217793 (SPIN)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFET
J&
0 COUNTY OF RIVERSIDE
FIELD OFFICE
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
GARBAGE DISPOSAL
SQ. FT. @
NO.
NO.
SQ. FT.
FIXTURE OR SOCKET
SQ. FT. @ MOTOR 1 OR LESS H.P.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
SQ. FT. @ MOTOR 5 OR LESS H.P.
WATER CLOSET
SQ. FT. Co) MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION is
INCINERATOR ❑ DOMESTIC C] INDUS. OR COMM.
FLOOR DRAIN
WATER HEATER
MECHANICAL FEES
SQ. FT. RESIO. @ 1 ¢
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER =K•W•
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR ❑SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM B.T.U.
SQ. FT. @ 4
BATH TUB
INCINERATOR ❑ DOMESTIC C] INDUS. OR COMM.
SQ. FT.@ 4
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESIO. @ 1 ¢
SEWAGE DISPOSAL
BOILER E== B.T.U.
SQ. FT. GARAGE @ i q
HOUSE SEWER
PERMIT FEE
9ALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I I IPERMIT FEE I I I I PERMIT FEE I I
PERMIT NUMBER I TOTAL MOB. HOOK FEE HEAT & VENT FEE DBL PL, CK. FEE CONSTT E�lCrIlB
r DBL /;�PLUMBING FEE DBL
J.
J
)17793
J F M A M J J A S O
72
N D
JOB ADDRESS
-Ple-hr
OWNE
P e-
73
74
yF BUILDING
USE OF
�G•i/!r.-���� Z�
F.C.
DATE
/V -51 7�
PEG I1
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76
/{f .'!!Bi
DST
-r
NITS
1
OOM
VALUATION
SUPP Tt%5 M9
2 U cy
OFFICE
MOBILEHOME
HOOKUP FEE
$
LEGAL DESCRIPTION �,..
Az�n j I -Ile z j
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE
Z NE
1//--/
USE NO.
GRP
TYPE
CK BY
�: tleS
F S R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPE
_
TOR
CONSTRUCTION FEE
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVO VED
ELECTRICAL FEE
DBL
$
ADDRESS
CITY STATE
7 •C. /i'�`l/ /,--FEE
$ //
/Q
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
CESSATION 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 ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF-
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
DBL
IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
CATIONS, H AS DONE SOT IN ACCORDANCEWARN SECTION 5541 OF THE BUSINESS AND
TOTAL FEES $ 14P
g90
PROA.
S CODE
CASH F-1 CHECK >&. ❑ N.C. El
7ZArrOR T
�!/A J
Received By �
yw.4REss � � � f ADDRESS
' r/
Sewage System
T
LL
P�(�_,/)
CITY,!�' CITY
j9 6U07
Trees Required
Yes
No
,
INFORMATION
FORM 284-208 (REV. 4/71)
TEL. � � TEL. NO. LICENSE