258680 (BLCK)1 BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 ST FL.
SQ.FT. @
2ND FL.
SQ.FT. @
POR.
SQ. FT. @
GAR.
SQ. FT. @
CAR P.
SQ.FT. @
WALL
�15
SQ. FT. @
iir vcl6
SQ. FT. @
ESTIMATED CONSTRUCTION
VALUATION $
NOTE: Not !o be used as property tax valuation
MECHANICAL FEES
VFNT CVCTFM n FAM n FVAP rnnl n HOC)D
DEPARTMENT OF BUILDING & SAFE
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER I I B.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER IAUTOI (DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR Cl 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
SOFT @ ¢ BATH TUB
SQ FT @ ¢ WATER HEATER
SQ FT RESID @ 1 ¢ SEWAGE DISPOSAL
SOFT GARAGE @ '/2a HOUSE SEWER
PERMIT FEE t TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE Is
PERMIT FEE PERMIT FEE
((}}vv((,,
25R`�1T .8 O
TOTAL FE
LF v
MOB. HM. FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
NST. FEE
Sa
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE PLUMB. FEE
OBL,
J F MA I M I J I A I S- . ON D
OL9LSRES /1 I SPNO
/C�'-✓tii'Wfi�/�'Yf6%I
OWNER T� _
73
74
u OF PERMIT
F.C.
���i
/ E �/ •
P 680
75
M H PERMIT FEE
$
COMMUNITY
DST/
UNITS
J
ROOMS
VALUATION •
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SETBACK LOT SIZE ZONE
F S R
r `
!FINAL
USE NO.
GRP
TYPE
CK BY
,_,,
PLAN CHECK FEE .
$
BOND AMT.
PLAN NO. PLAN CHECKER
DATE INSPECTOR
CONSTRUCTION FEE
DBL'
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
t✓
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 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
$ �
PYA
.,�
OWNER/AGENT'S SIGNATURE
\Ac- VL J
CONTRACTOR a
q�
CASA CHECK ❑ M.O. ❑N.C. ❑
ADDRESS t
fi /6 -
ADDRESS
RECEIVED B %
TREES REQUIRED
.SEWAGE SYSTEM
T
-
LL P
CITY ZIP CODE
t • ti f1 f
... , r� ; jam' Is t ( 4
CITY ZIP CODE
' INFORMATION
J
;FORM 284 208 (Re, 9.73)
TEL. NO.
TEL. NO. LICENSE