276090 (RPL)BUILDING PERMIT�DEPARTMENT OF:BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
WE
CONSTRUCTION ESTIMATE NO ELECTRICAL FEES NO PLUMBING FF -Fc p
1 ST FL. •
2ND FL.
' POR.
GAR.
CAR P.
ALL --
SQ'.FT. ,@
UNITS
LAVATORY
SO. FT. @
YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVG.,
BAR SINK
SQ.,FT. @ POWER OUTLET
ROOF DRAINS'
SOFT. @
DRAINAGE PIPING
._ ,
SQ. FT. @
DRINKING FOUNTAIN
f,q
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $ - !Pi
�,
URINAL
WATER PIPING
NOTE: Not to be used as property tax voluotion
SWIM POOL; -'PVT fr`� '
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
SEWAGE DISPOSAL
VENT �YSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
OGE
J 1
APPLIANCE
GARBAGE DISPOSAL
FURNA E O UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
GAS PIPING
LAUNDRY TRAY.
MOBILE HOME PERMIT FEE Is
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK '
PERMIT FEE
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR 0 HP
POLE, TEMP/PERM
OWNER
LAVATORY
'.t`•-d'-•t,e'„rC.:71.C+'.P•✓''!"IfYL.VT.G"i:t.t%t.�.%t,,.t��1o3ili.G./j,
HEATING SYSTEM ❑ FORCED Cl GRAVITY
AMPERES -SERV ENT
U_ SPERMITV
r �
SHOWER
DATE
BOILER � B.T.U.
SQ FT @ a
BATH TUB
SQ FT @ a
M H PERMIT FEE
WATER HEATER
$
-,SOFT RESID @ 14
D§T
_ f
SEWAGE DISPOSAL
ROOMS
VALUATION
SQ FT GARAGE @ 'ha
OGE
J 1
HOUSE SEWER
PERMIT FEE '
GAS PIPING
MOBILE HOME PERMIT FEE Is
,ter PERMIT FEE
PERMIT FEE
..a
PERMIT NO,
276
TOTAL 5f.ESr
MOB. HM.FEE
MICRO FEE
-MECH. FEE
DBI,.
PL. CK. FES,
CON T..E f
DBL.
ELEC EBF
DBL.
j
SMI -FEE
z�el
FEE
PLUMB. FYeJDBL,
I
J I F IM A M J J A S O N D
74
JOB ADDRESS SP NO
OWNER
'.t`•-d'-•t,e'„rC.:71.C+'.P•✓''!"IfYL.VT.G"i:t.t%t.�.%t,,.t��1o3ili.G./j,
.
75
U_ SPERMITV
r �
F.C.
DATE
P76 E V O
6090
2 _
M H PERMIT FEE
$
COMt9)NITY
I
D§T
_ f
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OGE
J 1
MICROFILM FEE
COPIES
$
LEGAL RI
DESCPTION
_ e°C_�� -Ion—oio
MECHANICAL FEE
DBL
$ '
/
SETBACK
F
LOT SIZEI-zo(Nj:E�
USE NO.
GRP
TYPE
S R&;
If1 it fiF '
✓l
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL D 4'('L J
INSP CT R
CONSTRUCTION FEE
DBL
$
�ifi
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER OVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNA' T�URE r
/
CONTRt;CTOR
{, r—
`
.I
�w
'
FEE
$
.ADDRESS. /'
'r
ADD,jiESS
C. i
PLUMBI NGFEE
DBL
$
CITY ZIP CODE
CITY / ZIPCOOE
i
TOTAL FEES
$
TEL. NO.
TEL. NO. 410ENSE
r f--
CASH ❑ hCHECK M.O. ❑ N.C. ❑
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.
RECEIVED BY_
TREES REQUIRED
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 ALSC
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I 1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) OP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.