158710 (ELEC)DEPARTMENT OF BUILDING & SAFETY
0:
W APPLIANCE VENT
COUNTY OF RIVERSIDE
WATER HEATER SHOWER
FIELD OFFICE
CONSTRUCTION ESTIMATE
ELECTRICAL
FEES
PLUMBING FEES
1st FI.
2nd Fl.
Por.
Gar.
Car P.
Wall
Sq. Ft. @
NO.
BOILER F_= B.T.U.
NO. j
Sq. Ft. @
SO. FT. @
Sq. Ft. @
PERMIT FEE
Sq. Ft. @ POLES
r,
Sq. Ft. @ SIGNS
ORAINAGE PIPING
TRANS. AND/
Sq. Ft. @ OR T. CLK.
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR H. P.
URINAL
MOTOR M.P.
WATER 'PIPING
ESTIMATED VALUATION $
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
M A M JJ
LAUNDRY TRAY
J
Z AIR HANDLING UNIT
O
SUB-PAMEL
M A M J
KITCHEN SINK
J GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
BALK
WATER CLOSET
Q COMPRESSOR HP
RANGE AND/AA.44(Ffl
�'vs
LAVATORY 1
0:
W APPLIANCE VENT
WATER HEATER SHOWER
2
2 ABSORPTION SYSTEM
D B.T.U.
SPACE HEATER BATH TUB
O
U INCINERATOR DOMESTIC
❑ INDUS. ❑ COMM.
CONSTRUCTION POLE WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE SEWAGE DISPOSAL
BOILER F_= B.T.U.
RESID. IC SO. FT, HOUSE SEWER
RESIDENTAL FEE
SO. FT. @
GARAGE jQ SO. FT. GAS PIPING
PERMIT FEE
j,
PERMIT FEE V U PERMIT FEE
y/M��
/
REN. DBL.
TOTAL FEES
HEAT & VENT FEE
CK. FEE
CONST. 'FEE
FEE
PLUMB. FEE
_-II
8
1 O
JPLN.
JELEC,
JF
M A M JJ
A 5
O N D
J F
M A M J
J A S
O NSET
BALK
LOT SILE
USE 4-
J
JOB ADDRESS
OWNER11.
IR
Im
ZONE j
OF BUILDING
DATE
N CHECK FEE
CHECKEO BY
COMMUNI DISTRICT
F.
UNITSVALUATIONHANICAL
FEE
./ t""*
A /y� '
-Cr)
�,} r
�
woQo—
�
GROUP
I TYPE
LEGAL DESC IPTION '
PER ITER
8�
0
-CONSTRUCTION FEE
J
i�. f_ r„ �,...ti`lC!'1`���f '7� 1� i,j„ Criy
Gs
SPEC. INSP.
SUPP. TO PERMIT
ELEG TRICA L FEE
fzoo'
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE it
FINAL DATE
INSPECTOR
1
PLUMBING FEE
.5�ILJ-ey
TOTAL FEES
$ Q^THIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
W
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.
DECEIVED 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
r
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
INFORMATION
TRACTORS IS ALSO GUARANTEED.
OWNER
CONTRACTOR
_
ADDRESS
ADDRESS
SS
TEL. NO.
TEL. NO.
! Ly
LICENSE NO.
F
84-208 11/87
/