228090 (SPIN)BUILDING PERMIT DEPARTMENT OF BUILDING &-SAFETY
VENT SYSTEM ❑ FAN' ❑EVAP. COOL ❑ HOOD
COUNTY OF RIVERSIDE'
CON STRUCTIO.N' ESTIMATE
:. ;.
,. .:ELECTRICAL :FEES.,,
I ST FL. SQ. FT. @
e':. N
L
2ND FL. SQ. FT. @
OUTLETS
SQ. FT. @
MOTOR-1POR. OR LESS H.P.
F.m
GAR. SQ.FT.@MOTOR
5 OR LESS H.P.
CAR:P, SQ. FT. @OTOR
20 OR LESS H.P.
WALL SQ.FT. '@
CONST. SERV. ENTRANCE
SQ. FT. - @
_
ESTIMATED CONSTRUCTION VALUATION $
K.W. UNITS
NOTE: Not to be used as property tax valuation
_ - AAr:rWAMir AI FFFC
AMPERES SERV. : ENT.,.
FIELD OFFICE
PLUMBING FEES-,... DST_
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
MOBILE KUME'KQUKU"Lk: 11 - I. , I 'I .. '.I'VtHMll rtt, L, 'I I I'tKM1I rtt . ,I . I
2 -SppP yp���J,
VENT SYSTEM ❑ FAN' ❑EVAP. COOL ❑ HOOD
SIGN-
WASHER (AUTO) (DISH)
DBL
APPLIANCE
TRANS-, K.W.
FORMER D
GARBAGE DISPOSAL
ELECL.FEE..DBL:
FURNACE ❑UNIT ❑WALL ❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
PLUMB. FEE
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 f
APPLIANCE VENT
AMPERES SERV. : ENT.,.
SHOWER
-, __J' I F I M A -1,M 14-F J "I A -S 1-0 1�N• D .JOB
ABSORPTION SYSTEM O B.T.U. "`
SQ. FT. @ Q
BATH TUB
73
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ 3
WATER HEATER
USE OF BUILDING
C/A
HEATING SYSTEM. 0 -FORCED ❑ GRAVITY
++' SQ: FT. RESID. @ 1 ¢
SEWAGE DISPOSAL
75
BOILER 0 B.T.U.
SQ. FT.'GARAGE @/24
HOUSE SEWER
_
PERMIT FEE ; •.
BALANCE OF MIN. FEE
GAS PIPING
MOBILE KUME'KQUKU"Lk: 11 - I. , I 'I .. '.I'VtHMll rtt, L, 'I I I'tKM1I rtt . ,I . I
2 -SppP yp���J,
.TOTAL FEES. '
MOB. HK. FEE MICRO FEE,
MECH. FEE
DBL
- PL CK. FEE
CONST; FEE "
ELECL.FEE..DBL:
.SMI FEE
�;.qF;:
PLUMB. FEE
DBL
6.0 6d o
IDBL.
A [✓
-, __J' I F I M A -1,M 14-F J "I A -S 1-0 1�N• D .JOB
ADDRESS-
�/l /
�f/f�
O • -
�1H�e�r
73
s1li/-r/
JR
.J
74
USE OF BUILDING
C/A
.
�-�
PERM NO-
75
M.H. HOOKUP FEE"
$_"
COMUNHY
DST
UNITS
' ROOMS'
VALUATION SUPP. TO PERMIT.,
OFFICE
,a
" MICROFILM FEE
COPIES
$
LEGAL DESCRIPTIION t �,yy • �/
MECHANICAL*FEE •'
..
i.DBL
' $
- SET BACK
LOT SIZE. zoNVE
•
CK BY
`;:
.,
�,
�.
, .✓
_
.
AIG
R
..
PLAN -CHECK FEE :.' -
s
$ •
�` t
BOND AMT.
PL'AWNO -
PLAN CHECKER
'. FINAL DATE INSPECTOR
-
• CONST.RUCT.ION FEE..,, :
: t DBL
NAME OF CONST. LENDER 4 :. BRANCH
OFFICE . -..NO
LENDER INVOLVED ..
' -
' S • .-.
rGRr' f /z f fffy.
t/13l3r'J!o�t,;_.
ELECTRICAL FEE'
DBL
$I3/r.r
.X, -
t• _
ADDRESS - CITY'
w
.' . - STATE
k..
SMI FEE"
$
.PERMIT -SHALL BECOME VOID IF WGRK.IS.NOT COMMENCED WITHIN 60 DAYS. CESSA-
TION Of WK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO.BECOME VOID. 7 ''
..OR
nTHIS
FEE
$
•
✓i�%
z�
0..
.
I;HEREBY AGREE THAT ALL WORK IN CONNECTION WITH, THIS PERMIT WILL BE DONE IN AC-
46
CORDANCE, WITH THE LAWS OF RIVERSIDE'COUNTY AND THE'.STATE OF CALIFORNIA, J ALSO
PLUMBING'FEE'
DBL'
$.. ,...,..:
'
r
AGREE -,TO CARRY COMPENSAXION "INSURANCE- UPON MY EMPLOYEES. COMPLIANCE WITH
THE LAWS OFdTHE STATE,OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEE6; e- S:
-'I HEREBY CERTIFY THAT THE `INDIVIDUAL WHO PREPARED THE "PLANS AND SPECIFICATIONS
i
$
' TOTAL FEES.
HAS DONE SO�IN ACCO.R NCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS T
-
E STATE OF -1FOR IA:
CASH ( CHECK C:)M.O. ❑ ` N.0 ❑. r
OWNER. ��,/��` -
NTRACTOR
j p"["
T1tli E"s
' v'.
'RECEIVED BY. -
ADDRESS -
ADDRESS - -
SEWAGE SYSTEM_...
T
Ptl:°
t
TREES REQUIRED
YES
NO
CITY _ ... ..✓. _. .
fj
4A1'
CITY. . . ...•.« ..
INFORMATION _. _ ///111
TEL. NO:- � �• �
� TEL. NO.. ... - - LICENSE '
FORM 284.2081Rev. tl/721 -,?7
r-• •.q
7.
s�.
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