258109 (PLBG)I BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 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 fl FAN fl FVAP. COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFE
COUNTY OF RIVERSIDE
NO. I ELECTRICAL FEES
UNITS 1
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER I I B.T.U.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
�f
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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 @ a WATER HEATER
SOFT RESID @ 1 a SEWAGE DISPOSAL
SQ FT GARAGE @ a HOUSE$EWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE S
'MOB.
PERMIT FEE PERMIT FEE di
PERMIT NO. F,ES HM. FEE MICRO EEE MECH. FEE DBL. PL. CK. FEE CONST. FEE DBL. ELECT. FEE DBL. SMI FEE FEE PLUM,E DBL.
e�7,j07A1
25810
J I F I M I -A I M Jy' A I $ O 1 ND JOB ADDRESS 1 SP NO OWNER
73 51-944 Washi ton I HUDSON, O.W.
74 ` USE OF PERMIT F.C. PFlt LyNOOO(ty�,
YY,
JDATE
7s Sx2i1 Seepage Pit 10-30•74 V
MH PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION d1Ci
TO PERMIT
OF;
OFFICE
LA t}UI"A
11
I
ISUPP.
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
Lot -90 Desert Club #E5 PC -769.131.002
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK BY
$-3
I
Ayers
F 5 1 R
PLAN CHECK FEE
$
BOND AMT.
PLAN No.
PLAN CHECKER
FINAL DATEINSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
TH'S'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 DON
$
AC-
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFOR
FEE
I ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIA
E WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS 1S ALSO GUA TEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS�ND SPECIFICATIONS
PLUMBING FEE
DBL
$
84)
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINE
OF THE STATE OF CALIFORNIA. ND PROFESSIONS CODE
TOTAL FEES77
�y
OWNER/AGENT'S SIGNATURE CONT TOR i c
1
CASH ,HECK ❑ M.O. ❑ N.C. ❑��
ADDRESS DDR a
CITY J 7160DE CITY l i Lf ZIP CODE
� el ,
TEL. NO. TEL. NO. LICENSE
RECEIVED BY
TREES REQUIRED
I
SEWAGE SYSTEM
T
--j����
LL P
INFORMATION
ORM 284.208 (Rev. 9.73) @s
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