260931 (BLCK)APPLIANCE
JOB ADDRESS--- -,` - _ SP NO
'FIELD OFFICE
BUILDING PERMIT
DEPARTMENTOFBUILDING & SAFETY ,
O SUSPENDED
75
COUNTY OF RIVERSIDE
-
CFM,
•�, y
DST
ABSORPTION SYSTEM
0 B.T.U.
r -TEMP USE PERM SVC
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
%
LAVATORY
1 ST FL. SQ.FT. @
UNITS
SHOWER
2ND FL. - SO. FT. @
VALUATION
YARD SPKLR SYSTEM
POR. SO. FT' @"
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
`CAR P. SOFT. @
SOFT RESID @ T1 ¢
DRAINAGE PIPING
WALLSO. FT. @
DRINKING FOUNTAIN
&k)00A i�F-N�t • SO. FT. @
PERMIT FEE
URINAL
' ESTIMATED CONSTRUCTION VALUATION $ , .
GAS PIPING '
WATER PIPING' -
NOTE: Not to be used as property fox voluotion
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
•
VENT SYSTEM ❑ FAN ❑, EVAP. COOL` ❑ HOOD SIGN
WASHER (AUTO) (DISH)
APPLIANCE
JOB ADDRESS--- -,` - _ SP NO
OWNER
GARBAGE DISPOSAL "
FURNACE • ❑ UNIT O WALL O FLOOR
O SUSPENDED
75
LAUNDRY TRAY
AIR HANDLING UNIT I
CFM,
IDLE METER
KITCHEN SINK
ABSORPTION SYSTEM
0 B.T.U.
r -TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR 0
HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM ❑ FORCED O GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 0 B.T.U.
VALUATION
SQ FT @ C
BATH TUB
.SQ FT @ C
WATER HEATER'
A t AlnA
SOFT RESID @ T1 ¢
SEWAGE DISPOSAL
•
SQ FT GARAGE @ 1/2¢
HOUSE SEWER
PERMIT FEE
$
..
GAS PIPING '
MOBILE HOME PERMIT FEE
$
PERMIT FEE •
I PERMIT FEE
PERMIT 11
260931
TOTAL FEES
,,
MOB. HM.FEE
MICRO FEE
_
MECH. FEE
08L.
PL. CK. FEE
CONST. FEE
asap1.
DBL.
ELECT. FEE
JDBL.
SMI FEE,
FEE
kLIMB. FEE
60L.
v J I F I M A I M I J I J.' A S 1 O 1 N I D
JOB ADDRESS--- -,` - _ SP NO
OWNER
74
V6 •` (O%-rGl! 5N11v - n9 -1v
1 c-7 !' /sd
75
USE OF PERMIT
F.C.
DATE
PERMIT NO.
26093.1
76
�o 1�1 Doo.v
M H PERMIT FEE - -
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
A t AlnA
' MICROFILM FEE -
COPIES
$
LEGAL DESCRIPTION
,
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE CK BY'
/
/
/FINAL
IR
PLAN CHECK FEE
$
BOND AML •
PLAN NO.
PLAN CHECKER
DATE
i
IN ECTOR
``
CONSTRUCTION FEE
DBL
$ -
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
' STRONG MOTION
INSTRUMENTATION FEE�y•'/l
$
OWNBB/AGENT'S SIGNATURE --�!�% Er`%' - '
v��fi
CONTRACTOR - -
'
$
ADDRESS ""f
ADDRESS
FEE-
PLUMBING FEE
DBL"
$
CITY ZIPCODE
--
CITY ZIP CODE
-
TOTAL FEES
$
a. A
f J
00
TEL. NO.
J/"'J Lf. I,/ o tf'
to
TEL. NO. LICENSE
CASH ❑. 1CHECK x M.O. ❑ N C ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA^
I ^ ONOF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
l
RECEIVED BY ;
t
TREES REQUIRED i
(
• I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC.
-CORDANCE WITH THE'LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
SEWAGE SYSTEM
- '
T
LL
P
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
r
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED.THE PLANS AND SPECIFICATIONS
'FORM 284-208 (Rei.10-74) OL
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
rT
OF THE STATE OF CALIFORNIA.