238320 (AR)BUILDING PERMIT
CONSTRUCTION. EST
I ST FL.
SQ. FT. @_
2ND FL.
SQ. FT. @_
POR.
SQ. FT. @_
GAR.
SQ.FT. @_
CAR P.
SQ. FT. @_
WALL
SQ.FT. @_
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE
ELECTRICAL_FEES PLUMBING FEES DST .
Y. !-Fsr... r....Cv
NO. I INO.1
ESTIMATED CONSTRUCTION VALUATION $ f
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD
APPLIANCE
FURNACE ❑UNIT ❑WALL ❑FLOOR ❑SUSPENDED
AIR HANDLING UNIT CFM
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
COMPRESSOR 0 HP
APPLIANCE VENT
ABSORPTION SYSTEM IBJ B.T.0
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
HEATING SYSTEM . ❑ FORCED ❑ GRAVITY.
BOILER 0 B.T.U.
PERMIT FEE
MOBILE HOME HOOKUP FEE $
23P&
� O •
TOTAL MOB.. HK FEE MICRO FEE
J _F I M I A. I M I J I J A I S `0 1 N I C
73
74
75.
M.H. HOOKUP FEE $
MICROFILM FEE COPIES $
MECHANICAL FEE DBL $
MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W. UNITS
SIGN.
TRANS-.K.W.
FORMER
OUTLETS
FIXTURE OR SOCKET
CONST. SERV. ENTRANCE
POLE
AMPERES SERV. ENT.
SO. FT. @ 4
SO. FT. @ 4
-1�60. FT. RESID. @) 4
SQ. FT. GARAGE @/24
BALANCE OF MIN. FEE
PERMIT FEE
MECH. FEE 1,01111 PI GK'rfEE I CONST. FEE
I1�=p i
JOB ADDRESS.
USE OF BUILDING . - -,ter/ F.C.
Jl P9 .'f jr�x y�—de-1
/ wr,4 . I // I -
CRIPTION
SET BACK LOT SIZE
R
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
SHOWER
BATH TUB
WATER HEATER
SEWAGE DISPOSAL
HOUSE SEWER
GAS PIPING
PERMIT FEE
DBL.. SMI FEE 'FEE
a 7'
�sc,y
P RM�
' SUPP. TO PERMIT
ZONE USE NO. - 'GRP TYPE
DBL.
.rI,
PLAN CHECK FEE
$
I :f D
I,
BOND AMT. PLAN NO.
PIAN CHECKERFINAL
DATE
INSPECTO
_
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER
BRANCH OFFICE
.NO LENDER INVOLVED
'
ELECTRICAL FEE
DBL
• $
•
ADDRESS
CITY
STATE
SMI FEE
$
6.
THIS PERMIT SHALL -BECOME VOID IF WORK IS NOT COMMENCED 'WITH IN 60 DAYS. CESSA-
TION OF. WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
FEE
$
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 PREPARED THE PLANS ND SPE iFICATIONS
$
TOTAL FEES
�q
HAS DONE 50 IN ACCORDANCE WITH SECTION 55 BSD ROFESSIONS
CODE F HE STATE OF CALIFORNIA.
CASH ❑ - CHECK (r ` � M.O. ❑, N:C. ❑
OWNER,
CONTRACTOR
RECEIVED BY.
ADDRESS
ADDRESS
gg
SEWAGE'SYSTEM
LL
P
CITY . -
CITY ✓
TREES REQUIRED
YES
N'O
A2fINFORMATION
TEL. TEL. NO. f.
TEL. NO. LICENSE
FORM (Rev.
� '[
284-208 1 11721