BMCH2014-1128y Zoning:
Application Valuation: $18,000.00
Applicant: II OCT 2 2014 Contractor:
LIBERTY PLUMBING HEATING & AIR 11 LIBERTY PLUMBING HEATING & AIR
OUTSIDE CITY LIMITS CITy OF LA QUINTA
OUTSIDE CITY LIMITS
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: _ License No.::LIC-762454
Date O'Z Contractor
OWNER -RI ILDE 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 a civil penalty of not more than five hundred dollars
($500).:
(1 I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not 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.).
( ) 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 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
Lender's
Llc. No.: :LIC -762454
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: _ Policy Number: _
_ 1 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 subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
P"VV
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL,
LOYER
AND SHALL SUBJECT AN EMPTO CR. INAL 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 Building Official 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
construction, and hereby authorize representatives of this city to en upon a above
mentioned pp?operty for inspection purposes.
Date: JR) - C S` Signature (Applicant or Ade*
'VOICE
� � �itiN1�ICl/
(760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/28/2014
Application Number:
BMCH2O14-1128
Owner:
Property Address:
78922 BRECKENRIDGE DR
KELLY ROBINSON
APN:
770320051
78922 BRECKENRIDGE DR
Application Description:
HVAC AND WATER HEATER
CHANFOUT
LA QUINTA, CA 92253
Propert
Q 11
y Zoning:
Application Valuation: $18,000.00
Applicant: II OCT 2 2014 Contractor:
LIBERTY PLUMBING HEATING & AIR 11 LIBERTY PLUMBING HEATING & AIR
OUTSIDE CITY LIMITS CITy OF LA QUINTA
OUTSIDE CITY LIMITS
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: _ License No.::LIC-762454
Date O'Z Contractor
OWNER -RI ILDE 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 a civil penalty of not more than five hundred dollars
($500).:
(1 I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not 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.).
( ) 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 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
Lender's
Llc. No.: :LIC -762454
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: _ Policy Number: _
_ 1 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 subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
P"VV
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL,
LOYER
AND SHALL SUBJECT AN EMPTO CR. INAL 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 Building Official 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
construction, and hereby authorize representatives of this city to en upon a above
mentioned pp?operty for inspection purposes.
Date: JR) - C S` Signature (Applicant or Ade*
FINANCIAL INFORMATION
DESCRIPTION. ACCOUNT
QTY
AMOUNT PAID' PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $1.00 10/28/14
PAID BY METHOD
RECEIPT # CHECK # CLTD BY
LIBERTY PLUMBING HEATING & AIR DEBIT
R2480 MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - OTHER EQUIPMENT
101-0000-42402
0
$36.26
$36.26
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #.
CLTD BY
LIBERTY PLUMBING HEATING & AIR
DEBIT
R2480
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - OTHER EQUIPMENT PC
101-0000-42600
0
$36.26
$36.26
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #.
CLTD BY
LIBERTY PLUMBING HEATING & AIR
DEBIT
R2480
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$72.52
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LIBERTY PLUMBING HEATING & AIR
DEBIT
R2480
MFA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$36.26
10/28/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LIBERTY PLUMBING HEATING & AIR
DEBIT
R2480
MFA
Total Paid forCHANGEOUT: $181.30 $181.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
10/28/14
*PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LIBERTY PLUMBING HEATING & AIR
DEBIT
R2480
MFA
Total Paid forPERMIT ISSUANCE: $91.85 $91.85
TOTALS: $274.1S $274.15
Description: HVAC AND WATER HEATER CHANGE OUT
Type: MECHANICAL Subtype: Status: SUBMITTED Applied: 10/28/2014 MFA
Parcel No: 770320051 Site Address: 78922 BRECKENRIDGE DR LA QUINTA,CA 92253 Approved:
Subdivision: TR 25389-3 Block: Lot: 51 Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $18,000.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 13 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.WATER HEATER CHANGE OUT
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
LIBERTY PLUMBING HEATING & AIR
OUTSIDE CITY LIMITS
(604)592-0204
CONTRACTOR
LIBERTY PLUMBING HEATING & AIR
OUTSIDE CITY LIMITS
(604)592-0204
OWNER
KELLY ROBINSON
78922 BRECKENRIDGE
DR
LA QUINTA
CA
92253
(604)592-0204
Printed: Tuesday, October 28, 2014 10:34:52 AM 1 of 3 O
' SYS7Eh1S
Printed: Tuesday, October 28, 2014 10:34:52 AM 2 of 3
V?sysrEMs
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL"*
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
HEATING & AIR
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$36.26
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
OTHER EQUIPMENT
HEATING & AIR
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$36.26
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
OTHER EQUIPMENT PC
HEATING & AIR
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$72.52
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
SPLIT -SYSTEM
HEATING & AIR
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$36.26
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
SPLIT -SYSTEM PC
HEATING & AIR
Total Paid forCHANGEOUT: $181.30 $181.30
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
10/28/14
R2480
DEBIT
LIBERTY PLUMBING
MFA
HE &AIR
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
Printed: Tuesday, October 28, 2014 10:34:52 AM 2 of 3
V?sysrEMs
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL"*
Printed: Tuesday, October 28, 2014 10:34:52 AM 2 of 3
V?sysrEMs
ATTACHMENTS
Printed: Tuesday, October 28, 2014 10:34:52 AM 3 of 3 C
SYSTf. tits
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 4 )
Project Name: Robinson I Date Prepared: 2014-10-27
A. General Information
MR -ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF111-ALT-02 document for each dwelling unit.
01
Project Name
Robinson
02
Date Prepared
2014-10-27
03
Project Location
78922 Breckenridge Dr
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Robinson
07
Zip Code
92253
08
Dwelling Unit Conditioned
2500
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
15
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
S. Space Conditioning (SC) System'Information � f
01
02
01
04�
05
06 /
07
,"08
09
10
Is the SC
Installing a
k��
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
2500
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 214-A0126597A-000000000-0000
Registration Date/Time
2014-10-27 12:36:34
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-27 12:37:23
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 )
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
05
06
07
08
09
10
it
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Dud
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Dud Length
R -Value
Central gas
All new
Central split
All new
Less than or
System 1
furnace
heating
AFUE
0.78
AC
cooling
SEER
13
Setback
equal to 40
R-8
components
components
feet
Rhe uired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Duds and Fans
-Duct Insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Dud Leakage testing required when heating or cooling components are installed In ducted systems, or when more than 40 ft of dud length is replaced.
-Leakage rate compliance: 515%x, ors 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton required when MCH -25 is required. As;
` ` `.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Dud Leakage -Testing requirements. t
-Heating-only systems and Air Handler/Furnace"changes do not require verification of Air Flow MCH -23; or Refrigerant Charge MECH-25.
-Existing duct systems constructed, Insulated or,, sealed with,astiestos are,exempt from MCH;20 Duct Leakage Testing requirements.
¢ .
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)IE, F)
This section does not apply to this project.
Registration Number: 214-A0126597A-000000000-0000
Registration Date/Time: 2014-10-27 12:36:34
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-27 12:37:23
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 4 )
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 214-A0126597A-000000000-0000 Registration Date/Time: 2014-10-27 12:36:34 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-27 12:37:23
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 4 of 4 )
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
howes, Jerry
���
Company:
Signature Date:
LIBERTY PLUMBING HEATING & AIR CONDITIONING INC
2014-10-27 12:36:34
Address:
CEA/ HERS Certification Identification (if applicable):
39252 WINCHESTER ROAD #107-371
City/State/Zip:
Phone:
MURRIETA CA 92563
(951) 326-4892
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The Information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business :and.Professions Code to accept- responsibility for the building design or,system.designiidentified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
Compl ante /the on
4. The building design features or system design features identified on this Certificate o aconsi tent with information provided other applicable compliance documents, worksheets,
calculations, plans and specifications submitted Rto the enforcement agency for approval with this building permit application:
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permits) Issued for,the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: /1�
howes, Jerry
Oma/ �
Company:
Date Signed:
LIBERTY PLUMBING HEATING & AIR CONDITIONING INC
2014-10-27 12:36:34
Address:
License:
39252 WINCHESTER ROAD #107-371
761640
City/State/Zip:
Phone:
MURRIETA CA 92563 1(951)
326-4892
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 214-AO126597A-000000000-0000 Registration Date/Time: 2014-10-27 12:36:34 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-27 12:37:23
Schema Version: O.SSSSDD
Bin. #
Qty of La Quinta
Building 8r Safety Division
P.O. Box 1504,78-49S Caife Tampico
ia.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address.— 1 Al,
Owner's Name: .
A. P. Number.
Address•
Legal Description:
City, ST, Zip:
Contractor. tt' /
Telephon /
Address -, Vi V1,41 Lf IV# , )
Pmjer4 Description:
City, ST, Zip: 1 Q
gog
Telephone 7LADLI�. "''
{r. 43 >.
State Lic. # : City Li c #,�
Arch., Eng., Designer
Address:
City., ST, Zip:
Telephone: Y. �
State Lic. #: `-. • 7�r
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
9
Submittal
Req'd
Reed
TRACKING
PERMIT FEES -
Plan Sets
Pian Check submitted'
Item Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs.
Called Contact Person
Plan Check Balance -
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted'
Mechanical
Giading plan
2'a Review, ready for correctionsliissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
t S.M.L
H.O.A. Approval
Plans resubmitted
Grading
Ii\ ROUSE:-
'^' Review; ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees