204524 (SFD)DEPARTMENT OF BUILDING & SAFETY
• COUNTY OF RIVERSIDE •
TOTAL FEES/
FIELD OFFICE
PL. CK. FEE CONST.
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
SPEC. INSP. FEE
PLUMBING FEES
y?
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
SQ.FT. @
NO.
NO.
i
SQ. FT. @
SO. FT. @ MOTOR I OR LESS H.P.
SQ.FT. @fit �" MOTOR 5 OR LESS H.P.
1
50. FT. @ 'MOTOR 20 OR LESS H.P. DRAINAGE PIPING
SQ.FT. @ DRINKING FOUNTAIN
i
SO. FT. @ URINAL
OK W. UNITS WATER PIPING
USE #
ESTIMATED VALUATION $ ,t
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FLOOR DRAIN
MECHANICAL FEES
S
R.n�
WATER SOFTENER
VENT SYSTEM ❑ FAN O EVAP. COOL .LTd HOOD
SIGN
WASHER (AUTO9(DISH)
APPLIANCE
FORMER O K.W.
DATE
GARBAGE DISPOSAL
$ f
�7
FURNACE ❑ UNIT ❑ WALL Cy. FLOOR ❑ SUSPENDED
OUTLETS
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LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
CHECKED BY
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
A.
VALUATION - FF CE l�
WATER CLOSET
04-1
COMPRESSOR C HP
c POLE
JDXTRICTJF.0rUNITS
AD
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
DBL
SHOWER
ri'sf:
ABSORPTION SYSTEM O B.T.U.
SQ. FT. Cal ¢
%
BATH TUB
ER IT M ER
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. Cal Q
$ �%w'
WATER HEATER
i
HEATING SYSTEM FORCED ❑ GRAVITY
SQ. FT. RESID. @1 ¢ /3
SEWAGE DISPOSAL
BOILER 0 B.T.U.
SQ. FT. GARAGE @+12¢ 2
PIAN CHECKER
HOUSE SEWER
SUP P. TO PERMIT
PERMIT FEE
BALANCE OF MIN. FEE
%
GAS PIPING
'ice
TRAILER ISSUANCE FEE - PERMIT FEE
l PERMIT FEE 1t)
1 -1 1
PER2
TOTAL FEES/
EN. TRAILER FEE HEAT & VEa,-W
PL. CK. FEE CONST.
FEE
oeL. ELEC. FEE BL,
rjI
SPEC. INSP. FEE
PLUMBING, FEE
DBL
_
J F
M __... A M _ J J _ A
M A M J .J A S
O N D
SET
LOT SIZE
USE #
JOB ADDRESS
OWNER r;
tt_
`�
F±VK`
S
R.n�
/� .l /.2 wv.+#
ZONE
USE OF BUILDING
DATE
PLAN CHECK FEE
$ f
�7
t .�}
a f
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` t1 a; J,. 7e7,1
r� ••!
CHECKED BY
COMMUNITY
A.
VALUATION - FF CE l�
MECHANICAL FEE
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JDXTRICTJF.0rUNITS
AD
�
�
DBL
_
GROP
f�J
TYPE
LEGAL DE RI ION
ER IT M ER
CONSTRUCTION FEE.
$ �%w'
j' 4
DBL
$'�
PIAN CHECKER
SUP P. TO PERMIT
ELECTRICAL FEE
q-��
DBL
$
BOND $
BOND
CASH
FILE H FINAL
DATE
INSPECTOR
PLUMBING FEE
[PLAN
TRAILER PERMIT
NAME OFCONSTRUCTION LENDER � ! -
< % �` + k' 'j ""
BRANCH OFFICE
ND .R
f
ISSUANCE FEE
$
jNOjLE
INVOLVES
A RESS
TV
STATE
FEE
$
i' �+lZfJ
t✓E�
TOTAL FEES.
$.
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSATION
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 ACCOR-
CASH CHECK M.O. N.C.
Q
DANCE WITH THE LAWS OF RIVERSIDE COUNTY AND TKE STATE OF CALIFORNIA. I ALSO AGREE To
CARRY. COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STAE
RECEIVED BY SEWAGE SYSTEM
1)}
IT
OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
HAS DONE
err 51
LL P
I HEREBY CERTIFY THATTHE INDIVIDUALWHO PREPARED THE PLANS AND SPECIFICATIONS
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STAN q
F INFORMATION
71
Gx 7
OF CALIFORNIA -+
OW
Ow
CONTRACTOR
3
� G.v ft
.✓
ADDRESS
ADDRESS
7
TEL. NO.
TEL.
LICENSE NO. {