181187 (CP)DEPARTMENT OF BUILDING & SAFETY
0 COUNTY OF RIVERSIDE • FIELD OFFICE
CONSTRUCTION ESTIMATE ELECTRICAL FEES PLUMBING FEES
1st FI. Sq. Ft. @ NO.
2nd FI. Sq. Ft. @
Par. Sq. Ft. @
Gar. Sq. Ft. @ POLES
Car P,,a rW Sq. Ft. @ SIGNS
C" TRANS. AND/
'J
W.II ,• Sq. Ft. @ OR T. CLK.
jSq. Ft. @ MOTOR ll—P—^ l
ESTIMATED VALUATION Is
MECHANICAL FEES
MOTOR H. P.
MOTOR H. P.
MOTOR H. P.
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
NUMBER
WASHER (AUTO) (DISH(
REN. DBL.
J
APPLIANCE
` FIXTURES
HEAT B VENT FE
GARBAGE DISPOSAL
1
FURNACE❑ UNIT❑ WALL❑ FLOOR❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
Z
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
WATER CLOSET
J F M A M J J A
COMPRESSOR OHP
RANGE AND/OR OVEN
p N D
LAVATORY
)
APPLIANCE VENT
WATER HEATER
USE it
SHOWER
OWNER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
'I
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
USE OF 13UILDING6_TE
S WAfF DISPOSAL
,
BOILER D B.T.U.
RESID. IQ SD. FT.
HOUSE SEWER
/
PERMIT FEE
GARAGE iQ SO. FT.
DISTRI T
GAS PIPING
'UNITS
-
PERMIT FEE
i 4
1
' PERMIT FEE
a1'V
PERMIT
NUMBER
REN. DBL.
J
TOTAL FEES I
HEAT B VENT FE
PLN. CK, FEE
CONST. FEE
ELEC. FEE
J
PLUMB. FEE
J F M A M J J A
J F M A M J J A s
p N D
SET BACK
LOT SIZE
USE it
JOB ADDRESS
OWNER
ZONE / f
USE OF 13UILDING6_TE
PLAN CHECK FEE $
,
_� `
/
FHECKIED BY
COMMUNITY'
DISTRI T
F.C.
'UNITS
AL A ION OFF) E
MECHANICAL FEE $
7
j
GR P
PE
I
LEGAL DESCTIFPTION
PERMIT
NUMBER
CONSTRUCTION FEE $
-1811
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE $
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
FINAL;AT)El
INS
PLUMBING FEE $�
I
I
5 '� / 'I"l•C,,YL�(,y
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.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
IP
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
3
T
LL
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
i
OWNER
CONTRACTOR '
BRANCH OFFICE
j` l
ADDRESS
' CITY STATE
ADDRESS
ADDRESS
Y p :.-
,+
NO LENDER INVOLVED.
INFORMATION
°
Ala f�e A/e c R,6 � til
TEL. NO.
TEL. NO.
r
LICENSE NO.
284-208 12/88 — -- / �
4 f -