 ❑GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ C BATH TUB
SQ FT @ C WATER HEATER
SOFT RESID @ le SEWAGE DISPOSAL
SQ FT GARAGE @ '/:a HOUSESEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE Is
PERMIT FEE PERMIT FEE
4RMIT
4�
NO.
N J�TAL FEES
Ir
HM. FEE
MICRO FEE MECH. FEE
DBL.
PL. C
77777EMOB.
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
_ - J- - - F— -M — 'I M I J J A I 'S "O 1 N- •D '
JOB ADDRESS �- ^ i SP NO
���f� ��a�
OWNER -,/ - - --- - -. - - -
/if 0.�r
73
74
USE OF PERMIT / /11 f �f'� '
,,ry
F.C. JDATEP
2-7
�/$}MI
LA46
NO
8
M H PERMIT FEE
$
COMMW 'TY L1-) oo-4,
DST`
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SETT BA/K
LOT SIZE/ ZONE
J
USE NO.
GRP
TYPE
CK BY
'
F/ 'AL S !/ a 11
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
Q
7-� <
PLAN CHECKER
fes' 15>10c-$4
FINAL DATE IN�SP)ECTOR
t -
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVE
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, 1 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
•
TOTAL FEES'
$
OWNER/AGENT'S SIGNATURE
�.r ..
CONTRACTOR
e,.� iL
CASH ❑ CHEy.�u N.C. ❑
ADDRESS
ADDRESS
l",. -._i 0% 1C It; �I�fl,e /\� tE
RECEIVED R S'AUIRED
SEWAGE SYSTEM
T
LL
P
CITY ZIP CODE
CITY -� ZIP CODE
y/lu+f r Ste"l5'0(G
1 f
INFORMATION
FORM 284.208 IRea. 9.731 @s
TEL. N0.
TEL. NO. LICENSE
f
W A-
G