176682 (SATT)DEPARTMENT OF BUILDING & SAFETY
I PE
VENT SYSTEM FAN ❑ EVAP. COOL HOOD
0
COUNTY OF RIVERSIDE
is
FIELD
OFFICE
yV
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st F1.
2nd FI.
Par.
Gar.
Car P.
Wall
4V C 40
'r
Sq. Ft. @
vv NO.
NO.
r
Sq. Ft. @
LAUNDRY TRAY
Sq. Ft. @ 42
AIR HANDLING UNIT
ls�llo
Sq. Ft. @ -r POLES a
SUB -PANEL
f SIGNS DRAINAGE PIPING
Sq. Ft. @TRN
y
fes' OR ATSCLK D/ DRINKING FOUNTAIN
Sq. Ft. @
CITECKED BY
Sq. Ft. @ MOTOR H.P. URINAL
MOTOR N.P. WATER PIPING
UNITS
ESTIMATED VALUATION $
'!� MOTOR
H. P.
FLOOR DRAIN
�u
RANGE AND/OR
MECHANICAL FEES
MOTOR
N P.
WATER'SOFTENER
APPLIANCE VENT
I PE
VENT SYSTEM FAN ❑ EVAP. COOL HOOD
SET BACK
MOTOR
N.P.
USE
WASHER (AUTO DISH)
yV
APPLIANCE
S
FIXTURES
GARBAGE DISPOSAL
Q
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
PLAN CHECK FEE $
AIR HANDLING UNIT
I'
SUB -PANEL
L), -/z & 'j1. `
es.4;-
KITCHEN SINK
CITECKED BY
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
UNITS
VALUATION O ICE
WATER CLOSET
�~
COMPRESSOR Mazl HP
�u
RANGE AND/OR
OVEN
LAVATORY
'
APPLIANCE VENT
WATER HEATER
TYPE
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
:U
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION
POLE
WATER HEATER
CONSTRUCTION FEE $
HEATING SYSTEM 'FORCED ❑ GRAVITY
_0
SERVICE ENTRANCE
I -Of � �' �-
1 SEWAGE DISPOSAL
BOILER B.T.U.
2
RESID. 10 SO.
FT.
HOUSE SEINER
PERMIT FEE
GARAGE zQ SO.
FT.
N
GAS PIPING
ELECTRICAL FEE $
PERMIT FEE
(%M�
PERMIT FEE
DBL. ITOTAL FEES
& VENT FEE PLN. CK. FEE
J
J J -
CONST. FEE JELEC. FEEPLUMB. FEE '
S D I N D I5 C I Y C I
SET BACK
l0T SIZE
USE
R
JOB ADDRESS OWNER
a6o A clidr A -kA 7 _
F
S
R.-VII9f-72
ZONE
USE OF BUILDING DATE
PLAN CHECK FEE $
+�""
I'
L), -/z & 'j1. `
es.4;-
'
CITECKED BY
COMMUNITY
UNITS
VALUATION O ICE
MECHANICAL FEE $
�~
A
1
I4� It J
JOISTRICf-IO.C.-
f
r I,1%y ep
GRVrJP
TYPE
LEGAL DIESCRIPTION
PERMIT
I
8M6R
CONSTRUCTION FEE $
V°y'�)
612
I -Of � �' �-
176
2
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE $
rd�•��
PLAN CHECKER
BOND
BOND
I CASH
PLAN FILE JV
FINAL DATE
INSPECTOR
PLUMBING FEE $
�,%
( - 1 7�
TOTAL FEES
r
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
177
WITHIN 60 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
CASH CHECK M.O. I ni.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
T
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNI COVERING CON -
Y°
NAME OF CONSTRUCTION
LENDER
f
OWNER
NT AC OR OR
J
BRANCH OFFICE
t
K `
ADDRESS d &/�) J +LR Q1AA
..r
ADDRESS
AD R SS
CITY
STATE
NO LENDER INVOLVED
INFORMATION
�J
,d
l� K fNa
TEL. NO.
E NO.
/J�V
LICENSE NO.
84-208 12/68 4.41
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