268784 (GRES)BUILDING PERMIT
Y
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1 ST FL. SQ.FT. @
UNITS
CFM
j 2ND FL. SO. FT. @
KITCHEN SINK
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SOFT. @
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
DRAINAGE PIPING
SQ. FT. @
BOILER 0 B.T.U.
DfFINKING FOUNTAIN
i r aif . FT. @
URINAL
j ESTIMATED NSTRUCTION VALUATION $
SQ FT @ ¢
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL. PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL. COMM
WATER SOFTENER
SQ FT GARAGE @ '/a¢
VENT SYSTEM ❑FAN O EVAP. COOL Cl HOOD SIGN
WASHER(AUTOI (DISH)
DST
APPLIANCE
JOB ADDRESS SP NO
OWNER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
/
J1 /F)l'J
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
BOILER 0 B.T.U.
ROOMS
SQ FT @ ¢
BATH TUB
OFFICE
SQ FT @ ¢
WATER HEATER
/
SOFT RESID @ 1¢
SEWAGE DISPOSAL
v
I
SQ FT GARAGE @ '/a¢
HOUSE SEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE
Is
PERMIT FEE
PERMIT FEE
26 611O_
8 841
70TAL� E5,
Ef
MOB. HM.FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
i I ✓
DBL.
ELECT. FEE
DBL
SMI EJ
fj
FEE
PLUMB. FEE
DBL.
J F M A M ) J A S O N D
JOB ADDRESS SP NO
OWNER
74"r1�.
f e�iY Y�
/
J1 /F)l'J
]cj
USE OF PERMIT
F.C.
DATE
P M N
J
8 7 84
M H PERMIT FEE
$
COMMUNITY
DST
UNIT'
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
/
I
v
I
MICROFILMFEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE
CK
FS R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKERFINAL
DATE
TOR
JINSPE
53)x,
,.
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER IN VED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNAUAIE,
CONTRACTOR
INSTRUMENTATION FEE
r /
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
A ; j_
TOTAL FEES
$
TEL. NO.
`-
TEL. NO. LICENSE
6
CASH ❑ CHECK M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA•
IT,N OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY i 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
SEWAGESYSTEM
T
LL
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
nI
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
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.