BLCK (219635)1
BUILDING PERMIT
CONST LICTION ESTIMF
IST FL. _
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. Co)
GAR.
SQ. FT. @
CARP
SQ. FT. @
—
WALL
SQ. FT. @ ,
CONST. SERV. ENTRANCE
SQ. FT. @
ESTIMATED VALUATION $
MECHANICAL FEES
DEPARTMENT OF BUILDING & SAFET
COUNTY OF RIVERSIDE'
TE ELECTRICAL FEES
NO. NO.
MOTOR 1 OR LESS H.P.
MOTOR 5 OR LESS H.P.
I MOTOR,20 OR LESS H.P.
0 K.W. UNITS
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENFR
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE.
TRANSFORMER =K•W•
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR ❑SUSPENDED'
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE E] NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM E= B.T.U.
SQ. FT. @
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT.@ ¢:
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @I (r
�' SEWAGE DISPOSAL
BOILER B.T.U.
SQ.FT. GARAGE@ z ?
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
�' GAS PIPING
MOBILEHOME HOOKUP FEE $ PERMIT FEE I � PERMIT FEE
PERMIT NUMBERTOTAL V! AT & VENT FE
MOB. HOOK FEE HEE �DBL� PL. C FEE CONSEE DBL �E�jYE DBL FEE, / PLUMBING FEE
JOBL
96 5
J F M A M J J A S O
N D
JOB ADDRESS y
%' :�)/ AY/: /ijg*7"tRo
OWNER , `f
A1`D �• W
72
/jjcvv i
73
USE OF BUILDIN N1.jVj4V . F.C.
DATE
PE IT
N
74
� �-ob Io .�y>,�� z,
�� -� �-ice
19635
75
COMMUNITY
DSTUNITSrOOMJVALUATION
��
SUPP. TO PERMIT
OFFICE
76
vr'iy rh
T/Az
7
x/77 2e1.
MOBILEHOME
$
LEGAL DESCRIPTION
LUT 7 TAP
HOOKUP FEE
7
DBL
SET BACK
LOT SIZE
ZONES
NO.
GRIP
TYPE
CK BY
F;/14'0s R -�
MECHANICAL FEE
$
�,% /
1
BOND AMT.
PLAN NO.
PLAN CHECKER
FINA�7j>y TE• INSPECTOR
PLAN CHECK FEE
$IF
O
1
-
DBL
NAME OF CONST. LENDER
BRANCH OFFICE'
NO LENDER INVOLVED
CONSTRUCTION FEE
DBL.
ADDRESS
CITY .STATE
,
ELECTRICAL FEE
$
�Y
$
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.
FEE
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE'STATE OF CALIF -
DBL
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
PLUMBING FEE
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
/
TOTAL FEES SvJ
CATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5,541 OF THE BUSINESS AND
PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
CASH CHECK M.O. ❑ N.C.
a o
OWNER
CONT ACTOR
`
ADDRESS ,.
ADDRESS
// �_
Received By64
Sewage System
T
LL
P
CITY
CITY '
Trees Required
Yes
No
INFORMATION
TEL...NO.
TEL. NO. LICENSE
FORM 284-208 (REV. 4/710 '4