186245 (PLBG)DEPARTMENT OF BUILDING & SAFETY
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SET BACK
COUNTY OF RIVERSIDE
H. P.
FIELD OFFICE'S
APPLIANCE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Por.
Gar.
Car P.
Wall
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
Sq. Ft. @
NO.
LISE OF BUILD NG rA
NO.
Sq. Ft. @
Sq. Ft. @
/` I,/
Sq. Ft. @ POLES
—
Sq. Ft. @ SIGNS
DRAINAGE PIPING
Sq. Ft. @ ORAT SCLK U/
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR H. P.
URINAL
MOTOR H. P.
WATER PIPING
ESTIMATED VALUATION Is
MOTOR
H. P.
FLOOR DRAIN
MECHANICAL FEES
MOTOR
M.P.
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SET BACK
MOTOR
H. P.
WASHER (AUTO) (DISH)
APPLIANCE
JOB ADDRESS I OWNER
/ )
FIXTURES
5 S'
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LISE OF BUILD NG rA
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
/` I,/
KITCHEN SINK
GAS PIPE NATURAL ❑ L. G. ❑ OIL
(%
CHEt KED Y
CO`M U YI
WATER CLOSET
COMPRESSOR / HP
v
RANGE AND/OR
OVEN
LAVATORY
APPLIANCE VENT
-/
WATER HEATER
SHOWER
ABSORPTION SYSTEM O B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
LEGAL DES R PTION /app y
CONSTRUCTION
POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
CONSTRUCTION FEE $
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER D B.T.U.
' % _. 4
RESID. IT SD.
FT.
HOUSE SEWER
PERMIT FEE
{
GARAGE 1C SO.
FT.
GAS PIPING
'
ELECTRICAL FEE $
PERMIT FEE
PERMIT FEE
PERMIT NUMBER REN. DBL. TOTAL FEES HEAT & VENT FEE PLN. CK. FEE CONST. FEE ELEC. FEE PLUMB. FEE
v
1 J e M A I M _ J J A c O N D
SET BACK
LOT SIZE
USE 4
JOB ADDRESS I OWNER
/ )
5 S'
R
ZONE
LISE OF BUILD NG rA
TIE
PLAN CHECK FEE$
/` I,/
CHEt KED Y
CO`M U YI
DISTRICT
F.C.
UNITS
VALUATION OFFICE
MECHANICAL FEE $ f VV
„► -(
-/
J/
J
I
GROUP
T E
LEGAL DES R PTION /app y
PERMIT
NUMBER
CONSTRUCTION FEE $
' % _. 4
8
62
SPEC. INSP.
'"' -- _Z
SUPP. TO PERMIT
ELECTRICAL FEE $
.� 7c.
1
PLAN CHECKER
BON $
BOND
C SH
#
N?Lv T
INSPECTOR
PLUMBING
PLUMBING FEE $
rt_.;,N�FILE
73
TOTAL FEES
$v�
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 INCONNECTION WITH THIS
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
CASH CHECK M.O. N.C.
RECEIVED BY
SEWAGE SYSTEM
T
IL
P
Yj+.�� •- � '
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
NAME OF CONSTRUCTION LENDER
OWNER
CONTRACTOR
BRANCH OFFICE
'
ADDRESS
ADDRESS
ADDRESS
CITY STATE
NO LENDER INVOLVED
INFORMATION
TEL. NO.
TEL. NO.
[,, �)) �✓
LICENSE NO.
284-208 12/8
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