280338 (ELEC)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
1 ST FL I UNITS
MOBILEHOME SVC.
POWER OUTLET
.40
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
APPLIANCE
SQ. .
2ND FL.
50. FT. @
POR.
SQ. FT. @
GAR.
SO. FT. @
CAR P.
SO.FT. @
WALL
SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION Is
NOTE: Not to be used as property tax valuation
TEMP USE PERM SVC
MECHANICAL FEES
VENT SYSTEM
❑ FAN ❑ EVAP. COOL O HOOD
MOBILEHOME SVC.
POWER OUTLET
.40
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
APPLIANCE
JOB ADDRESS I� } SP NO
OWN
74
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL O FLOOR ❑ SUSPENDED
75
USEERMITThl glec, J e Y v; c
LAUNDRY TRAY
AIR HANDLING UNIT I
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
� B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR �
HP
POLE, TEMP/PERM
UNITS
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
Q AMPERES SERV ENT
—4F 44
SHOWER
BOILER 0 B.T.U.
SQ FT @ C
tki
BATH TUB
SQ FT @ C
WATER HEATER
MICROFILM FEE
COPIES
SQ FT RESID @ 1¢
SEWAGE DISPOSAL
MECHANICAL FEE
DBL
SQ FT GARAGE @ 'he
HOUSE SEWER
PERMIT FEE
USE NO.
GRP
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
i
PERMIT FEE
2 PERM 3 3 8
,T�FEJS
OB. HM.FEE
ICRO FEE
71
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
E ,, fF�E
DBL.
SMI FEE
FEE
PLUMB. FEE
108L.
J I F I M A I M I J I J A I S 1 O 1 N I D
JOB ADDRESS I� } SP NO
OWN
74
75
USEERMITThl glec, J e Y v; c
FCIDATf�.,
I �1.�/'
PERMIT280338
76
M H PERMIT FEE
$
CO ITY
D12 -S
DST
1�
UNITS
ROOMS
VALUATION
300
SUPP. TO PERMIT
OFFICE
tki
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
(0f7- v -mat po r c LV Sec3N-5--Tk 7 y-
MECHANICAL FEE
DBL
$
SETBACK
z
LOT SIZE ZONE
�
USE NO.
GRP
TYPE
Y
14.
F S R
/
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INS CTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$ ��
(�d
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNATURE
CON}'R J )
JAmcS N FEA60k
FEE
$
ADDRESS
ADD y '
r. 61 fjCyK
PLUMBING FEE
DBL
$
CITY ZIP CODEto
ZIP CODE
AGAPff &
TOTAL FEES
$ R�j
V
-
TEL. NO.
TE NO. LICENSE_
S�f� 5 t"� 4/ c,
CASH ❑ CHECK M.O. O N.C. O
�' t THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BYFy
TREES REQ UIREDION
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 MAIC l C TUC CTATC^C PAI IC -11A r- %ICDIAIr_!' KITDA!T( DC IC AIC(1/'_IIADAAITCCn _
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-,208 (Rem. 10-74) O► L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.