230367 (RPL)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY:
FIELD OFFICE
COUNTY OF RIVERSIDE
MECH. FEE
L.
CONSTRUCTION ESTIMATE__.
ELECTRICAL FEES
PLUMBING FEES
Dsr
SMI' FEE
.
PLUMB. FEE DBL.a
1ST FL. SQ. FT. @
NO. NO.
2ND FL. SQ. FT. @
-
� �-'e,,
POR. SQ. FT. @
MOTOR I OR LESS H.P.
GAR. SQ.FT. @
MOTOR 5 OR LESS H.P.
CAR P. SQ. FT. @
MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
1
WALL SQ.FT. @
DRINKING FOUNTAIN
yrPi9Y"" IQ SQ. FT. @
URINAL
A M J - .J
ESTIMAT � STRUCTION VALUATION $
K.W. UNITS
WATER PIPING
73
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
'•1
WATER SOFTENER
VENT SYSTEM ❑ FAN Cl EVAP. COOL Cl HOOD
I N
WASHER (AUTO) (DISH)
DATE
APPLIANCE
FORMER ' K.W.
GARBAGE DISPOSAL
M.H. HOOKUP FEE
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
$
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
DS
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
TO PERMIT
COMPRESSOR 0 HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM 0 B.T.U.
SO. FT. @ 4
BATH TUB
I
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SO. FT. @
WATER HEATER
m -
HEATING SYSTEM ❑: FORCED ❑ GRAVITY
Y SQ. FT. RESID. @) 4
SEWAGE DISPOSAL
$
BOILER 0 B.T.U.
SQ. FT. GARAGE @/24
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE f
GAS PIPING
MOBILE HOME HOOKUP FEE $
♦ PERMIT FEE .E� s] s.
PERMIT FEE
MECHANICAL FEE
-
P IT O 5
- TOTAL FEE$
MOB. HK. FEE MICRO FEE
MECH. FEE
L.
PL. CK. FEE
CONST. FEE
DBL. ELECT. FEE
BL.
SMI' FEE
FEE
PLUMB. FEE DBL.a
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1
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J. F M
A M J - .J
A S - O N D
Jos -ADDRESS• -.- -� ---- - -_-r --- -- -
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OWNER •_ _ _ _ a
73
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74
USE OF BUILDING - - F.C.
ep
DATE
ER2N
X36367
75
M.H. HOOKUP FEE
$
oNI Yg4
DS
UNITS
ROOMS
VALUATION
TO PERMIT
OFFICE
I
ISUPP.
MICROFILM FEE
COPIES
$
IFGAC•DEs IPTIO
r ''�
MECHANICAL FEE
-
DBL$'
SET BACK LO SIZ
ZO
USE NO.
GRP TYPE
CK BY
F S R
� *
o
$
PLAN CHECK FEE
BOND AMT:
PLAN NO. PLAN CHECKER t
FINAL DATE - INSPECTOR
f. '
40 0,
/(3 - ; -�
l
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE .NO
LENDER INVOLVED
60
ELECTRICAL FEE
DBL
v
ADDRESS CITY
STATE
SMI FEE
$
�VVr
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. OSSA
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
1�
- FEE
$
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC-
C•PLUMBING
CORDANCE WITH'THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
FEE
PLUMBING-FEE
DBL
$
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH
. THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEEDL
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
$
TOTAL
FEES
0.'
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS
conp OF THF STATE OF CALIFORNIA. !
CASH ❑
CHECK
M.O. Cl
N.C. Cl
OWNER.
CONTRACTOR
!
� �
r
RECEIVED BY.'
r
ADDRESS
DDR >
SEWAGE SYSTEM
T
_ LL
P
CITY
CITY
TREES REQUIRED
YES
NO
".9
-
INFORMATION
�
TEL. NO. -
TEC. NO. � LI NSE
VORM 284-2081Rm 11/721
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