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MECH (12-0555)P.O. BOX 1504 78-495 CALLETAMPICO LA QUINTA, CALIFORNIA 92253 Application Number. 1,-12 -_0 0000555--" Property Address: 52651 AVENIDA NAVARRO APN: 773 -304 -018 -5 -000000 - Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 4500 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes als Code, and my License is in full force and effect. License Class: C20 License No.: 953452 . t ate:6 of—I1 C ractor: OWNER -BUILDER DECLARATION - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more thah five hundred dollars ($500).: (_) I, as owner of the property, of my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.l. (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). I _ I I am exempt under Sec. B.&P.C. for this reason Date: Owner: - CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner- JIM wnerJIM KELLER 52651 AVENIDA NAVARRO- LA QUINTA, CA 92253 Contractor: SOUTHERN AIR CONDITIONING 2050 JASON COURT PALM SPRINGS, CA 92262 (760)992-0296 Lic. No.: 953452 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760).777-7153 Date: 5/21/12 D Q!- mW $ 1 1.2 CITY J) ' m QUINTA. -F1.N4mc?F DEPT. ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor. Code, for the performance of the work for which this permit. is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier E} MPT Policy Number EXEMPT I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become sect to the workers"compensation laws of California, and agree that, if I should become subje t o the the compensation provisions of Section 3700 of the Labor Code , h rthwi comply with those provisions. r Date: Iicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the - conditions and restrictions set forth on this application. ' 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, . the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for. 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construct ,and hereby authorize representatives of this county to enter upon the above-mentioned prop y f pecti purposes. LAB/: 2 - Sign re (Applicant or Age Application Number . . . . . 12-00000555 Permit MECHANICAL Additional desc . Permit Fee 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/17/12 Qty 'Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 'Special Notes and Comments HVAC CHANGE -OUT. INSTALL NEW 3.5 TON 13 SEER PACKAGE UNIT AT EXISTING LOCATION ON ROOF. 2010 CODES. -----------------_-_------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 40.50 .00 00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.63 .00 .00 51.63 LQPERMIT Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 1 of 5 Project Name: Climate Zone # # of Stories S General Information Site Address: Enforcement Agency: Date: 21 _ )Z Building Type 0 Single Family ❑ Multi Family Circle the Front Orientation: N,(D S, W, or degrees Conditioned Floor Area (CFA): Project Type: ❑ Alterations ❑ Envelope ❑ Fenestration ❑ Roof I& RVAC Values From JA4 Replacement or Change Out ❑ Duct Replacement ❑ Water Heater NOTE. This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑ Opening of framed cavity alone— Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H. ❑ Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A —J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B C D E F G R I J Proposed see Note Standard Values From JA4 Table Framing Thickness, in Furring Space from Reference Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, ID' or Type' and Size or Othe? U- factor° JA4 Table Numbers Cavity Insulation R-value6 R-Value7 Assembly Assembly Cell Values U -facto? U Assembly ° Y�, O a UG� R y C A > Final Mass Name or JA4 Table o v Assemb,zrl Thickness' Type' Number' ¢ > c c ' ¢ > U-factor� Comment Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Furring Construction table below. 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For Wood Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24"OC; or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc.... 4. Based on the Climate "Lone; enter the Standard U factor from Table 151-B, C or D for each different assembly Name or type. 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. Furring Strips Construction Table for Mass Walls Onl A I B I C I D I E F G I H I J K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5 4.3.6 43.7 Joint Appendix Table 4.3.13 U Assembly ° Y�, O a UG� R y C A > Final Mass Name or JA4 Table o v Assemb,zrl Thickness' Type' Number' ¢ > c c ' ¢ > U-factor� Comment Registration Number: Registration DatelTime: HERS Provider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 2 of 5 Project Name: Climate Zone # # of Stories and 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can befound Reference Joint AppendixJ44. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interioi or exterior of the assembly. 4. The Calculated R- Value is the R -value of the furred out section of the assembly. -6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column added to Column I. Column K is the inverse from column J. 7. Insert the calculated U- actor value on to the Opaque Surface Details in Column J FENESTRATION PROPOSED AREAS ❑ Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. The Total Fenestration and West facing Area requirements are not applicable. ❑ Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. ❑ Adding more than 50fe of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT Orientation Fenestration Type and Frame (North, East, PropsedAreal Maximum Maximum NFRC or Default Window, Glass Door or Skylight) South, West) (ft) U-factor2, 3 SHGC2' 3.4 Values 1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration area may be the glass area plus a "2 inch frame" around the glass. 2. Enter value from Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the CF -11? ALT Form. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5. Vapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default " valuesfound in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50ftZ of fenestration is added) A B C D E F G Allowed Existing Fenestration Total Area CFA of Entire % of Fenestration Area Fenestration Allowed Proposed Areal Dwelling CFA Area Removed Area Added A x B) (E -D) + C Total Fenestration Area Rz .20 > West Fenestration Area (Required In .05 > CZ's 2,4&7-15 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Total Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas. Registration Number: Registration Date/Time: HERSProvider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 3 of 5 Project Name: Climate Zone # # of Stories ROOFING PRODUCTS (COOL ROOFS) §1511912 When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000 ft , whichever is less, the new roofing area must meet the roofing product "Cool Roof ' requirements of §152(b)IHi, 152(b) M4 or 152(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof 'requirements. Note: If any one oflhe alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emiltance requirements for roofing products in §118(1) are not applicable. Do not fill table below. ❑ Cool Roofs Not Required in Climate Zones 1-12,14, and 16 with a Low Sloped. Less or 2:12 pitch. ❑Cool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less than 5lb/ft2. Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2.12) ❑ Insulation with a thermal resistance of at least 0.85 hr•ft2•°F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or ❑ Existing ducts in the attic are insulated and sealed according to § 151(f)10; or ❑ In climate zones 10, 12 and 13, with 1 f? of free ventilation area of attic ventilation for every 150 fix of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or ❑ Building has at least R-30 ceiling insulation; or ❑ Building has radiant barrier in the attic meeting the requirements of §151(02; or ❑ Building has no ducts in the attic; or ❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic. Exception to §152(b)lHiii, Low -slope roof (pitch <_ 2:12) ❑ Building has no ducts in the attic. Other Exceptions ❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria. ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 is exempt from the below Cool Roof criteria.. Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, Check the applicable box below if Exem t from the Roofing Products "Cool RoofRequirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number' < 2:12 > 2:12 < 5lb/ft2 > 5lb/ft2 Type2 Reflectance 3,4 Emittance SRI ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.orglproducts/search.nhn 2. Indicate the type ofproduct is being used for the roof top, i.e. single ply roof, asphalt roof, metal roof, etc. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(pi„iiia1— 0.2) to obtain a calculated aged value. Where pis the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at ht6p:/Avww.enerim.cagov/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -1 R. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage commended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating: ❑ Aluminum -Pigmented Asphalt Roof Coating 713C,,ent-Based Roof Coating ❑ Other Registration Number: 2008 Residential Compliance Forms Registration Date/Time: HERS Provider: August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 4 of 5 Project Name: Climate Zone # # of Stories HVAC SYSTEMS - HEATING List water heaters and boilers for both domestic hot water (DHW) healers and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground Minimum Duct or Piping Configuration Heating Equipment Type and Capacity 1•2'3 Efficiency Distribution Insulation Thermostat (Central, Split, AFUE or HSPF Type and Location' R -Value Type Space, Package or H dronic (` p./ \1 ?OL- External Tank 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if tolal capacity < 2 KW or 7,000 Btulhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See ,¢151(6)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF -IR -ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc) HVAC SYSTEMS - COOLING Type' (Standard, Recirculating)2 Minimum Capacity (gal) Thermal Efficiency Efficiency Duct or Piping Configuration Cooling Equipment Type and Ca aci "2 (SEER/EER or Distribution Insulation COP) Type and Location R -Value Thermostat (Central, Split, Type Space, Package or H dronic 1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc) 2. Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable boxes. 3. Indicate Type or Location Ducts, H dronic in Floor, Radiators, etc. WATER HEATING List water heaters and boilers for both domestic hot water (DHW) healers and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all component packages in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation . Type' (Standard, Recirculating)2 System Capacity (gal) Thermal Efficiency R-Value3 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and pipes shall be insulated to meet the requirements o 150 ' . SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written 'usli kation and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of § 151 (02 does not apply to roof alterations. Slab Edge (Perimeter) Insulation ❑ YES ❑ NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation ❑ YES ❑ NO YES: Slab edRe insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations age 5 of 5 Project Name: Climate Zone # # of Stories HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §I52(b)1Dii and the newly installed ducts are to be insulated per §151(f)10. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §I52(b)IDi. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating.coil, or the furnace heat exchanger) the ducts are to be sealed per § 152(b)1 E. ❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge- Split System HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per §152(b)IF. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of § 150(o) do not apply to existing residential homes. Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verifiedper 152(b)1 Ci to meet therequirements of 151(f)7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete_. Name: cl r Sign i Company: P Y • Date: I Address: If Applicable ❑ CEA or ❑ CEPE (Certification #): City/State/Zip • 1 r � �� n" Phone: -7 - 0-0 Responsible Building Designer'sl a ar•ation Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300. Registration Number: Registration DatelTime: HERS Provider: 2008 Residential Compliance Forms August 2009 BIR # City Of Lel Qu%lita B&Whig 8r Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92233 -:(760) 7777012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name:. A P. Number. Address: Jia, (oS I A(/enda- TWO Legal Description: Contractor.' C � rnA 1 /(2, City, ST, Zip: U1 fn Telephone: On '!& ��p, ice" " Address: Project Description: City, ST, Zip: " 1 5 L!� Telephone: " State Lia 4: City Lie. !R Arch, EW., Designer Address: City., ST, Zip: Telephone: Construction Type:, Occupancy: Project type (circle one): New Add'n Repair Demo State Lia #: Name of Contact Person: Sq. Ft.: # Stories: ' #Unita Telephone # of Contact Person: Estimated Value of Project: 5001 00 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACKING PERM T FEFS- Pian Sets Plan Check submitted item Amount Structural CRIcs. Revlewed, ready for corrections Plan Check Deposit. . Truss Calls. Called Contact Person Plan Check Balance Tide 24 Calcs. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for correctionsliissue Electrical Sabeoatactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading W MUSE:- ''" Review; ready for correedonsrusue Developer Impact Fee Planning Approval Called Contact Perm A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees