176653 (PLBG)DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE 'i
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
Sq. Ft. @
NO.
NO.
2nd FI.
Sq. Ft. @
Par.
Sq. Ft. @
POLES
Gar. _
Sq. Ft. @
SIGNS
DRAINAGE PIPING
Car P.
Sq. Ft. @
_
OR. SCLK.9/
DRINKING FOUNTAIN
Wall
Sq. Ft. @
MOTOR H.P.
URINAL
Sq. Ft. @
MOTOR M.P.
WATER PIPING
ESTIMATED VALUATION Is
MOTOR H.P.
FLOOR DRAIN
MECHANICAL FEES
MOTOR H.P.
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H.P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
1
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
WATER CLOSET
COMPRESSOR �HP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
u�
BOILER E=� B.T.U.
RESID. iC SO. FT.
HOUSE SEWER
PERMIT FEE
GARAGE 2Q SQ. FT,
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT
NUMBER
DBL.
FEES
HEAT
HEAT & VENT FEE
PLN. CK. FEE
FEE
ELEC. FEE
PLUMB. FEE
�REN,
[TOTAL
/ ''
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F M A M J J A 5
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O N D
SET BACK
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USE #
JOB ADDRESS
OWNER I
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ATE
PLAN CHECK FEE $HECKED
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MECHANICAL FEE $)
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TYPE
LEGAL DE CRIPTION
PERMIT NUM R j
CONSTRUCTION FEE $
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176
6 lIl
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE $
!- f. ..— -
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
FINAL DATE
INSPECTOR
v�
T
PLUMBING FEE $—
�1
,.
rL-3 7O9_c—.�
TOTAL FEES
A
PERMIT SHALL BECOME I R1 COMMENCED
��
WITTHIS
HIN 0 DAYS.CESSATION ONOF WORKFOR 120DAYS SHALLALSO
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—
ILL
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
T j%
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI—
LAWS OF THE STATE OF CALIFORNIA COVERING CON—
MWITH
TRACTORS IS ALGUARANTEED.
i
NAME OF CONSTRUCTION LENDER
OWNER
CONTRACTOR
BRANCH OFFICE
F
3
j
ADDRESS
•%
•=
ADDRESS
ADDRESS i
CITY STATE
I
9
NO LENDER INVOLVED
INFORMATION
'
TEL. NO.
TEL. NO.
LICENSE NO.
284-208 12/88 -- [r`O�_m l