234915 (RPL)BUILDING PERMIT
CONSTRUCTION ESTIMAI€:... ,
I ST FL.
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ.FT. @
CAR P.
SQ. FT. @
WASHER (AUTO) (DISH)
SQ.FT. @t5
C3��/ �':;
SQ. FT. @
T� S RUCTION VALUATION
$
NOTE: Not to be used as property tax valuation
DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE A
ELECTRICAL FEE$.-._ .
NO.
MOTOR I OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
% nA/I "'"'1K.W.UNITS
FIELD OFFICE
PLUMBING FEES DST
INO.1 t r_1
VENT SYSTEM ❑ FAN ❑EVAP. COOL ❑ HOOD
SIGN
URINAL
APPLIANCE
WATER PIPING
TRANS-, Q K.W.
FORMER
FLOOR DRAIN
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑SUSPENDED
WATER SOFTENER
OUTLETS
WASHER (AUTO) (DISH)
AIR HANDLING UNIT CFM
$
FIXTURE OR SOCKET
LEGAL DESCRIPTION
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
COMPRESSOR 0 HP
MECHANICAL FEE
POLE
$
APPLIANCE VENT
SET BACK
AMPERES SERV. ENT.
ZONE
ABSORPTION SYSTEM j B.T.U.
GRP
SO. FT. @ d
dl?
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
,
�t7
SO. FT. @
FEE
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
DBL. .
-SQ. FT. RESID. @ I Q
BOILER O B.T.U.
PER
SQ. FT. GARAGE @/24
PLAN CHECK FEE
PERMIT FEE
MOBILE HOME HOOKUP FEE $
/
BALANCE OF MIN. FEE
PERMIT FEE
BOND AMT. PLAN NO.
PE`9 IfTM�NO. ;
N.� i
TOTAL FEES
MOB. HK. FEE MICRO FEE
MECH. FEE
DBL
PL. CK+FEE
7
CONST. FEE
DBL.
ELECT. FEE
J F I M. A M J- J. A I S 1 Q 1 N I D
JJ7OOBADDRESS
lr �
"3 Z 74vl
OWNER
73
74
USE OF BUILDING
f
a
C. DATE
75
M.H. HOOKUP FEE
$
OFFICE .NO
COMMUNITY
ELECTRICAL FEE
DST'
uNlrs
ROOMS
VALUATION
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
._Fy
WATER SOFTENER
WASHER (AUTO) (DISH)
GARBAGE DISPOSAL
$
LAUNDRY TRAY
LEGAL DESCRIPTION
KITCHEN SINK
WATER CLOSET
LAVATORY
MECHANICAL FEE
SHOWER
$
BATH TUB
SET BACK
WATER HEATER
ZONE
SEWAGE DISPOSAL
GRP
k101.1$F,.SF�R
dl?
GAS PIPING
PERMIT FEE
,
�t7
SMI FEE
FEE
PLUMB. FEE
DBL. .
�
�1
A'
PER
Z34Q15
PLAN CHECK FEE
IPP. TO PERMIT
I OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
4- {�4
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
ZONE
USE NO.
GRP
TYPE
CK BY
_%
�
F f S 'r 40 R,
PLAN CHECK FEE
$
BOND AMT. PLAN NO.
PLAN CHECKERFINAL
DATE
I PECTOR
r9-15 - 200
�
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE .NO
LENDER VOLVED
J,j
ELECTRICAL FEE
DBL
$
f
✓
O .O
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"
/
L?
THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED:
1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFIC T,bQNS
$
TOTAL FEES01
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF U A PR S
rODF OF THE STATE OF ALIFORNIA. - r
CASH ❑ CHECK 99"M.O. ❑ , N.C. ❑
OWNER. CONTRAC R ;
f
i�
RECEIVED BY
ADDRESS ADDRESS
v
SEWAGE SYSTEM
T
P
EYES
clTv CITY i
TREES REQUIRED
NO
`
INFORMATION
L
TEL. NO. TEL. NO. �^j LICfE� SE
FORM 284-208 1Rm 1 1 /721 1 t
d�% — 3 0 T_ `, to
J a L�