222641 (BLCK)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY
' COUNTY OF RIVERSIDE Ill
,y: _. ELECTRICAL FEES.--,
NO.
MOTOR I OR, LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
D K.W. UNITS
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
CONSTRUCTION ESTIMATE-,,
1 ST FL.
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ.FT.: @ '
CAR P.
SQ. FT. @
WALL
C SQ.FT. @
FIXTURE OR SOCKET
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
CONST. SERV. ENTRANCE
MF(-HANICAI FFFS
DEPARTMENT OF BUILDING & SAFETY
' COUNTY OF RIVERSIDE Ill
,y: _. ELECTRICAL FEES.--,
NO.
MOTOR I OR, LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
D K.W. UNITS
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
F2 PE I O
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
DBL.
APPLIANCE
TRANS- K W
FORMER
GARBAGE DISPOSAL
ELECT. FEE DBL:
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS-
LAUNDRY TRAY
DBL..
AIR HANDLING UNIT I CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR 0 HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
OWNER ^' — ^•
ABSORPTION SYSTEM O B.T.U.
SQ" FT" @ d
BATH TUB
F.
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ d
WATER HEATER
M. H. HOOKUP FEE
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 4
SEWAGE DISPOSAL
_
BOILER 0 B.T.U.
SO. FT. GARAGE @I�ZQ
HOUSE SEWER
SUPP. TO PERMIT"
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
F2 PE I O
FEES
MOB. HK. FEE1:71
MECH. FEE
DBL.
PL. CK. FEE
CONST
DBL.
ELECT. FEE DBL:
SMI FEE
.
FEE PLUMB. FEE
DBL..
t �AL
J I F I M A 1 M I J I J I A S . O- N -I D
JOB ADDRESS
,�Z2
OWNER ^' — ^•
73
74
USE OF BUILDING
L z ,
F.
C. DATE I
17-;
N
PERM %�j
6 L.: �.
75
M. H. HOOKUP FEE
$
COMMUNITY DST
UNITS
ROOMS
VALUATION�'"
SUPP. TO PERMIT"
OFFICE
1 /
2-7 .
MICROFILM FEE
COPIES
$
LEGAL SCRIPTION i
'MECHANICAL FEE
DBL
$'S%
SETBACK
SIZE - ZONE
-
USE NO. GRP
TYPE
CK BY
..
`FINAL
F 5 R
PLAN CHECK FEE
$'
BOND AMT.
PLAN NO.
PLAN CHECKER
DATE INSP
TOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE .NO
LENDER INVOLVED
/
,�/'
DBL
ELECTRICAL FEE
$ .
'
-
ADDRESS - CITY
STATE
SMI FEE
$
TH-IS 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.
FEE
$�
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WIL BE,J ONF !lt4 AC
CORDANCE WITH "THE.LAWS'OF RIVERSIDE COUNTY AND THE STATE OF CFORNIAJ I ALSO
PLUMBING FEE .
DBL
$
AGREE TO CARRY COMPENSATION INSURANCE UPQN MY EPPLOYEES. IANGE WITH
THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTR OTORS IS 'LS UA NTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED PLA ECIFIQATIONS
$
9C]
TOTAL FEES
-HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF I B ESST A D;P 0 .SSIONS
).CALIFORNIA.
r0r)F OF THE STATE O - f- . - t
CASH ❑ CHECK O. ❑ N.C. ❑
OWNER, t -
CONTRACTO
f.
RECEIVED BY
ADOREss
AD 5RESS
SEWAGE SYSTEM
T 11
LL
P
CITY. . . .. -
.CITY
'
TREES REQUIRED
a
YES
NO
- INFORMATION
TEL. NO.
TEL. NO. - LICENSE -
FORM 284.208 (Re, 11 /72)
.+.i.+:.�.► -