206080 (AC)BUILDING PERMIT
CONSTRUCTION ESTIMA
1ST FL.
SQ. FT. @
2ND FL.
SQ. FT. @
POR.
SQ. FT. Co)
GAR.
SQ. FT. @
CAR P.
SQ. FT. @)
WALL
SQ. FT.
CONST. SERV. ENTRANCE
SQ. FT. @
ESTIMATED VALUATION $
MECHANICAL FEES
DEPARTMENT OF BUILDING & SAFET
COUNTY OF RIVERSIDE
U ELECTRICAL FEES
7 NO. I I I I NO.
MOTOR 1 OR LESS H.P.
MOTOR 5 OR LESS H.P.
MOTOR 20 OR LESS H.P.
K.W.
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
warRD crICTRAICD
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 UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL Cl L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM O B.T.U.
SQ.•FT.@ Q
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT.@ 4•
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 ?
SEWAGE DISPOSAL
BOILER O B.T.U.
SQ. FT. GAR AGE @ z
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE
$
PERMIT FEE
PERMIT FEE
PERMIT NUMBER
TOTAL
MOB. HOOK FEE
MEAT 6 VENT FEE
DBL PL. CK. FEE
CONST. FEE
DBL ELEC. FEE D FEE
p6
PLUMBING FEE
DBL
USE OF BUILDING
I
DATE pN
74
J -rU /?
021
,3 - l p_ y
U
080 80
75
J F M A M
J J A
S O
N D
JOB ADDRESS #t ,I�w`
OWNER
72
/ jO -/D / 44 F9",1
73
USE OF BUILDING
F.C.
DATE pN
74
J -rU /?
021
,3 - l p_ y
U
080 80
75
COMMUNITY DST
UNITS�ROOM
VALUATION�s
SUPP. TO PERMIT
OFFICE
76
v O
I
MOBILEHOME$
LEGA DESCRTIPON
d .I
HOOKUP FEE
C4 c.,o15 rj
DBL
SET BACK
LOT SIZE
ZONE
USE NO.
GRP
TYPE
MECHANICAL FEE
$
ICKBY
F S
.� j R
.,.
„
s
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
INsP CTOR
PLAN CHECK FEE
$
_ � 5. ,, �
DBL
�V
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOL ED
CONSTRUCTION FEE
DBL
ADDRESS
CITY
STATE
ELECTRICAL FEE
$
$
THIS PERMIT SHALL BECOME0 O IS OE N 60 DAYS.
IVOID.
FEE
CESSATION OF WORK FORDAYS SHALL ALSO CAUSRK
PERMIT TO BECONCED ME
1 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.
CERTIFY S AND SPECIFI-
THE INDIV DUAL WO PREPARED TOF NBUSIN
,j
TOTAL FEES $
v
CATIONSEHAS DONE SOH IBY
N ACCORDANCE WI HHSECT ON 55441T EHE
SS AND
---
PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
CASH F-1 CHECK
M.O. ❑
N.C. Q
OWN R
CONTRACTOR
f /_�r..5� 4`1A4> z �tAV
Received By
ADDRESS
ADDRESS
=
41
�o 7"
Sewage System
T
L L
P
x
CITY _\%
CITY
Trees Required
Yes
No
INFORMATION
TEL. NO.
TEL. NO. LICENSE
FORM 284-208 (REV. 4/71)