236428 (SFD)BUILDING PERMIT
DEPARTMENT OF BUILDING &`SAFETY
COUNTY OF RIVERSIDE
NOTE: Not to be used as property tax valuation r A
MECHANICAL FEES
VENT SYSTEM p FAN ❑EVAP. COOL ,❑ HOOD
APPLIANCE /
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑ USPENDED
AIR HANDLING UNIT CFM
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
COMPRESSOR HP
APPLIANCE VENT
ABSORPTION SYSTEM 0 B.T.U.
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
HEATING SYSTEM ;�D FORCED ❑GRAVITY
BOILER 0 B.T.U.
PERMIT FEE
MOBILE HOME HOOKUP FEE Is
2 3PT2
TOTAL FEES MOB HK FE MICRO FEE
A I -M I J I J A I S 1 O 1 N I D
73
74
75
M.H. HOOKUP FEE $
MECHANICAL FEE
.CONSTRUCTION ESTIMAI
I ST FL.�f,
DRINKING FOUNTAIN
SQ. FT.
2ND FL.
ELECTRICAL FEE
SQ. FT. Cia
POR.
O K.W. UNITS
SQ. FT.
GAR.
PI I IMRINr. FFF
SQ.FT.
CAR P.
FLOOR DRAIN
SQ. FT. �a
WALL
SQ.FT. CiD
03
SIGN
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION
DEPARTMENT OF BUILDING &`SAFETY
COUNTY OF RIVERSIDE
NOTE: Not to be used as property tax valuation r A
MECHANICAL FEES
VENT SYSTEM p FAN ❑EVAP. COOL ,❑ HOOD
APPLIANCE /
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑ USPENDED
AIR HANDLING UNIT CFM
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
COMPRESSOR HP
APPLIANCE VENT
ABSORPTION SYSTEM 0 B.T.U.
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
HEATING SYSTEM ;�D FORCED ❑GRAVITY
BOILER 0 B.T.U.
PERMIT FEE
MOBILE HOME HOOKUP FEE Is
2 3PT2
TOTAL FEES MOB HK FE MICRO FEE
A I -M I J I J A I S 1 O 1 N I D
73
74
75
M.H. HOOKUP FEE $
MECHANICAL FEE
DBL
PLAN CHECK FEE
DRINKING FOUNTAIN
CONSTRUCTION FEE
DBL
ELECTRICAL FEE
DBL
SMI FEE
O K.W. UNITS
FEE
WATER PIPING
PI I IMRINr. FFF
I)RI
_ ELECTRICAL FEES..,,,,
'°- NO.
MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
FIELD OFFICE
PLUMBING FEES DST
S.'... 7e
JI
$ LEGAL 5 RIPTION
SET BACK LOT SIZE ZONE �` USE NO. GRP TYPE CI
1 -z n
TOTAL FEES
CASH Cl CHECKS M.O. ❑ • N.C. ❑
RECEIVED BY `
a.
SEWAGE SYSTEM
a -1aq' 7s
NAM
7URES5 CITYSTATE
� t
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.
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
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 PREPAREDJHE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE,. BUSINESS AND PROFESSIONS
CODE F THE STATE OF CALIFORNIA.
NNER. CONTRACTOR
(DRESS - ADDRESS
T LL P CITY
TREES REQUIRED YES NO
INFORMATIONfb p }� TEL. NO.
ORM 284.208 (Rev. 11/72)
df
TEL. NO. i
DRINKING FOUNTAIN
URINAL
i
O K.W. UNITS
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
03
SIGN
WASHER (AUTO) (DISH)
TRANS-. Q K.W.
FORMER
/
GARBAGE DISPOSAL
OUTLETS
LAUNDRY TRAY
FDCTURE OR SOCKET
KITCHEN SINK
CONST. SERV. ENTRANCE
d
WATER CLOSET
POLE
LAVATORY U
AMPERES SERV. ENT.
SHOWER
SQ. FT. �10 ¢
BATH TUB
SQ. FT. @° d
WATER HEATER
.q•- �.
-SQ. FT. RESID. @I
SEWAGE DISPOSAL
SQ. FT. GARAGE @.1�2Q
HOUSE SEWER
BALANCE OF MIN. FEE
/
GAS PIPING
PERMIT FEE el + o ,
PERMIT FEE �G
MECH�FEE
•�
y�•�
:DBL.
PLCKXFEE
CONST.aFEE
DBL ELECT. FEE
DBL.
SMI`FEE
FEE
- PLUMB. FEE
a �..�
DBL.
JOB ADDRESS _. - - .. —.
OWNER--,—,_ .,.. .. _
USE OF BUILD( G
F.C.•.
DATE
-
ERM2N30642,
3642,
MMUNI -
DST
UNITS
ROOMS
VALUATIaN
SUPP. TO PERMIT
OFFICE
S.'... 7e
JI
$ LEGAL 5 RIPTION
SET BACK LOT SIZE ZONE �` USE NO. GRP TYPE CI
1 -z n
TOTAL FEES
CASH Cl CHECKS M.O. ❑ • N.C. ❑
RECEIVED BY `
a.
SEWAGE SYSTEM
a -1aq' 7s
NAM
7URES5 CITYSTATE
� t
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.
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
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 PREPAREDJHE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE,. BUSINESS AND PROFESSIONS
CODE F THE STATE OF CALIFORNIA.
NNER. CONTRACTOR
(DRESS - ADDRESS
T LL P CITY
TREES REQUIRED YES NO
INFORMATIONfb p }� TEL. NO.
ORM 284.208 (Rev. 11/72)
df
TEL. NO. i