162248 (SATT)DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
USE # -
JOB ADDRESS OW N.ER
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
F r.`a`
PLUMBING FEES
R
1st FI. e.
2nd FI.
Gar. f
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Wall
Sq. Ft. 017 � `�`'
Sq. Ft. @
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NO.
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Sq. Ft. @ `� C
dOMMUNI
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Sq. Ft. @ i, POLES
F.CJUNITS
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4
Sq. Ft. @ SIGNS ORAINAGE PIPING
VA�TION
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_ TRANS. AND/• DRINKING FOUNTAIN
Sq. Ft. @ - OR T. CLK.
CONSTRUCTION FEE'+'..
Sq. Ft. @ MOTOR N.P. URINAL
TYPE
MOTOR H.P. WATER PIPING
ESTIMATED VALUATION $ =
>
MOTOR - K. P.
FLOOR DRAIN
ELECTRICAL FEE
MECHANICAL FEES
MOTOR H. P.
PLAN CHECKER
WATER SOFTENER
BOND
CASH IPLANFI
VENT SYSTEjd FAN ❑ EIAP.-CO.I XHOOD
�i
MOTOR it. P.
PLUMBING FEE �+ `�
WASHER (AUTO) DISH)
Jg
GiJ
APPLIANCE
FIXTURES
I
GARBAGE DISPOJA;L
s
$ �
.�
y FURNACE ❑ UNIT ❑•WALL ❑ FLOOR ❑ SUSPENDED
J -
�••+
OUTLETS
CASH CHECK M:o: N.C.
LAUNDRY TRAY
x.r'•
_
- Z AIR HANDLING UNIT
0
SUB -PANEL
KITCHEN SINK -
Jr`
J GAS PIPE ❑.NATURAL ❑L.P. G. ❑OIL
Q
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
•
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.WATER CLOSET
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORN CO ERING CON-
TRACTORS IS ALSO GUARANTEED.
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U COMPRESSOR HP
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RANGE RANGE AND/OR OVEN
C�otNTRACTOR
LAVATORY
71"
U:
W APPLIANCE VENT
ADDR EBS
WATER HEATER
,
SHOWERIq
W
. ABSORPTION SYSTEM B.T.U.
0
SPACE HEATER
ell
BATH TUB'
i
TEL. NO. -
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE -
WATER HEATER
284.208 11-/67 -. -
HEATING SYSTEM Q, ORCED ❑ GRAVITY
..
SERVICE ENTRANCE
r� do, j
SEWAGE DISPOSAL ,
7�5�
BOILER C�B.T.U.�Y
M� RESID. 1C SO. FT.
�9 "'[✓.
HOUSE SEWER
RESIDEN TAL FEE SQ. FT. E=:�@
GARAGE iQ.sO. FT. �j"" !
GAS PIPING
S
PERMIT FEE
`,o PERMIT FEE
AA
PERMIT FEE
PERMITy/Mi� /� 8'
REN.
DBL.
TOTAL E
HEA - VENT S�..�+� FEE
PLN. CK. E
CO.'E
NST
ELEC. FPEE
PLUMB. FEE
J F M
C
A M
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J .A S
O
N D
'
SET BACK
LOT SIZE
USE # -
JOB ADDRESS OW N.ER
b
F r.`a`
S
R
J�11"3 f i co
•
PLAN CHECK FEE
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459 OF BUILDING •- �� J,,,''///'''
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DISTRICT
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VA�TION
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CONSTRUCTION FEE'+'..
GROUP{
TYPE
LE GAI DES RIPTION ``
PEReMM T NUM
2 2�
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE
'j
' �I.M
PLAN CHECKER
BOND $
BOND
CASH IPLANFI
LE #
FINAL DATE
J
INSPECTOR
.•
PLUMBING FEE �+ `�
/"IG -6q
I
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:o: 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
?
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORN CO ERING CON-
TRACTORS IS ALSO GUARANTEED.
pt
INM1FORMATION
OWNER - -
C�otNTRACTOR
71"
ADDRESS -
ADDR EBS
.
ell
•
'TEL. NO.
TEL. NO. -
LICENSE NO. .
284.208 11-/67 -. -
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