205905 (ELEC)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFET
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 E] NATURAL ❑ L.P.G. ❑ OIL
SQ. FT. @ MOTOR 5 OR LESS H.P.
WATER CLOSET
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
OK.W.UNITS I
WATER PIPING
ESTIMATED VALUATION 1 $
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
1 IFLOOR DRAIN
WATER HEATER
MECHANICAL FEES
SQ. FT. RESID. @ 1 ¢
I IWATPP Cn FTFNFR
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER OK•W•
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR❑SUSPENDED*
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE E] NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR Emm= HP
! POLE a JALAVATORY
�
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM E= B.T.U.
SQ. FT.@ Q
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT.@ a.
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 ¢
SEWAGE DISPOSAL
BOILER B.T.U.
SQ. FT. GARAGE @ i Q
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I�I �IPERMIT FEE I41 I PERMIT FEE
PERMIT NUMBER I TOTAL FEES I MOB. HOOK FEE I HEAT & VENT FEE JOBLI PL. CK. FEE I CONST. FEE IDBLI ELEC. FELJOSLI FEE I PLUMBING FEE DBL
J F M A M J J A S O
N D
JOB ADDRESS
WNER
72
73
USE OF BURG
F.C.
DAT
PER r�I
0 9 0 5
74
�
4 �Gl
75
COMM NITV
DST UNITS
OOMJ
VALUATION
SUUPP. TO PERMIT
OFFICE
76
I
MOBILEHOME
$
LEGAL DE CRIPTION
HOOKUP FEE
DBL
SET BACK LOT SIZE
ZONE
GRP
TYPE CK BY
MECHANICAL FEE
$
JUSENO.
F 5 R
BOND AMT.
PLAN NO. PLAN CHECKER
FINAL DATE INSP
CTOR
PLAN CHECK FEE
$
I
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
CONSTRUCTION FEE
V"
DBL
ADDRESS
CITY STATE
ELECTRICAL FEE
$
$
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.
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
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 PLANS AND SPECIFI-
TOTAL FEES $
CATIONS HAS DONE SOIN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND
PROFESS � 0S CODE OF) ATE OF CALIFORNIA.
CASH ❑ CHECK 00" M.O. ❑ N.C. ❑
OWNE1=1J/
CONTRACTOR
Received By
ADD ESS
ADDRESS
Sewage System T LL P
CITY---
CITY
Trees Required
Yes
No
INFORMATION
TEL. NO.
TEL. NO. LICENSE
FORM 284-208 (REV. 4/71)
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