176738 (PLBG)DEPARTMENT OF BUILDING & SAFETY
• COUNTY OF RIVERSIDE •
' FIELD OFFICE?
i;
CONSTRUCTION ESTIMATE ELECTRICAL FEES PLUMBING FEES
lst FI.
2nd FI.
Por.
Gar.
Car P.
Wall
Sq. Ft. @
No.
No. y
Sq. Ft. @
FIXTURES
Sq. Ft. @
9SIGNS
a�
Sq. Ft. @ POLES
OUTLETS
Sq. Ft. @
DRAINAGE PIPING
Sq. Ft. @ TRANS. AND/
OR T. CLK.
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR H. P.
URINAL
MOTOR H.P.
WATER PIPING _
ESTIMATED VALUATION is
MOTOR H.P.
FLOOR DRAIN 3!
MECHANICAL FEES
MOTOR H.P.
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H. P.
WASHER (AUTO) (DISH)
ILOT SIZE
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
a�
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
11
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
,J��JJ
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
WATER CLOSET
COMPRESSOR OMP
RANGE AND/OR OVEN
LAVATORY
)
APPLIANCE VENT
WATER HEATER
SHOWER
COMMUNITYV.C.DISTRICT
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
BATH TUB
IVALUATION
j
INCINERATOR DOMESTIC V INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑I FORCC50 ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSALe
V
BOILER B.T.U.
RESID. 1Q SO. FT.
HOUSE SEWER
TYPE
PERMIT FEE
GARAGE zQ 50. FT.
GAS PIPING
CONSTRUCTION FEE $
PERMIT FEE
PERMIT FEE
V
P1 R T U E REN. DBL. TOTAL FEns HEAT & VENT FEE PLN. CK. FEE CONST. FEE ELEC. FEE PLUMB. FEE
RID
I J e M A NJ J J A 5 O N D
SET BACK
ILOT SIZE
USE 4
JOB ADDRESSfI OWNER
�i - JJ �- 7
lA a 46 il
U OF BUILD DATE
F
5
R
ZONE f}
Y
PLAN CHECK FEE $
,J��JJ
e-,- /S
CHECCKK�ED BY
UNITS
OFFICE
COMMUNITYV.C.DISTRICT
J
IVALUATION
j
MECHANICAL FEE $
GROUP
TYPE
LE GA L�{ESCRIPTIO"N'
PERMIT NUMBER
CONSTRUCTION FEE $
j`�
i4oI � �' 2 Ee ,u k j/�,- _
176738
SPEC. INSP.
SUPP. TO PERMIT
ELECTRICAL FEE $
n"
j/L ..� ec9
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
FINAL DATE
INSP T`OR
/�/y�
PLUMBING FEE $ • Ob^'
'I V�"�C�V'ti�
. o
.i
TOTAL FEES
/, 00
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.C.
RECEIVED er
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
,r,n•"^
T
LL
P; I4j
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
i!
BRANCH OFFICE
ADDRESS
CITY STATE
ADDRESS
ADDRESS ,I
"
'd
1�
NO LENDER INVOLVED
INFORMATION
!
i+
TEL. NO.
TEL. NO.
LICENSE NO.i
284-208 12/88