268742 (SFD)APPLIANCE
JOB ADDRESS " "' SP NO
FIELD OFFICE
BUILDING PERMIT DEPARTMENT
OF BUILDING & SAFETY
[OWNER
LAUNDRY TRAY
COUNTY OF RIVERSIDE
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
CONSTRUCTION ESTIMATE
•6
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL.
4�
SQ.FT. @ Fa 7.2
UNITS
LAVATORY
II. -FT. .@
AMPERES SERV ENT
YARD SPKLR SYSTEM
2ND FL.
POR. �' %p
_
$O. FT. @ r1!'�
7=7 MOBILEHOME SVC.
BAR SINK
GAR. J d
SO. FT. _ @
^ ""'^ POWER OUTLET
ROOF DRAINS
SQ.FT. @
'
DRAINAGE PIPING
CAR P.
FT. @
SOFT GARAGE @ 'ha
DRINKING FOUNTAIN
WALLSQ.
' SQ. FT., @ "
~ tJ
URINAL
ESTIMATED CONSTRUCTION VALUATION $•'
$
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
MECH. FEE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD .
SIGN
WASHFR (At Tr)I (F)ISH)
APPLIANCE
JOB ADDRESS " "' SP NO
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
[OWNER
LAUNDRY TRAY
AIR HANDLING UNIT
CFM
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
AMPERES SERV ENT
0 SHOWER
BOILER � B.T.d.
ROOMS
SQ FT @ a
BATH TUB
OFFICE
SQ FT @ a
WATER HEATER
SQ FT RESID. @ la
SEWAGE DISPOSAL
ISUPP.
SOFT GARAGE @ 'ha
HOUSE SEWER
PERMIT FEE
COPIES
$
GAS PIPING
MOBILE HOME PERMIT FEE
$
PERMIT FEE
PERMIT FEE
2 _P9104
TOTL��
MOB. HMSEE
MICRO FEE
MECH. FEE
DBL.
P CK.,FE,
CONST. FEE
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE
PLUMB. FEE
DBL.
J I F I M A I M I J I J I A I S I O N I D
JOB ADDRESS " "' SP NO
74
[OWNER
75
USE OF PER .
F.C.
J
DATE
P M N
8-142
76
.5 %
M H PERMIT FEE
$'
C MMUNITY
DST
U TS
ROOMS
VALUATION
TO PERMIT
OFFICE
ISUPP.
MICROFILM FEE
COPIES
$
LEGALDESCRIIT10N
MECHANICAL FEE
DBL
$
SETBACK If
LOT SIZE ZONE
USE NO.
GRP
TYPE
CKKB�Y
%
.
,t R }
= , 0 S�l .
PLAN CHECK FEE
$
BOND AMT. PLAN NO.
PLAN CHECKER
FINAL DATE
JINSPECTOR
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
STRONG MOTION
$
O ,f1E ATUR
CONTRACTOR
INSTRUMENTATION FEE
$
ADDRESS
ADDRESS
FEE
PLUMBING FEE
DBL
$
CITY. ZIP CODE-
CITY ZIP CODE
0 �fC7ffi J .0 2
TOTAL FEES
$
f
TEL. NO.
TEL. NO. LICENSE
CASH ❑ CHECK ,Jj M.O. ❑ N.C. ❑i
:-
�j
,/t V THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
GY"{V1°( TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
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
RECEIVED By > Gip
TREES REQUIRED 1
SEWAGE SYSTEM
T
LL
p
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10.74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.