236258 (PLBG)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMAJ�-,,.._..
ELECTRICAL FEES.,— PLUMBING FEES DST
1 ST FL.
SQ. FT. @
NO. NO.
2ND FL.
SQ. FT. @a
o
POR.
SQ. FT. Cia
MOTOR "I,,OR LESS H.P.
GAR.
SQ.FT. Ca
MOTOR 5 OR LESS H.P. rn�KG�i? d'D
CAR P.
SQ. FT. Cat
MOTOR 20 OR LESS H.P. DRAINAGE PIPING
WALL
SOFT. Cat
DRINKING FOUNTAIN
SQ. FT. Ca
URINAL
ESTIMATED CONSTRUCTION VALUATION $
K.W. UNITS WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN j
MECHANICAL FEES
tee- WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN WASHER (AUTO) (DISH)
APPLIANCE
TRANS- K.W. GARBAGE DISPOSAL
FORMER D
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS LAUNDRY TRAY
ji
AIR HANDLING UNIT I CFM
FIXTURE OR SOCKET KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE WATER CLOSET
COMPRESSOR I—� HP
POLE LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT. SHOWER j
ABSORPTION SYSTEM O B.T.U.
SQ. FT. @ ¢ BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SO. FT. @ 4 WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
-*ASO. FT. RESID. Ca 14 SEWAGE DISPOSAL
BOILER 0 B.T.U.
SQ. FT. GARAGE Cia 1�2¢ HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE GAS PIPING
MOBILE HOME HOOKUP FEE Is
PERMIT FEE PERMIT FEE
A
TOTAL
MOB HK FEE MICRO FEE
MECH.FEE
DBL
PL CKs FEE
CONST FEE
DBL ELECT FEE
DBL
SMI FEE
FEE
PLUMB�'jDBL.,,.
{U�GJ (`V�)
Z 3P�/ Y S
1 f
11
J I F I M A I M I J I J A I $ 1 O 1 N D
JOBADDRESS+�
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OWNERa
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j
L�ni S�f�i>I� .✓T .���1%r
73
74
USE OF BUILDING
F.C.
DATEPERM
N
'
75
M.H. HOOKUP FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT OFFICE i
e
r
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
Z...00NNjjjE
USE NO.
GRP
TYPE
CK BY
F 5 R
—/
'+/perFINAL
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
DATE INSPE
OR a
�_ f
CONSTRUCTION FEE
DBL
$
! /3
�L+�
NAME OF CONST.
LENDER BRANCH
OFFICE
LENDER
INVOLVED
ELECTRICAL FEE
DBL
$
J.NO
u
'I
ADDRESS CITY
STATE
SMI FEE
$
it
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSA•
FEE
$.
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- ?:
PLUMBING FEE
DBL
$
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.
$
p
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
TOTAL FEES *I$
HAS DONE SO, IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS
DE F THE STATE OF CALIFORNIA.
CASH CHECK ❑ M.O. [3N.C. ❑
OWNER,
Sr,
CONTRACTOR
j
& ��/�iv��usJ o t/,��le.�ey
RECEIVED BY "��fJ
ADDRESS
ADDRESS
SEWAGE SYSTEM
�✓!3 G'�✓L°7+L w�✓v
T
LL
P
1
CITY
CITY
TREES REQUIRED
YES
NO
� � `
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t
INFORMATION
TEL. NO.
TEL. NO. LICENSE
FORM 284.2081Re, 11/72)
% 2 I i' / & l 4
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