222830 (SATT)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
• COUNTY OF RIVERSIDE •
CONSTRUCTION ESTIMATE;.,_ ELECTRICAL FEES;...,,.,.,:_
1 ST FL.
SQ. FT. @`
I 2ND FL.
SQ. FT. @
POR.
4 SQ. FT.
GAR.
SQ.FT. @
CAR P.
SQ. FT. @
WALL
SQ.FT. @
AIR HANDLING UNIT I CFM
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used CIS property tox valuation
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
MFC•HANICAI FFFS
MOTOR I OR LESS H.P.
"MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UN
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
DST
VENT SYSTEM -FAN ❑EVAP.000L gklOOD
SIGN
OB. HK. FEE MICRO FEE
WASHER (AUTO ISH)
APPLIANCE
TRANS- K.W.
FORMER D
CONST. FEE
GARBAGE DISPOSAL
FURNACE ❑UNIT ❑WALL ❑FLOOR ❑SUSPENDED
OUTLETS
FEE
LAUNDRY TRAY
AIR HANDLING UNIT I CFM
FIXTURE OR SOCKET
vim
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP s
POLE
RLAVATORY
-n
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM j B.T.U.
SO. FT. @ Q
OWNER
1
0
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SO. FT. @ 3
,
WATER HEATER
HEATING SYSTEM (�r FORCED ❑ GRAVITY Sl va
SO. FT. RESID. @ 14
! /
SEWAGE DISPOSAL 3
BOILER 0 B.T.U.
SQ. FT. GARAGE @1/2¢
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
OMMUNITY
GAS PIPING:zk
MOBILE HOME MOOKUP FEE I I I 1 1 Y I r[KIVIIi rcc I w( IdO 1 / I VCKMH rcc I L IOU
TOTAL FEES
OB. HK. FEE MICRO FEE
MECH. FEE
DBL
PL. CK. FEE
CONST. FEE
DBL. ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
OBL.
2 2793
vim
.
�,� .
.� ��
,
, s.-
J I E I M A I M I J I J A
I S 1 0 1 N D
'.:OB ADDRESS
F
OWNER
1
0
73
74
USE +OF BUILDING
f 1lY ! e'
F. C.
Ali
D`Xf E -
""
I_PER�f% Q
�283C
75
M.H. HOOKUP FEE
$
OMMUNITY
ST
UNITS
ROOMS
VALUATION SUPP. TO PERMIT OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESMIPTION
!
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
ZONE
NO.
GRP
TYPE
CK BY
��
i _
%U,SE
-&
F s O R `�
PLAN CHECK FEE
$
B ND AMT. PLAN NO.
PLAN CHECKER
FINAL DATE INS
ECTOR
411
z�
q - �% - � _>
1 .
CONSTRUCTION FEE
DBL '
$
NAME OF CONST. LENDER - BRANCH
' 1 � �
OFFICE .NO
LENDER INVOLVED
ELECTRICAL FEE
DBL
$
/ 7
ADDRESS CITY
STATE
a.b
f Y': !
�� A4
q
YC
SMI FEE
$
_
THIS PERMIT SHALL BECOME VAID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESS/.
FEE
$
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. S.
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 PR RED HEP NS AND SPECIFICATIONS
$
TOTAL FEES
G
t
7
HAS DONE SO IN ACCORDANCE WITH SECTION 5K41 T BUS ESS P O SS NS
E STATE OF CALIFORNIA.
CASH [_1CHECK [fir" M.O. ❑ '
N.C. ❑
OWNER.
CONTRACTOR
RECEIVED BYADDRESS
ADDRESS IF
SEWAGE SYSTEM T
LL
P
CITY
CITY
TREES REQUIRED
YES
NO
7.R
!
li�i]J2MAjION
TEL. NO.
TEE. NO. LICENSE
FORM 284-208 (Rev. 11/721
A.
�4 J ,