260065 (RER)10
APPLIANCE
FIELD OFFICE
OWNER
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
GARBAGE DISPOSAL
COUNTY OF RIVERSIDE
USE OF PERMIT
..
F.C.
DATE
LAUNDRY TRAY
DST
AIR HANDLING UNIT CFM
v.��
IDLE METER
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES
NO. PLUMBING FEES
f'
ABSORPTION SYSTEM B.T.U.
I ST FL. g* 4-;-Z SQ.FT. @ </ / 3 �!� -- UNITS
TEMP USE PERM SVC
1
2ND FL. SO. FT. @
YARD SPKLR SYSTEM
COMPRESSOR !tKHP
I POR. SQ. FT. @ MOBILEHOME SVC.
BAR SINK
✓
GAR. SQ. FT. @ POWER OUTLET
ROOF DRAINS
HEATING SYSTEM K FORCED ❑ GRAVITY
I CAR P. SQ.FT. @
DRAINAGE PIPING
WALL SQ. FT. @
DRINKING FOUNTAIN
BOILER � B.T.U.
//
perjl2%�C NASO. FT. @ .`1 Ccs < b
URINAL
ESTIMATED CONSTRUCTION VALUATION $ x,WATER
PIPING
'
NOTE: Not to be used os property tax valuation SWIM POOL, PVT
FLOOR DRAIN
' MECHANICAL FEES SWIM POOL, COMM
WATER SOFTENER
$
VENT SYSTE .I?lf FAN ❑ EVAP. COOL A HOOD SIGN
Vb (AUTO) (DISH)
SEWAGE DISPOSAL
10
APPLIANCE
JOB ADDRESS SP NO
OWNER
74
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
USE OF PERMIT
..
F.C.
DATE
LAUNDRY TRAY
76
AIR HANDLING UNIT CFM
v.��
IDLE METER
KITCHEN SINK
f'
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
1
WATER CLOSET
VALUATION
COMPRESSOR !tKHP
OFF%JGE
POLE, TEMP/PERM
✓
LAVATORY
HEATING SYSTEM K FORCED ❑ GRAVITY
old
AMPERES SERV ENT
SHOWER
!/
BOILER � B.T.U.
SQ FT @ a
BATH TUB
SQ FT @ a
WATER HEATER
COPIES
$
SQ FT RESID @ l a'
a r
SEWAGE DISPOSAL
SQ FT GARAGE @ '/7¢
DBL
HOUSE SEWER
PERMIT FEE
4,4
1
USE NO.
GAS PIPING
TYPE CK BY
MOBILE HOME PERMIT FEE Is
IPERMIT
fJ
Y
FEE
//00
PERMIT FEE
PERMIT NO,
26006
TOTAL FEES
>
MOB. HM.FEE
MICRO FEE
MECH. FEE
yM
DBL.
PL. CK. FEE
/ .�
CONST. FEE
�� �
DBL.
ELECT. FEE
DBL.
SMI FEE
�
FEE
PLUMB. FEE
iso
DBL.
J F M A M J J A S O N D
JOB ADDRESS SP NO
OWNER
74
.. O Y.S` eA I -/ 4 Lair I 1121
75
USE OF PERMIT
..
F.C.
DATE
PERMIT NO.
260065
76
,c-��►-o ,�s�vz i� tdr
v.��
- z
M H PERMIT FEE
$
COMMUNITY DST
UNITS
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFF%JGE
MICROFILM FEE
COPIES
$
LEGAL DE CRIPTIONI��r E5 f,"t C'/u�
MECHANICAL FEE
DBL
$
SET BACK
SIZE ZONE
USE NO.
GRP
TYPE CK BY
-
fJ
Y
F .wLOT
-1 R./ 0
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INS ECTOR
J
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
INSTRUMENTATION FEE
$
Lf
k3
OW/N-E�R/A ENT'S SIGNATURE
(�`/
CONT TO ?k
��/
FEE
$
ADDRESS
-2,f?
ADDRESS
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
TOTAL FEES
$ V
r
S
TEL. NO.
TEL. NO. LICENSE
S 2 V
CASH ❑ CHECK M.O. ❑ N.C. Cl
HIS PERMIT SHALL BECOME VOID IF WOR CN C,OM f 20 DAYS. CESSA
4fN OF WORK FOP 120 DAYS SHALL ALS USE PERI,,j/f0 BECOME ID.
RECEIVED BY
TREES REQUIRED
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 ALSC
SEWAGE SYSTEM
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
I AEA/C (IC TUC CTATC nc rAI IC(lDKI1A rn\/CDIKI(_ ('(IKITDA(Tn DC IC AI C(l (_I IA DA I\ITFFr)
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) QP L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.