191575 (SPIN)VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFETY
WASHER (AUTO) (DISH)
APPLIANCE
•
COUNTY OF RIVERSIDE •
FIELD OFFICE
OUTLETS
LAUNDRY TRAY,.
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
CONSTRUCTION ESTIIVMATE."""""
ELECTRICAL FEES
PLUMBING -FEES .
1 ST FL.
POLE
SO. FT. @
NO.
NO.
SQ. FT. Cal
ABSORPTION SYSTEM O B.T.U.
SQ. FT. @ 4
2ND FL.
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @
MOTOR I OR LESS H.P.
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
POR.
SEWAGE DISPOSAL
SQ.FT. @
MOTOR 5 OR LESS H.P.
HOUSE SEWER
GAR.
BALANCE OF MIN. FEE
SO. FT. @
MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
CAR P.
WALL
9
SOFT. @
TOT ES 40
DRINKING FOUNTAIN
SQ. FT. Cai
PL. CK. FEE
URINAL
DBL.
ELEC. FEE
IDBL.ISPEC.INSP.
OK w. UNITS
WATER PIPING
DBL.
ESTIMATED VALUATION $
FLOOR DRAIN
I
MECHANICAL FEES.
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANS- FORMER O K.W.
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED-
OUTLETS
LAUNDRY TRAY,.
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR 0 HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM O B.T.U.
SQ. FT. @ 4
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ d
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 14
SEWAGE DISPOSAL
BOILER 0 B.T.U.
SQ. FT. GARAGE @/24
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
-
TRAILER ISSUANCE FEE PERMIT FEE
PERMIT FEE
PERMIT FEE
PERT
9
Ar
TOT ES 40
1 REN. TRAILER FEE
HEAT & VENT.. FEE
PL. CK. FEE
I CONST. FEE
DBL.
ELEC. FEE
IDBL.ISPEC.INSP.
FEE
PLUMBING FEE
DBL.
FORM 284-208 1REV. 1-70)
SET C
LOT SIZE
USE #
JOB ADDRESS _ OWNER '
' 1
F
S
R
r
ZONE
US OF BUIL NG r
DATE '
Y
/^ j
PIAN CHECK FEE
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4p
CHECKED BY
C Mj1 ITY
TRICT
F -I.
.UNITS
VALU TION '16F ICE
lbI
I
I
MECHANICAL FEE
f
DBL
1i
�i P
TYPE
LEGAL D RI O
ERRMIT
NUMBER
PG
CONSTRUCTION FEE
F
W/
DBL
PLAN CHECKER
SUPP. TO PERMIT
ELECTRICAL FEE
DBL
BOND
BOND
CASH
PLAN FIIE#
FINAL DATE
INS4YJ��'-IP CTOR
PLUMBING FEE
`i
� I
.
-
NAME OF CONSTRUCTION LENDER
BRANCH OFFICE
NO LENDER -
TRAILER PERMIT
$
I
INVOLVED
ISSUANCE FEE
ADDRESS
CITY
STATE -
FEE
g r}
V
0 V
13
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSATION
OTAL FEES�
SOF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. 4
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCOR-
CASH Q CHECK
M.O. N.C.
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
IT
OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
f
I HEREBY CERTIFY THATTHE INDIVIDUALWHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
LL P
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
OF CALIFORNIA,
; INFORMATION
OWNER
CONTRACTOR
t
ADDRESS - ' ��
ADDRESS
14
t
•
EL. NO.
TEL. NO. "
y
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f� ♦y .I
/VIAY �J
LICENSE NO,
FORM 284-208 1REV. 1-70)