268165 (SFD)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
IST FL. f M SQ.FT. @/ UNITS
2ND FL. SQ. FT. @
POR. ' rr SQ. FT.
MOBILEHOME SVC.
GAR. �r!'1 $q. FT. @.� !' / iii POWER OUTLET
CAR P. SOFT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $ : r
NOTE: Not to be used as property tax voluotion r
MECHANICAL FEES
VENT SYSTEM O FAN ❑ EVAP. COOL EXHOOD
APPLIANCE
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 IAUT01 ,01?1TI
GARBAGE DISPOSAL
DST
FURNACE ❑ UNIT O WALL ❑ 40OR ❑ SUSPENDED
JOB ADDRESS SP NO
LAUNDRY TRAY
[��EP,
75
AIR HANDLING UNIT CFM
F. C.
IDLE METER
`
KITCHEN SINK
s ( !
ABSORPTION SYSTEM 0 B.T.U.
,,2- 7,
TEMP USE PERM SVC
__2
WATER CLOSET
$
{)
COMPRESSOR 0 HP
DST
POLE, TEMP/PERM
S
LAVATORY+'
SUPP. TO PERMIT
U
HEATING SYSTEM Of FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 0 B.T.U.
I
SQ FT @ ¢
BATH TUB
COPIES
$
SQ FT @ ¢
i
WATER HEATER
J
¢J f SQ FT RESID
/
SEWAGE DISPOSAL
40
SET BACK
SQ FT GARAGE @
HOUSE SEWER
-GRP
TYPE I
PERMIT FEE
GAS PIPING
to 42
-r/'?
MOBILE HOME PERMIT FEE Is
PERMIT FEE
y 13
PERMIT FEE
IF i (J
ERMIT O.
28�6
TOTAL FEES
.!
MOB. HM.FEE
MICRO FEE
MECH. FEE
�� aw
DBL.
PL. CK. FEE
CONST. FEE
DBL.
BJ?
ELECT. FEE
-
DBL.�.IIEE
FEELLUMB.
FEE
JDBL.
J F M A M J J A S O N D
JOB ADDRESS SP NO
[��EP,
75
USE OF PERMIT
F. C.
DATE
PE IT 0.
7e
t
e
,,2- 7,
X8165
M H PERMIT FEE
$
COMMUNITY
DST
NITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
I
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONEUSE
NO.
-GRP
TYPE I
CK 9N
to 42
-r/'?
,
R � /
F r t/ � � �J
PLAN CHECK FEE
$
BOND AMT
PLAN NO.
PLAN CHECKER
FINAL DATE je4�{/
1
NSP,ECrT�OR/f;
-
�/7
/ / ! . / G
t1t�tJ/Vv.. QL /Vl
(� (/�
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER ED
/INV
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
CONTRACTOR E'r SNI /, ✓""� �t.�! '
INSTRUMENTATION FEE
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
y�0
^
TOTAL FEES
$J
TEL. NO.
CASH ❑ CHECK 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 �'
L11 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
SEWAGESYSTEM
T
LL
IN _
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
t %\AIC �CTUC CTATC/ C!'AI IC! DAI1A I'!"1\/CDI!\I/". l'lI .AiTl1DC IC A1Cn(_I IADAAITCCh
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
I
FORM 284-208 (Rev. 10-74) &L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.