290914 (RIV CNTY)48900 Avenida Anselmo
AMDEPARTMENT OF BUILDING & SAFETY AbFIELD OFFICE
F M A M f J A S Q N D
MSI
mw COUNTY OF RIVERSIDEIIII III IIII II III IIII 74
2 EIRM'T NO.
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1 ST FL.
2ND FL.
FOR.
GAR.
CAR P.
WALL SQ.
! AO
ESTIMATED CONSTRUCTION
SQ. FT. @ $ UNITS
SQ. FT. @ YARD SPKLR SYSTEM
SQ. FT. @ MOBILEHOME SVC. BAR SINK
SQ. FT. @ POWER OUTLET ROOF DRAINS
SQ. FT. @ DRAINAGE PIPING
FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ WATER PIPING
NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER
VENT SYSTEM [-j FAN ❑ EVAP. COOL ❑ HOOD SIGN WASHER (AUTO)(DISH )
APPLIANCE ❑ DRYER GARBAGE DISPOSAL
F.C.
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDEp LAUNDRY TRAY
NO.
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT. @ ¢ BATH TUB
29091
SQ. FT. @ 4 WATER HEATER
SQ.FT.RESID @ 11/4c SEWAGE DISPOSAL
COPIES
SQ.FT.GAR @ 3/4¢ HOUSE SEWER
BOOK PAGE PARCEL
GAS PIPING
PERMIT FEE .
PERMIT FEE PERMIT FEE
DBL.
I TOTAL FEES,
IMOB.HM.FEEFMICRO
FEE MECH. FEE PL. CK. FEE
I CONST. FEE ELECT. FEE SMI FEE
FEE PLUMB. FEE
F M A M f J A S Q N D
JOB A`DDRESSSP NO
f r ,, / 1
,} ve
OWNER
1.2
77
COMMUNITY
VALUATIONDATE
AW. e2a
/J r;i
IOFFICE_
-'M H PERMIT FEE
$
USE OWPERMIT
F.C.
SUPP. TO PERMITPERMIT
NO.
/ f
G ll1+ ClG.
29091
MICROFILM FEE
COPIES
$
BOOK PAGE PARCEL
LEGAL DESCRIPTION
611-3 -33j 005(
4 441 jQ a - `
MECHANICAL FEE
DBL
$
USE NO.
ZONE
SET ACK
LOT SIZE
GRP
TYPE
CK BY
1"
/✓
I
S
5
R
%
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
PECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
1
r rr
1
>>
ELECTRICAL FEE
DBL -
$_
f r
ADDRES CITY
STATE
S
STRONG MOTION
$
.Qw hlr3RiA S SI AT' E -f CONTRACTOR
i
INSTRUMENTATION FEE
,SPECIALINSP
$
ADDRESS ADDRESS
DEMOLITON
FEE
REGISTRATION
f
PLUMBING FEE
DBL
$
CITY ZIP CODE CITY
ZIP CODE
TOTAL FEES
TEL, NO AREA
CODE TEL.
NO.
AREA CODE
LICENSE u
CASH❑CHECK 0.❑N.C.❑$
J
1
RECEIVED BY TREES REQUIRTHIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
':SEWAGE SYSTEM
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T LL P
WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
f n"DFAICATll k! IAICI
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED. LC VY! lrl 1 n LN YYJ VI- IriC J1MIG VF
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
FORM 2B4-ZOB (REV. 6-761 OF CALIFORNIA.