236425 (SFD)BUILDING PERMIT
NOTE: Not to be used os property tax voluotion
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
. �LECT,RICAL FEES,
�7o NO.
MOTOR I OR LESS H.P.
Q? MOTOR 5 OR LESS H.P.
FIELD WTI"
PLUMBING FEES DST
MOTOR 20 OR LESS H.P. DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
dQ 0 K.W. UNITS WATER PIPING
FLOOR DRAIN
MECHANICAL FEES
(Play
CONSTRUCTION ESTI
1 ST FL.
SQ. FT.
2ND FL.
SQ. FT.
Ca _
POR.
APPLIANCE
wAUS
SQ. FT.
TRANS-_ FORMER K.W.
GAR.
s
r h
SQ.FT.
_
FURNACE ❑ UNIT ❑ WALL ❑FLOOR EPENDED
CAR P.
OUTLETS
SO. FT..,
LAUNDRY TRAY
WALL
AIR HANDLING UNIT CFM
SQ.FT.
Cal_
CK BM
KITCHEN SINK
SQ. FT.
Cal_
ESTIMATED CONSTRUCTION VALUATION
CONST. SERV. ENTRANCE
NOTE: Not to be used os property tax voluotion
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
. �LECT,RICAL FEES,
�7o NO.
MOTOR I OR LESS H.P.
Q? MOTOR 5 OR LESS H.P.
FIELD WTI"
PLUMBING FEES DST
MOTOR 20 OR LESS H.P. DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
dQ 0 K.W. UNITS WATER PIPING
FLOOR DRAIN
MECHANICAL FEES
(Play
$
WATER SOFTENER
VENT SYST pL❑ FAN ❑ EVAP. COOL p0 HOOD
SIGN
LEGA=MCKIVI ION
WASHER (AUT (DISH) +0
APPLIANCE
wAUS
$
TRANS-_ FORMER K.W.
GARBAGE DISPOSAL
_
FURNACE ❑ UNIT ❑ WALL ❑FLOOR EPENDED
w
OUTLETS
DBL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LO S ZE
FIXTURE OR SOCKET
CK BM
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
7T.,ALK
SPLAN
COMPRESSOR HP
POLE
LAVATORY
NO.
APPLIANCE VENT
FI L
AMPERES SERV, ENT.
%
SHOWER
ABSORPTION SYSTEM 0 B.T.U.
$O. FT. @ ¢
/
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ ¢ _
/
WATER HEATER -
DBL
HEATING SYSTEM .Q FORCED ❑ GRAVITY
"+„'60. FT. RESID.'ClD 11
SEWAGE DISPOSAL
n 20
BOILER 0 B.T.U.
BRANCH OFFICE .NO
SQ. FT. GARAGE @1/,O,
ELECTRICAL FEE
HOUSE SEWER
$
PERMIT FEE
•
BALANCE OF MIN. FEE
,
GAS PIPING
'ADDRESS •
MOBILE HOME HOOKUP FEE Is I
STATE ,
PERMIT FEE
PERMIT FEE
p
E
IJTOTAL FEES_
G/e�
MOB. HK. F;E MICRO FEE
•MECHEE
=DBL.
.P . CKf E
_
CONST. FEE
DBL.
'ELECT. FEE
1 f7�t7�
DBL.
SMI FEE-
ej
-FEE
PLUMB. FEE DBL.,,
F M A I M I J I J A I $ 1 Q 1 N I D- JJO'BADDRESS _ ,: _�- ,,,^,,,•;.OWNER w
74 USE OF BUILDING - F.C. DATE PER
• 75 -1 �� X6425
M.H. HOOKUP FEE -
$
MUNI D 7 UNITS ROOMS VALUATION SUPP. TO PERMIT OFFICE
LEGA=MCKIVI ION
MICROFILM FEE
COPIES
$
w
MECHANICAL FEE
DBL
$
LO S ZE
GRP TYPE
CK BM
ZE JU
�
7T.,ALK
SPLAN
CHECK FEE
$N
NO.
PLAN CHECKER, �
FI L
IN PECTOR
/
- N
CONSTRUCTION FEE
DBL
NAME OF CONST. LENDER -
BRANCH OFFICE .NO
LENDER INVOLVED,_
ELECTRICAL FEE
DBL
$
•
,
'ADDRESS •
CITY
STATE ,
SMI FEE
$
'
THIS PERMIT SHALL BECOME VOID IF WORK ISNOT COMMENCED WITHIN 60 DAYS. CESSA•
$
FEE
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
L. EREBY 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
6.0
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 FEESHAS
DONE SO IN ACCORDANCE WITH SECTION 5541 OF -THE BUSINESS AND PROFESSIONS
-
T TE OF CALIFORNIA.
CASH ❑ CHEC M.O. ❑ ' N.C. ❑
OWNER
�
CONTRACTOR •
RECEIVED BYE.
• /t
��
ADDDRESS
ADDRESS
SEWAGE SYSTEM TT
LL
P ..
f1 2 ff .14-/2,00
CITY
CITY
TREES REQUIRED YES
NO'`
INFORMATION
TEL./NO.
TEL. NO. LICENSE
yFORM 284-208 (Rev. 11/721 r '
F •�