268784 (CRES)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
DST
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
Vj —4" y
ESTIMATED CONSTRUCTION
SQ.FT. @
SO, FT. @
SQ- FT. @
SQ. FT. @
SO.FT. @
SQ @
UNITS
YARD SPKLR SYSTEM
MOBI LEHOME SVC.
BARSfNK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
FT. @��
VALUATION
URINAL
$ 'Fl j --OF
WATER PIPING
NOTE: Not to be used os property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL Cl HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL Cl FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM O 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.
SQ FT @ ¢
BATH TUB
SQ FT @ ¢
WATER HEATER
SQ FT RESID @ 1 ¢
SEWAGE DISPOSAL
SQ FT GARAGE @ '/a¢
HOUSE SEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE Is
PERMIT FEE
PERMIT FEE
_PLY1A 7" 4
6 jLTJ]4 III[VVV'lCCC
TOTAL F
MOB HM.FEE
MItRC1 FEE
MECH FEE
DBL.
PL, CK. FEE
CONST, FEE
DBL,
ELECT. FEE
DBL,
SMI FEX
FEE
PLUMB FEE DBL.
LAWS
F
M
I A
I M I
J I
J
Aj
raN
1 D
JOB ADDRESS . SP NO
�T �r
OWNER
J
74
c$ - r�
/ 7
75
USE OF PERMIT
I-) - I t'-- �-' - —7 [2,2
F.C.
DATE
P+ M N Q
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION Sli PP. TO PERMIT.
OFFICE
el
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
'� }-rarer UPI 1�",,•I,
-��.:�t�,'
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
USE ?Jr. GRP TYPE
CK
w
r
I S
0
PLAN CHECK FEE
$
BOND AMT
PLAN NO-
PLAN CHECKER FINA1. DRTE E T 0 R
�N5
CONSTRUCTION FEE
DBL
$
NAME OF CONST LENDER BRANCH
OFFICE
NO LENDER IN'J VEd
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
OWNER/AGENT'S SIGNAO
— Y+�-�►�C
CONTRACTOR
/ /'
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
$'91d
TEL
❑ CHECK M.O. ❑ N C ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS CESSA
TI N 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
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES- COMPLIANCE WITH THI
T.
LL
OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED
/ I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
`ORM 284-208 (Rev, 10-74) QL HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OFTHE STATE OF CALIFORNIA J