200241 (SATT)EPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE •
0
FIELD OFFICE
REN. TRAILER FEE HEAVE�T�EE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
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Del. SPEC. INSP. FEE
PLUMBING FEES
DBL.
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CAR P.
WALL
SQ. FT. 0"� r NO.
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SQ. FT. @
NO.
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SQ. FT. ± U MOTOR I OR LESS H.P.
SO FT. @ I �' MOTOR 5 OR LESS H.P. J vi
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SQ. FT. @ MOTOR 20 OR LESS H.P. DRAINAGE PIPING
SQ.FT. @ DRINKING FOUNTAIN
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SQ. FT' @ URINAL
OK W. UNITS WATER PIPING j
ESTIMATED VALUATION is ,d
USE #
JOB ADDRESS J OWNER
FLOOR DRAIN
MECHANICAL FEES
d1)
WATER SOFTENER
VENT SYSTEM] FAN ❑ EVAP. COOL i1 HOOD
SIGN
-
WASHER (AUTO IHSH)
)
APPLIANCE f.i , #3
FORMER O K.W.
PLAN CHECK FEE
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GARBAGE DISPOSAL
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FURNACE ❑ UNIT ❑ WALL CYFLOOR ❑ SUSPENDED
OUTLETS
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LAUNDRY TRAY
CHECKED BY
AIR HANDLING UNIT I CFM
FIXTURE OR SOCKET
N S
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KITCHEN SINK
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MECHANICAL FEE
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
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WATER CLOSET
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.
COMPRESSOR HP F '�
POLE
DBL
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
LEGAL DES -RI ION -
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SHOWER
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ABSORPTION SYSTEM O B.T.U.
SO. FT. @ Q
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BATH TUB
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I INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SO. FT. @ Q
DBL
%
WATER HEATER
HEATING SYSTEM 14- FORCED O GRAVITY
SQ. FT. RESID. @ j
SUPP. TO PERMIT
ELECTRICAL FEE
SEWAGE DISPOSAL
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.9 IJ
BOILER 0 B.T.U.
SQ. FT. GARAGE @/24
DBL
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
BONDS
J
GAS PIPING
PIAN FILE p_
FINAL DATE
TRAILER ISSUANCE FEE - PERMIT- FEE i
PERMIT FEE
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PERMIT FEE
PER
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REN. TRAILER FEE HEAVE�T�EE
PL. CK. FEDEL CO��T. FF���e;
DBL.
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SET BACK
LOT SIZE
USE #
JOB ADDRESS J OWNER
d1)
4/3P— 790
-
ZONE
USE OF BUILDING
DATE
PLAN CHECK FEE
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, 3` f i s/ -y 'moi 07e
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CHECKED BY
COMMUNITY DISTRICT
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VAtI,UA�TyI.O�N rv�•
�ll/ca.
OF ICE
MECHANICAL FEE
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DBL
GRO�IP
TYPE
LEGAL DES -RI ION -
ERMIT NUM ER
-
CONSTRUCTION FEE
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200 1
DBL
PLAN CHECKER
SUPP. TO PERMIT
ELECTRICAL FEE
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DBL
BONDS
BOND
CASH
PIAN FILE p_
FINAL DATE
INSPECTOR
PLUMBING FEE
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_
_D �3 � • �d-
TRAILER PERMIT
•
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NAME OF. CONSTRUCTION LENDER -
BRANCH OFFICE
NLENDER '
1, vOLV%D
ISSUANCE FEEKZI
r
t
ADDRESS
CITY
STATE ;�
FEE
f
TOTAL FEES
THIS PERMIT SHALL COME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSATION
$
1
OF WORK FOR 120 DA SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCOR-
CASH Q CHECK
M.O.
N.C. Ej
DANCE WITH THE LAWS OF RIVERSIDE COUNTY AND T.H•E STATE OF CALIFORNIA. I ALSO AGREE TO
CARRY. COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE ,
RECEIVED BY SEWAGE SYSTEM
OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
LL
1324,115v
IHEREBY CERTIFY THATTHEINDIVIDUALWHOPR RED E PLAVS AND SPECIFICATIONS HAS DONE '
SO IN ACCORDANCE WITH SECTION 5541 OF THE NE 'S D OIROFE 10 S COD F THE STATE
f INFORMATION
OF CALIFORNIA,i
OWNER CONTRACTOR
ADDRESS ADDRE _
0 � -
TEL. NO. '•� TEL. NO.
�T
L
LICEN "
FORM 284-208 (REV." 1-70) Os