176876 (PLBG)DEPARTMENT OF BUILDING 81 SAFETY
0 w 0
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE ELECTRICAL FEES
lst FI.
Sq. Ft. @
2nd FI.
Sq. Ft. @
Por.
Sq. Ft. @
Gar.
Sq. Ft. @
Car P.
Sq. Ft. @
Wall
Sq. Ft. @
AIR HANDLING UNIT
Sq. Ft. @
ESTIMATED VALUATION Is
MECHANICAL FEES
NO.
POLES
SIGNS
MOTOR
H. P.
MOTOR
H. P.
MOTOR
H. P.
MOTOR
H.P.
eip
FIELD OFFICE 3I
PLUMBING FEES
D RA I N A GEl P I P I NG
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR
H. P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
S
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
-✓h [7
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
ZONE
USE OF BUILDING DATE
WATER CLOSET
COMPRESSOR �HP
RANGE AND/OR
OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
COMMUNITY- •
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
VALUATION O ICE
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION
POLE
WATER HEATER
HEATING SYSTEM ❑I FORCED [I GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER 1 J B.T.U.
RESID. 11 SO.
FT.
HOUSE SEWER
PERMIT FEE
GARAGE iQ SO.
FT.
GAS PIPING
PERMIT FEE
,.
PERMIT FEE
P R T U .' REN. DBL. TOTAL FEES I HEAT 6 VENT FEE PLN. CK, FEE CONST. FEE ELEC. FEES PLUMB. FEE
J
J
J
J F M A I M I J J, I A S n N D
SET BACK
I LOT SIZE
USE A
JOB ADDRESKOWJ�N�'yEERr ��•
` '
F
S
R
-✓h [7
ZONE
USE OF BUILDING DATE
PLAN CHECK FEE $
•^ T "' '{
•
CHECKED BY
COMMUNITY- •
DI CT
F.C.
U ITS
VALUATION O ICE
MECHANICAL FEE $
GRr P
fyP
EGAL DE&EOTP ION
PERMIT NUMBER
CONSTRUCTION FEE $
% 'j
C/ I J •�• ^moi
176876
SPEC. INSP.
,�jC— 6 py .w1 2 Q� .�
SUPP. TO PERMIT
'
r(!
ELECTRICAL FEE $
i
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE 0
FINAL DATE
INSPECTOR
I
PLUMBING FEE $
��
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. r N.C. I
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
T
LL
P
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
f
ADDRESS
ADDRESS
ADDRESS
CITY
STATE
NO LENDER INVOLVED .1
INFORMATION
/ Ali 7
TEL. NO.
TEL. NO.
1
LICENSE NO.
'/
�'r
84.208 12/6arl-_
_.—_—.. . ___._ _. _/
,� / ' /
` /, / -