221571 (GRES)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
•
COUNTY OF RIVERSIDE •
CONSTRUCTION ESTIMA"TEw-»w7 -
ELECTRICAL FEES,, -
1 ST FL. SQ. FT. @
NO:, '
2ND FL. SQ. FT. @
`
AIR HANDLING UNIT CFM
MOTOR I OR LESS H.P.
POR. SQ. FT. @
•
GAR. V-4/11 SQ.FT. @ '�
MOTOR 5 OR LESS H.P.
�'�"
CAR P. SQ. FT. @
MOTOR 20 OR LESS H.P.
WALL SQ.FT. @
APPLIANCE VENT
SQ. FT. @
SHOWER
ESTIMATED CONSTRUCTION VALUATION $
tf—,o K W. UNITS
NOTE: Not to be used as property tax valuation
INCINERATOR Cl DOMESTIC ❑ INDUS. OR COMM.
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANS- O K W
FORMER
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM j B.T.U.
SO. FT. @ Q
BATH TUB
INCINERATOR Cl DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @° d
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SO. FT. RESID. @I d
SEWAGE DISPOSAL
BOILER 0 B.T.U.
SQ. FT. GARAGE @I�,4 y
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILE HOME HOOKUP FEE
I S I 1 1 / I FtHMI I rtt 11 I! tj 1 I PtHM11 I-tt I I
PE MI
TOTAL FEES
MOB. H.K. FEE MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL. ELECT.
FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J I F M I
A I M I J 'J
A-1 S 1 0 -1 N I D'
JOB ADDRESS
' �,.
ow �R�'� -^ -
f ,,
74
S F B IN F.C.
_
DATE11112142P
.�j
7 1.
75
—+ V
M.H. HOOKUP FEE
$
G1 NITV DST S ROOMS VALUATION SUPP. TO PERMIT OFFICE
j.t+`.r—
QR. T o
MICROFILM FEE
COPIES
$
,- y ` t
MECHANICAL FEE "
DBL
$
3LEGAL
SETBACK
LOT SIZE ZONE
USE NO.
GRP TYPE CKs BAY
S RPLAN
CHECK FEE
$
AMT.
LAN NO.
PLAN CHECKER
FINAL DATE
IN OR
1-3
j
1 �a$ �3
'h—
CONSTRUCTION FEE
DBL
" $
NAME OF CONST. LENDER
BRANCH OFFICE .NO
LENDER INVOLVED
ELECTRICAL FEE
DBL
$
•
ADDRESS
CITY
STATE
SMI FEE
$
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.
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.
THEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
$
TOTAL
FEES
G�fleHAS
DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS
coniz OF THE STATE O iEORNIA.
CASH ❑
�
CHECK' M.O. ❑
N.C. ❑
OWNER,
CONTRACTOR -
RECEIVED BY
ADDRESS
-
CITY
CITY h
TREES REQUIRED
YES
TEL. NO. LICENSE'
FORM 284.208 IRev. 11/72)
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