176917 (CSCS)DEPARTMENT OF BUILDING & SAFETY
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ MOOD
0
COUNTY OF RIVERSIDE
•
FIELD OFFICE"
GARBAGE DISPOSAL
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Por.
Czar.
Car P..
Wall
SUB -PANEL
Sq. Ft. @
NO.
NO.
d
Sq. Ft. @
RANGE AND/OR OVEN
Sq. Ft. @
APPLIANCE. VENT
Sq. Ft. @ - POLES
SHOWER
Sq. Ft. @ SIGNS
DRAINAGE PIPING
TRANS. AND/
Sq. Ft. @ OR T. ELK.
DRINKING FOUNTAIN
MOTOR .� H. P. - `,i%�
Sq. Ft. @
URINAL '
MOTOR H. P.
WATER PIPING
ESTIMATED VALUATION $
MOTOR
H. P.
FLOOR DRAIN
PERMIT FEE - -,
MECHANICAL FEES
GAS PIPING -
PERMIT NUMBER
PERMIT FEE
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ MOOD
MOTOR H. P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
rUSE
WATER CLOSET ,
COMPRESSOR E::�HP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE. VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. 12 SO. FT.
HOUSE SEWER
PERMIT FEE - -,
GARAGE yQ SO. FT.
GAS PIPING -
PERMIT NUMBER
PERMIT FEE
PERMIT FEE
PERMIT NUMBER REN. DBL. TOTAL FEES HEAT & VENT FEE PLN. CK. FEE CONST. FEE ELEC. FEE ,�r� PLUMB. FEE
Q � e>O
i �y �.
J �_ F_ . __ .. -I I _ »�.) Ate_ �_ M.�+.... J - J I A 5 O�
SET BACK LOT SIZE
USE # I f J� j%
JOB A�,DDORESS OWNER -
/(}I}
0
f: Ifo
F 5 R
if l
ZON Ef�j
OF BUILCkPNO 9
PLAN CHECK FEE $
rUSE
/�_l' All
CHECKED BY
COMMUNITY
DISTRICT
F.C.
UNITS
VALUAT ON
FFI E/
MECHANICAL FEE $�/V�
`~�""°`N.
GROUP
TVP
LE GA LDE CRIPTI
PERMIT NUMBER
CONSTRUCTION FEE $
0) fill.` 1• L L..' ! C.? �..�
17
o�
SPEC. INSP.
�_r
SUPP. TO PERMIT
ELECTRICAL FEE $ r
.f, &.. _.
'
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
DATE
INS P CTOR
PLUMBING FEE $
oFINAL
O-/� 70
TOTAL FEES
$
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
CASH CHECK M. 0. N. C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
IP
(t ,p� d
T
LL
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
NAME OF CONSTRUCTION LENDER
BRANCH OFFICE
OWNER
CONTRACTOR
"
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ADDRESS
�•''1 •�/"�' r`i
ADDRESS
ADDRESS
CITY STATE
..f r/ 1
NO LENDER INVOLVEDLlel'
INFORMATION
f t -
TEL. NO. -'TEL./NO.
ie r -
/f
LICENSE NO.
284-208 12/68 7llJJf'�\