214624 (SFD)BUILDING PERMIT DEPARTMENT OF BUILDING & .SAFET
IO
• COUNTY OF RIVERSIDE
FIELD OFFICE
VENT SYSTEM [XFAN [3EVAP.COOL HOOD
CONSTRUCTION ESTIMATEELECTRICAL
FEES
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
o
d
a(%
SQ. FT. @� -� �
NO.
NO.
SQ. FT. @
FURNACE ❑ UNIT ❑WALL❑FLOOR❑SUSPENDED
SQ. FT. @ V " MOTOR 1 OR LESS H.P.
JDBL ELEC. FEE
SQ. FT. @ LX MOTOR 5 OR LESS H.P.
FEE
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION is X,Z
UNITSOOM
FLOOR DRAIN
POLE
MECHANICAL FEES
LAVATORY
WATFa Cr1F7FNFR
VENT SYSTEM [XFAN [3EVAP.COOL HOOD
SIGN
FEE I
WASHER (AUT ISH)
I PERMIT FEE
APPLIANCE Ile -IT -.-
TRANSFORMER F---JK.w.
MOB. HOOK FEE
GARBAGE DISPOSAL
DBL
FURNACE ❑ UNIT ❑WALL❑FLOOR❑SUSPENDED
OUTLETS
JDBL ELEC. FEE
LAUNDRY TRAY
FEE
AIR HANDLING UNITI I CFM
FIXTURE OR SOCKET
KITCHEN SINK
g!
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
COMMUNITY
WATER CLOSET
UNITSOOM
COMPRESSOR N HP
POLE
SUPP. TO PERMIT
LAVATORY
�--
APPLIANCE VENT
AMPERES SERV. ENT.
17-1
SHOWER
�-
ABSORPTION SYSTEM B.T.U.
SQ. FT.@ g
BATH TUB
INCINERATOR ❑ DOMESTIC ❑INDUS. OR COMM.
SQ. FT.@ ¢.
LEGAL 13ESCRIPTION
WATER HEATER
HEATING SYSTEM FORCED E]GRAVITY
SQ. FT. RESID. @ 1 ¢
1—ar yo moi? 3Y A?
SEWAGE DISPOSAL
1,9
BOILER O B.T.U.
SQ. FT. GARAGE@ z q
SET BACK
HOUSE SEWER
IZONE
PERMIT FEE
BALANCE OF MIN. FEE
TYPE
GAS PIPING
MECHANICAL FEE
MOBILEHOME HOOKUP FEE .I$ I I
I I IPERMIT
FEE I
JI i= I /
I PERMIT FEE
I 1(I
PERMIT NUMBER TOTAL FLj
2J4,2
MOB. HOOK FEE
I HEAT 6 VENz.XEE
DBL
PL. CN. FEE
I CONST. FEE
JDBL ELEC. FEE
DBL
FEE
PLUMBING EE
DBL
t�- 7�
214624
75
COMMUNITY
DST
UNITSOOM
V�AAL�UfATIOyNN
SUPP. TO PERMIT
OFFICE
76
I - i4 Lq
17-1
J F M A M J J A S O
N D
JOB ADDRESS
SAGLE
OWNER
II Sohl AG7y
72
7S -46S-,? ,r stir
--
73
USE OF BUILDING
F.C.
DAT
PERMIT/ o.
74
d✓�G�.l�TT.
t�- 7�
214624
75
COMMUNITY
DST
UNITSOOM
V�AAL�UfATIOyNN
SUPP. TO PERMIT
OFFICE
76
I - i4 Lq
17-1
:K
MOBILEHOME
$
LEGAL 13ESCRIPTION
HOOKUP FEE
1—ar yo moi? 3Y A?
DBL
SET BACK
LOT SIZE
IZONE
USE NO.
GRP
TYPE
CK BY
MECHANICAL FEE
$
S�
-3
C
:3
F IS R !�
PLAN CHECK FEE
$ /amu
S
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INS
ECTOR
�,
-O
1�
%•J'
CONSTRUCTION FEE
DBL
q
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBLADDRESS
$
?.f'
CITY STATE
Ji
$
G
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
`1111
CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
FEE
-�
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF -
DBL
_
PLUMBING FEE
....
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE ANS ND SPECIFI-
TOTAL FEES $
U3'
CATIONS HAS DONE SO IN ACCORDANCE WITH SECT N 541 EYSINESS AND
PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
=
CASHED CHECK[ -M.0.0 N.C. F -I
OWNER
CONTRACTOR
7,311, -.7U
Received By
ADDRESS
ADDRESS
41n
Sewage System
T 0
LL
PSS ?
CITY
CITY
Trees Required
Yes
No
INFORMATION
TEL. NO.
TEL. NO. LICENSE
)
-
��Y 3 (o 13
FORM 284-208 (REV. 4/71) �.+