239683 (AR)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIM_ AT. _ E,LECTR.ICAL FEES,—,
1ST FL. SQ. FT. Cia yLT� NO.
2ND FL. SQ. FT. Cia
POR. SQ. FT. @ MOTOR eI OR "LESS H.P.
GAR. SQ.FT. @
MOTOR 5 OR LESS H.P.
-
FIELD OFFICE
PLUMBING FEES DST_ _.
CAR P. SQ. FT. @ MOTOR 20 OR LESS H.P. DRAINAGE PIPING
WALL SQ.FT. @ " DRINKING FOUNTAIN
E�El SQ. FT. t70 URINAL
ESTIMATED CONSTRUCTION VALUATION $ o,� 0 K ` . UNITS WATER PIPING
NOTE: Not to be used as property tax valuation d FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD SIGN WASHER (AUTO) (DISH)
APPLIANCE TRANS-
FORMER K W. GARBAGE DISPOSAL
D
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED OUTLETS LAUNDRY TRAY
AIR HANDLING UNIT I CFM FIXTURE OR SOCKET KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL CONST, SERV. ENTRANCE WATER CLOSET
COMPRESSOR 0 HP POLE LAVATORY
APPLIANCE VENT AMPERES SERV. ENT. SHOWER
ABSORPTION SYSTEM _j B.T.U. SO. FT. G° Q BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM. SQ. FT. O° Q WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY }SQ. FT. RESID. @ 14 SEWAGE DISPOSAL
BOILER 0 B.T.U. SQ. FT. GARAGE @,'/,0 HOUSE SEWER
PERMIT FEE BALANCE OF MIN. FEE GAS PIPING
MOBILE HOME HOOKUP FEE is PERMIT FEE PERMIT FEE
E
2
I O
TOTAL FEES
�/S S9
MOB.•HK. FEE MICRO FEE
MECH. FEE
DBL.
PL. CKaFEE
/%' �+r_
CONST. FEE
(� ��'
DBL.
ELECT. FEE
3
DBL.
SMI FEE
jai`
FEE PLUMB. FEE
DBL.
- JF I M A I- M I J -I J A I S 1 O 1 N D
JOBADDRESS-
OWN�EL�
73Y`
74
USE OF BUILDING F.C.
y-,/ 7
DATE +�
PER N
683
75
M.H. HOOKUP FEE
$
COMMUNITY
v'/A/i`�4
I DST
df
ITS
ROOMS
I VALUATION
-S lr
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
,,r - P/-
MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
fi'",
j
USE NO.
GRP
TYPE
CK BY
Fat S P R,�,
PLAN CHECK FEE
$ s
!
4� W
BOND AMT.
PLAN NO,
PLAN CHECKER
I FINAL DATE INSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE .NO
LENDER INVOLVED ZF
�A
ELECTRICAL FEE
DBL
$
•�
ADDRESS CITY
STATE
SMI FEE
$
•THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSA-
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
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 ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH
THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I 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 OF CALIFORNIA.
FEE
$
PLUMBING FEE
DBL
$
TOTAL FEES
$
1
,�
CASH CHECK ❑ M.O. ❑ ' N.C. ❑f.)
OWNER,
�y
CONTRACTOR
RECEIVED BY
ADDRESS
ADDRESS
SEWAGE SYSTEM
LL
P
TREES REQUIRED
YES
NO
CITY
C A
CITY
INFORMATION
FORM 284.2061Rev. 11/721
TEL. NO.
TEL. NO. LICENSE