239595 (RPL)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE ELECTRICAL FEES PLUMBING FEES DST
1 ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @ NO. °+ NO. S'
SQ. FT. @
SQ. FT. @ MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
SQ.FT. @
SQ. FT. @ MOTOR 20 OR LESS H.P. DRAINAGE PIPING
SQ.FT. @ DRINKING FOUNTAIN
SQ. FT. @ URINAL
VALUATION $ 2JB OK.W. UNITS WATER PIPING
NOTE: Not to be used as property tax valuation FLOOR DRAIN f S E7
MECHANICAL FEES j, : ,APl+�a rGA WATER SOFTENER
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD SIGN if WASHER (AUTO) (DISH)
APPLIANCE TRANS- K.W. GARBAGE DISPOSAL
FORMER O
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED OUTLETS LAUNDRY TRAY
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 AMRERES SERV. ENT. SHOWER
ABSORPTION SYSTEM B.T.U. SO. FT. @ ¢ BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM. SQ. FT. @ ¢ WATER HEATER Sl%
HEATING SYSTEM ❑ FORCED ❑ GRAVITY -*wSQ. FT. RESID. @ 1 ¢ SEWAGE DISPOSAL
BOILER 0 B.T.U. SQ. FT. GARAGE @,'/,4 HOUSE SEWER
PERMIT FEE BALA-NCE OF MIN. FEE GAS PIPING S'sJ
MOBILE HOME HOOKUP FEE Is If PERMIT FEE Dd PERMIT FEE '00
E I OQ LTlOTeA�L FEES
`,
21 a J f -j 4-1/
MOB. HK. FEE MICRO FEE
MECH. FEE
aDBL.
PL. OK.tFEE
/01110
CONST. FEE
a D'vE
DBL.
ELECT. FEE DBL.
d do
SMI FEE
,'�
FEE
PLUMB. FEE
.., 0
DBL.
J I F I M A M I J J A I S 1 O N D
JOB ADDRESS
,�"3 - f, J /S `+4l ncc? L�
OWNFR -
A/0l firdA 13
73
74
USE OF BUILDING
-'
t�bao }rR�D fa
F.C.
���
DATE
/t - �� j3
PERM11T NO
19595::
75
M.H. HOOKUP FEE
$
COMMUNITY
�urn�ra
DST
�/
I fUNITS
/j
ROOMS
I VALUATION
o a�-�
ISUPP. TOPERMIT
,�9 y't
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
SAV7,4 r,4 #^ P1.4 ly It
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
.��
USE NO.
GRP
TYPE
CK BY
-�
F s � R
PLAN CHECK FEE
$
l O
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INSP TOR f P
CONSTRUCTION FEE
DBL
$
,rpC o
�
eZ
NAME OF CONST. LENDER BRANCH
OFFICE J.NO
LENDER INVOLVED
G^"
ELECTRICAL FEE
DBL
$
f}
/
_-D
L+�
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.
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
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
S
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS
CODE OF THE T T F CA IFORNIA.
FEE
$
tTHE
PLUMBING FEE
DBL$
E6
$
TOTAL FEES
/�'
y�
CASH ❑ CHECK I X' M.O. ❑ N.C. ❑
Ti
OWNER.�r.R, M� /,
I rP f("
r/A�/tst"tj/2
CONTRACTOR
RECEIVED BY
ADDRESS
ADDRESS
SEWAGE SYSTEM
LL
P��,�
TREES REQUIRED
YES
NOA-
CITY. �ry
"f
CITY - '9
INFORMATION
FORM 284.2081Rev. 1 1 /721
TEL. NNO. -
TEL. NO. LICENSE
`h