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FORM 284-208 (2/81)
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FORM 284-208 (2/81)
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NO.
OPERATION
r
DATE
INSPECTOR
NO.
"'OPERATION
DATE .�
INSPECTOR
BUILDING APPROVALS
�.-
MECHANICAL APPROVALS
1
Set Bock
33
Ventilation System
2
Ftgs 8 Frms
34 .
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Geroge Fire Wall
42
Commercial Hood -
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o ADDITIONAL INFORMATION
l `I / V ✓/`� o "`�
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IfC7,1 / 3
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'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internol Lath
—
12A Drywall
13 Finish Grade
' INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Botts)
12C 'Ceiling (Blown)
Final
-_. -_. - - PLUMBING APPROVALS- -- -- - ----- ---------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank
Pit L. Line "
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
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26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire i
29B Bonding
30 Fixtures '
31 Service
32 Final
4 �'r
✓ STREET NAME
DEPARTMENT USE ONLY)
DEPARTMENT. OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
The following extraction
APPLICATION FOR REFUND
Ordinance 457.57, Section
«! c r3L,c/oil
1. Section 304 (e)
C1 aim— ant s Name
'Date of Claim
to read:.
•2. The building'official
Street Address or. P.O. Box
during the terry of the.permit,
/__&Z dQ u 1 �4 9 Cs4 9 S 3
refunding.of
City State Zip Co a No:
of,the,permit fee paid when
no work has
been done under
Telephone No.
'in accordance with this code;"-howev.er;
_ CLAIM -ON THE TREASURER OF THEI000NTY OF
RIVERSIDE,
STATE OF CALIFORNIA
be.'refunded on any permit.
1. Was., c_1 im complete and
signed?
5�. Fee:. $
_ Instructions:
Ye/ x No 0
(1) Permit Numberm
6• Less Plan Check1
.1 Fill out and sign this application
2. Were at achments included?
Yes V1 No
(?) Date Issued
Less S.M.I.
as clearly..as possible.
t Balance
2. Attach your. -receipt (yellow copy
3. Was claim filed within,180_days
(3) Total Fees Paid $ aD ,50
of permit), and -submit to a staff i
permit i sue date?
(4 ,.Reason for refund:
Balance x 80%
y member at our counter.
Yes No
Missin g 0
`
i Minimum wi thl el d .
4. Have plan check or field
inspections
6!. Refund allowed i
I CERTIFY THAT -THIS CLAIM IS TRUE AND.CORRECT,AND THAT'NO
PARTIHEREOF HAS BEEN
'PREVIOUSLY PAID BY THE COUNTY OF RIVERSIDE:`:,.
been ma e?
(Do not write below this line) i
-Cl-a,imant's:�Signatur.e
DEPARTMENT USE ONLY)
The following extraction
is from Riverside .County
Ordinance 457.57, Section
2, Paragraph I.
1. Section 304 (e)
of the Uniform Administrative
Code is amended
to read:.
•2. The building'official
may authorize
during the terry of the.permit,
•the
refunding.of
not more than 80%
of,the,permit fee paid when
no work has
been done under
a 'permit issued
'in accordance with this code;"-howev.er;
a minimum of
$15.00 shall not
be.'refunded on any permit.
1. Was., c_1 im complete and
signed?
5�. Fee:. $
Ye/ x No 0
Missing []
6• Less Plan Check1
2. Were at achments included?
Yes V1 No
Missing
Less S.M.I.
..�-
t Balance
3. Was claim filed within,180_days
of
permit i sue date?
Balance x 80%
Yes No
Missin g 0
`
i Minimum wi thl el d .
4. Have plan check or field
inspections
6!. Refund allowed i
5 S 0
been ma e?
Yes No
Missing(
7, Approved/Disapprovedc
rPtIEF BUILDING- INSPECTOR
E ORBUILDINa AND,,OTAFETY
.�
284-288 Rev ..6/81
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APPICAQ+N�T! NAME, (L., F, MI),,
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NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Deice
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
loA
Fireplace T. 0.
°o
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
---------- _. - FLUMIGING--
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank
Pit L. Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
' 28 -' Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME