BLCK (188055)DEPARTMENT OF BUILDING & SAFETY
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
COUNTY OF RIVERSIDE
•
FIELD OFFICEr
GARBAGE DISPOSAL'
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FL
2nd FI.
Par.
Gar.
Car P.
Wall
SUB -PANEL
Sq. Ft. @
NO.
6,fT
NO.
Sq. Ft. @
RANGE AND/OR OVEN
Sq. Ft. @
APPLIANCE VENT
Sq. Ft. @ POLES
SHOWER
Sq. Ft. @ SIGNS
DRAINAGE PIPING
Sq. Ft. @ 09ORAT SCLK.D/
DRINKING FOUNTAIN
fd
Sq. Ft. @ MOTOR H. P.
URINAL
' MOTOR H. P.
WATER PIPING 1
ESTIMATED VALUA I ZION $ 1��
MOTOR
M.P.
FLOOR DRAIN
PERMIT FEE
MECHANICAL FEES
MOTOR
W A T ER'SOF TF N FR
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL'
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK '
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
6,fT
WATER CLOSET `
COMPRESSOR �HP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE -
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. IQ SO. FT.
HOUSE SEWER
PERMIT FEE
GARAGE zQ SO. FT.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT NUMBER REN. DBL. TOTAL FEES
v
rr
IJ F M I A
HEAT & ENT FEE JPLN. CK. FEE CONST. DFEE
P�
ELEC. FEE
SET BACK
LOT SIZE
VSE Jt
JOB ADDRESS IOVI"ER'_, -
1✓ -^j '9 ..J
F
S
R
ZONE
lust OF_BUfLCmdG
6,fT
PLAN CHECK FEE $
•
/ f' `-
CHECKED BY
COMMUNITY
DISTRI T�
F.
UN fYS
VALUATION
OFF C
�'b
MECHANICAL FEE $;'.
Q ta!e`
Ic
.1
—I:ROU P
TYP
LEGAL DES RIPTI ON
PERMIT NUMBER
CONSTRUCTION FEE $�
1 8805'
SPEC. INSP.
-
SUPP. TO PERMIT
ELECTRICAL FEE $
-
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILEN
FIHAL DATE
INS TOR
PLUMBING FEE $
1
I
91-1,
'
TOTAL FEES
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.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
CASH CHECK M.O. N.C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
COMPLI-ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
NAME OF CONSTRUCTION
LENDER
-
OWNER
CONTRACTOR
41/
BRANCH OFFICE
ADDRESS
"-
ADDRESS
ADDRESS 1
CITY -
STATE
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y� .�--�f�r S" -• / ,� j
NO LENDER INVOLVED
.
INFORMATION -
O y
'
TEL. NO.
T/EL. WO.
LICENSE NO. f- -
284-208 12/68