223027 (PAT)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE 4
, ELECTRICAL FEES
NO.
MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UNITS
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATFR'OPTFNFR
CONSTRUCTION ESTIMATE,
1 ST FL.
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT.
GAR.
SQ.FT. @
CAR P.
SQ. FT. @
WALL
SQ.FT. @
FIXTURE OR SOCKET
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
CONST. SERV. ENTRANCE
MFCHANICAI FFFS
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE 4
, ELECTRICAL FEES
NO.
MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UNITS
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATFR'OPTFNFR
MOBILE HOME HOOKUP FEE I$- 1 1 I 1 I PERMIT FEE I I i I PERMIT FEE I I
MI NO.
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
DBL.
APPLIANCE
TRANS- K.W.
FORMER D
GARBAGE DISPOSAL
ELECT. FEE
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
DBL:.
AIR HANDLING UNIT I = CFM
FIXTURE OR SOCKET
KITCHEN SINK
I
GAS PIPE ❑ NATURAL O L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
I
COMPRESSOR 0 HP
POLE
LAVATORY
^
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
-I OWNER f--
J
ABSORPTION SYSTEM 0 B.T.U.
SO. FT. @ 4
BATH TUB
F.C.
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ d
WATER HEATER
M.H. HOOKUP FEE
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SO. FT. RESID. @ 14
SEWAGE DISPOSAL
+
BOILER 0 B.T.U.
SO. FT. GARAGE @1/,41HOUSE
SEWER
TO PERMIT
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILE HOME HOOKUP FEE I$- 1 1 I 1 I PERMIT FEE I I i I PERMIT FEE I I
MI NO.
TOTALICRO
FEES
MOB. HK. FEE MFEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEU FEE
PLUMB. FEE
DBL:.
2PE
S
I
I
It
I
I
I
J -1 F 1 M A I4M I J I J A 1 S 1 Q I N I D
JOB ADDRESS J
Aj ! i
-I OWNER f--
J
73
74
On OF BUILDING
- r 1+302?
F.C.
DAT
ERM N
75
M.H. HOOKUP FEE
$
COMMUNITY DST
UNI
OMS
VALUATION
TO PERMIT
OFFICE
I;PP,
:.
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
9 '3 ' � 4�
MECHANICAL FEE
DBL
$
SET BACK
'`�
LO SIZE ZONE
USE NO. •`
G P PE' BY
MFINAL
F 5,,,r.. R
PLAN CHECK FEE
$
BON AMT.
PLAN NO.
PLAN CHECKER
DATE INSPECTOR
CONSTRUCTION FEE
DBL
$,�`-
NAME OF CONST. LENDER BRANCH
OFFICE .NO
LENDER INVOLVED
♦�
V
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.
FEE
$
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
PLUMBING FEE '
DBL
$
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
$
TOTAL FEES_ '
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS
rr')nr OF THF STATE OF CALIFORNIA.
CASH ❑ CHECK M.O. ❑, N.C.❑
OWNER.
A/
CONTRACTOR
RECEIVED BY
ADDRESS
ADDRESS
t -
SEWAGE SYSTEM
T
LL
P-1,;?
CITY
CITY
TREES REQUIRED
YES
NO
INFORMATION
TEL. NO.
TEL. NO. LICENSE
FORM 284.2081Rev. 11/721
+ -