JOB ADDRESS:
DATE: TENTATIVE COMPLETION DATE:
ACOUSTICAL
CABINET & MILL
WORK
CEMENT &
CONCRETE
DEMOLITION
HOUSE MOVING
ELECTRICAL
EXCAVATING
GRADING
FRAMING
FIRE PROTECTION
FLOORING/
CARPETING
GLAZING
HEATING/AIR
CONDITIONING
INSULATION/
WEATHER STRIP
LANDSCAPING/
IRRIGATION
DRYWALL
MASONRY
METAL SASH/DOOR
BUSINESS TAX SECTION
951-826-5465
CITY OF RIVERSIDE
CONTRACTORS VERIFICATION FORM
3900 MAIN ST
RIVERSIDE, CA 92522
TELEPHONE NO:
BUILDING PERMIT NO:
BUILDING OWNER:
BUILDING OWNER TELEPHONE NO:
GENERAL CONTRACTOR:
PAINTING
SUBCONTRACTOR/FIRM/INDIVIDUAL
NAME
TRADE OR
SPECIALTY
ADDRESS & ZIP CODE TELEPHONE
NUMBER
STATE LIC
NUMBER
CITY TAX
NUMBER
DATE WORK
STARTED
PAVING
PLASTERING
PLUMBING
ROOFING
SEWERS
SHEET METAL
STEEL/IRON
TILE
SUBCONTRACTOR/FIRM/INDIVIDUAL
NAME
TRADE OR
SPECIALTY
ADDRESS & ZIP CODE STATE LIC
NUMBER
TELEPHONE
NUMBER
DATE WORK
STARTED
CITY TAX
NUMBER
OTHER SPECIALTIES OR TRADES
PORTABLE
SANITATION DEVICE
RENT-A-FENCE
SUPPLIERS, PLEASE DO NOT LIST IF SHIPPED VIA COMMON CARRIER
APPLIANCES
CONCRETE/STONE
PRODUCTS
LUMBER/WOOD
PRODUCTS
PLUMBING/
HEATING SUPPLIES
I DECLARE, UNDER PENALTY OF MAKING A FALSE STATEMENT, THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE STATEMENTS HEREIN ARE CORRECT AND TRUE.
DIGITAL SIGNATURE: TITLE:
OTHER