205906 (ELEC)BUILDING PERMIT
SIGN
DEPARTMENT OF BUILDING & SAFETO
COUNTY OF RIVERSIDE
FIELD OFFICE
TRANSFORMER =K•W•
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
AIR HANDLING UNITI CFM
SQ. FT. @
KITCHEN SINK
NO.
NO.
SQ. FT. @
COMPRESSOR HP
SQ. FT. @ MOTOR 1 OR LESS H.P.
LAVATORY
SQ. FT. @ MOTOR 5 OR LESS H.P.
AMPERES SERV. ENT.
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. Ca)
URINAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION is
SEWAGE DISPOSAL
BOILER O B.T.U.
FLOOR DRAIN
HOUSE SEWER
MECHANICAL FEES
BALANCE OF MIN. FEE
GAS PIPING
WATFR SOFTFNFR
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER =K•W•
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑NATURAL ❑ I.P.G. ❑OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE V
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM E:= B.T.U.
SQ. FT.' q
BATH TUB
INCINERATOR ❑ DOMESTIC ❑INDUS. OR COMM.
SQ. FT.@ q.
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. = 1 q
SEWAGE DISPOSAL
BOILER O B.T.U.
SQ. FT. GARAGE 2 z q
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I I / IPERMIT FEE I o�10 ol I PERMIT FEE I 1
PERMIT NUMBER I TOTAL F.EE$_ MOB. HOOK FEE I HEAT & VENT FEE IDBLI PL. CK. FEE I CONST. FEE OBLI ELEC. FEE IDSLI FEE I PLUMBING FEE DBL
J F I M I A M J I J I A S O
N D
JOBADDRESS CQWNER
/
73
USE OF BUILDING
F.C. DATE
PERMIT NO.
205906
74
,�
Wig-
75
COMMU ITY
DST UNITS
OOM
VALUATION
SUPP. TO PERMIT
OFFICE
76
_
op—
MOBILEHOME
$
LEGAL DESCRIPTION
HOOKUP FEE
'404
DBL
SET BACK
LOT SIZE
ZONE
USE NO.
GRP
TYPE
CK BY
MECHANICAL FEE
$
F S R
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECTOR
PLAN CHECK FEE
$
S 1q. 7}
I
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INV LVED
CONSTRUCTION FEE
•/
1�
DBL
ADDRESS
CITY STATE
ELECTRICAL FEE
$
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
CESSATION 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 ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF-
DBL
ORNIA. 1 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 PREPARED THE PLANS ANDSPECIFI-
TOTAL FEES $
CATIONS HAF?..DONE SO IN ACCTROANCE WITH SECTION 5541 OF THE BUSINESS AND
PROFESSION$ A
CObE OFITHE STF CALIFORNIA.
CASH ❑ CHECK l? M.O. ED N.C. ED
OWNER { 't �i�d'
t�
CONTRACTOR
}
Received By
ADDRESS
ADDRESS
Sewage System
I T LL
P
CITY
CITY
Trees Required Yes
No
INFORMATION
TEL. NO.
TEL. NO. LICENSE
!��
FORM 284-208 (REV. 4/71)