348878 (SFD)AgTMENT'OF BUILDING & SAFETY FIELD OFFICE
COUNTY OF RIVERSIDE
Supp: Permit
Job Address - Space
DST
Owner" -
NO. ELECTRICAL FEES .
NO. PLUMBING FEES
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MN Permh Fee3
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MOBILEHOME SVC.
BAR SINK
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Form 284.208'IP.ev. 4-771 03
SQ.. F.T. @. a
WATER HEATER
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/* �3SEWAGE DISPOSAL
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SEWER
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PERMIT FEE
PERMIT FEE
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PL_ GK. FEE.
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PERMITNO.
Supp: Permit
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Community'Vcluation
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Cbmt.'Lender - Branch - - A certify that in the performance of the work for which thispermitis issued (shall
employ any•persort in any manner so as fo become subject to the workmens oom-
f1 pensation lows of CatifornTa."
Add Zip' - Owner Signature
- J Builder Sigpature
Istr. Fee E
.fiY111eoge Fee $
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Address
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M,O. ❑ N.C. C] Cash ❑ eck.�3
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Contractor. - -
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Address
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Workers"Comp.
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THIS PERMIT SHALL BECOME ID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF �erifind'Mi%
WORK FOR 120 DAYS:SHAII RMI BECOME VOID.
1 -HEREBY AGREE THAT A , TION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THE LAWS OF RIVIBRSIDECOUNTYA,Q THESTATEOFCALIFORNIA. -
HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO I N ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF
F
CALIFORNIA.
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Form 284.208'IP.ev. 4-771 03