206154 (SFD)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFET
is COUNTY OF RIVERSIDE
ESTIMATED VALUATION Is
MECHANICAL FEES
ELECTRICAL FEES
MOTOR 1 OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UN
FIELD OFFICE
PLUMBING FEES
tr6l� k5/ fwr
DRAINAGE PIPING
DRINKING FOUNTAII,
URINAL
WATER PIPING
FLOOR DRAIN
WATFR SOFTFNFR
VENT SYSTEM AN ❑ EVAP.COOL❑re HOOD
CONSTRUCTION ESTIMATE
SIGN
WASHER (AUTO) ISH)
'� �"
b
3c
1ST FL.
TRANSFORMER =K•W•
SQ. FT. @
DBL
2ND FL.
FURNACE❑UNITE] WALL❑FLOOR ❑ SUSPEND ED
SQ. FT. @
OUTLETS
POR.
��
SQ. FT. @
'
GAR.
FIXTURE OR SOCKET
SQ. FT. @
�
CAR P.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
SQ. FT. @
CONST. SERV. ENTRANCE
WALL
COMMUNITY
SQ. FT. @
COMPRESSOR 0 HP.
VALUATION
POLE
SQ. FT. @
¢G
ESTIMATED VALUATION Is
MECHANICAL FEES
ELECTRICAL FEES
MOTOR 1 OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UN
FIELD OFFICE
PLUMBING FEES
tr6l� k5/ fwr
DRAINAGE PIPING
DRINKING FOUNTAII,
URINAL
WATER PIPING
FLOOR DRAIN
WATFR SOFTFNFR
VENT SYSTEM AN ❑ EVAP.COOL❑re HOOD
�
SIGN
WASHER (AUTO) ISH)
I PERMIT FEE
OO
APPLIANCE I i`I
3v c�
TRANSFORMER =K•W•
! GARBAGE DISPOSAL
DBL
PL. CK. F E
FURNACE❑UNITE] WALL❑FLOOR ❑ SUSPEND ED
DBL
OUTLETS
LAUNDRY TRAY
FEE
PLUMBING SEE
ci
AIR HANDLING UNITI CFM_
OWX 6. V -,A
FIXTURE OR SOCKET
KITCHEN SINK
�
�
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
4
CONST. SERV. ENTRANCE
3WATER CLOSET
COMMUNITY
S Zi
COMPRESSOR 0 HP.
VALUATION
POLE
LAVATORY
¢G
APPLIANCE VENT
,L�GiNI`v4
AMPERES SERV. ENT.
` SHOWER
.�
v.•—...
ABSORPTION SYSTEM B.T.U.
MOBILEHOME
SQ.FT.@ Q
BATHTUB
'S"D
INCINERATOR ❑ DOMESTIC ❑INDUS. OR COMM.
SQ. FT.@ ¢:
WATER HEATER`
7% r� , af_- .e T
MECHANICAL FEE
HEATING SYSTEMFORCED ❑GRAVIq:q
$
SQ. FT. RESID. @ 1 ¢
SEWAGE DISPOSAL
ZONE
BOILER B.T.U.
GRP
SQ. FT. GAR AGE @ i ¢
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
A
11 C3
MOBILEHOME HOOKUP FEE
I$ I I I I IPERMIT FEE I
3I
--I
I PERMIT FEE
I A "!
PERMIT NUMBER
TOTAL FEE
_ OB. HOOK FEE
HEAT & VENT FEE
DBL
PL. CK. F E
CONST. FEE
DBL
ELEC. FEE
DBL
FEE
PLUMBING SEE
ci
DBL,30
J F MIA M J J A S O
N D
JOB ADDyRESS
OWNER
72
/
11,F_
t T
IWr
73DAT
SE O'F BUILDING
F.C.
E
PE MI
N
74
OWX 6. V -,A
as
3-1.7-7.2
�
�
� 15
4
75
+
COMMUNITY
DST UNITS
ROOM
VALUATION
SUPP. TO PERMIT
OFFICE
76 1 1 1 1
,L�GiNI`v4
33�5f2.L�
/C
MOBILEHOME
$
LEGAL DESCRIPTION
*/,o
HOOKUP FEE
7% r� , af_- .e T
MECHANICAL FEE
DBL��,y
$
SET BACK LOT SIZE
Q
ZONE
USE NO.
GRP
TYPE
CK BY
PLAN CHECK FEE15
BOND AMT.
PLAN NO. PLAN CHECKER
FINAL DATE INSPE
TOR
A
CONSTRUCTION FEE
DBL
0
NAME OF CONST. LENDER
BRANCH OFFICE
INVO VED
%t14,
DBL
�
-Y
ADDRESS
ENDDER
CITY
ATE
ELECTRICAL FEE
$ 16
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
S, I
02
CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
/I' FEE
,Z
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF -
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
DBL
p �
PLUMBING FEE
'
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
k3
IS ALSO GUARANTEED.
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
TOTAL FEES $
CATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND
�/��
[,ca
PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
CASH CHECK [. M.O. ED.. N.C. 0
i�� OWNER
T
CONTRA" ,R , J cc
Received By
ADDRESS
ADDRESS
I
Sewage System
T
LL
P
CITY
r j'�� , 1
CITY
f�f �J 1
Trees Required '
Yes
No
i•''�'!
INFORMATION
TEL. NO.
TEL.,.N,(O.. 1. ayF'. LICENSE
FORM 284-208 (REV. 4/71)
r