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BMCH2016-0142S a� VOICE (760) 777-7125 78-495 CALLE TAMPICO 4 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/1/.2016 Application Number: BMCH2O16-0142 Owner: Property Address: •51290 AVENIDA BERMUDAS BANK OF THE DESERT NATL ASSN APN: 770151001 915 HIGHLAND POINTE 350 Application Description: RABID BANK / HVAC CHANGE OUT ROSEVILLE, CA 92253 Property Zoning: Application Valuation: $28,000.(30 Applicant: Contractor: ACCO ENGINEERED SYSTEMS INC ACCO ENGINEERED SYSTEMS INC 6265 SAN FERNANDO ROAD 6265 SAN FERNANDO ROAD GLENDALE, CA 91201 GLENDALE, CA 91201 ----------------------------------------- LICENSED CONTRACTOR'S DECLARATION I 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 Professions Code, and my License is in full force and effect. License Class: C-4 C20 C36 C38 C10 B A cense No.: 12 6 Dat ef r Contractor:' 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 a civil penalty of not more than five hundred dollars ($500).: ( ) 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 Nork himself or her 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 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 (818)244-6571 Llc. No.: 120696 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 ,Wk 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: _ Polity Number: _ 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 subject to the workers' compensation laws of California, and agree that, if I.should become subject to the workers' compensation provisions of Section 37 0 of the Labor ode, I shall fo ith comply it these provisions. C /Date:W1 1'0 Aoolicant: 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 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 4cityter upoVthe above-ment• n property for inspection purposes. r Date: Llo Signature (Applicant or Agen DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT r PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 PAID BY METHOD' RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $217.56 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $108.78 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for CHANGEOUT: $326.34 $0.00 DESCRIPTION ACCOUNT. QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 ' TOTALS:0• Description: RABO BANK / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: ON HOLD Applied: 5/3/2016 RSE Approved: Parcel No: 770151001 Site Address: 51290 AVENIDA BERMUDAS LA QUINTA,CA 92253 Subdivision: Block: 10 Lot:2 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $28,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: CHANGE OUT (2) 13SEER/80AFUE SPLIT SYSTEMS AND (1)DUCTLESS SPLIT. [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES Printed: Wednesday, June 01, 2016 10:23:05 AM 1 of 2 SYSTEMS CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT ACCO ENGINEERED SYSTEMS INC 6265 SAN FERNANDO ROAD GLENDALE CA 91201 CONTRACTOR ACCO ENGINEERED SYSTEMS INC 6265 SAN FERNANDO ROAD GLENDALE CA 91201 OWNER BANK OF THE DESERT NATL ASSN 1915 HIGHLAND POINTE 350 ROSEVILLE CA 92253 Printed: Wednesday, June 01, 2016 10:23:05 AM 1 of 2 SYSTEMS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $2.00 $0.00 BSA: HVACCHANGEOUT- 101-0000-42402 0 •$217.56 $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $108.78 $0.00 SPLIT -SYSTEM PC Total Paid for CHANGEOUT: $326.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 1 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:i i 00 INSPECTIONS PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Wednesday, June 01, 2016 10:23:05 AM 2 of 2 SYSTEMS J I H l t Ut• UALIt•UMIN MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION ^A. CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 1 of 4) Project Name: p /t BOB /tt� K Date Prepared: 05/17/2016 B. MECHANICAL COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. YES NO Form/Worksheet # Title l� • ❑ NRCC-MCH-01-E (Part 1 of 3) Certificate of Compliance, Declaration. Required on plans for all submittals. QUI ❑ NRCC-MCH-01-E (Part 2 of 3) Certificate of Compliance, Required Acceptance Tests (MCH -02A to 11A). Required on plans for all submittals. MCH -04A ❑ NRCC-MCH-01-E (Part 3 of 3) Certificate of Compliance, Required Acceptance Tests (MCH -12A to 18A). Required on plans where applicable. MCH -08A ❑ NRCC-MCH-02-E (Part 1 of 2) Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans. Equipment ❑ INRCC-MCH-02-E (Part 2 of 2) Mechanical Wet Equipment Summary is required for all submittals with chilled water, hot water or condenserwater systems. It is optional on plans. ❑ �1 NRCC-MCH-03-E Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. Itis optional on plans. ❑ IN NRCC-MCH-07-E (Part 1 of 2) Power Consumption of Fans. Required on plans where applicable ❑ C4 NRCC-MCH-07-E (Part 2 of 2) JPower Consumption of Fans, Declaration. Required on plans where applicable C. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms) Test Performed By: Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVACsystems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of systems. Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or.installation for which they are responsible. Enforcement Agency: Plancheck — The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH -02A MCH -03A MCH -04A MCH -05A MCH -06A MCH -07A MCH -08A MCH -09A MCH -10A MCH -11A Equipment # of Outdoor Single Zone Air Economizer Demand Supply Fan Valve Leakage Supply Water Hydronic Automatic Requiring Testing units Air Unitary Distribution Controls Control VAV Test Temp. Reset System Demand Shed or Verification Ducts Ventilation Variable Flow Control (DCV) Control CU/FC - 1 &2 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ .CU/FC - 3 1 ❑ ❑ ❑ ❑ ❑ . ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑. ❑ CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 MECHANICAL SYSTEMS M. CEC-NRCC-MCH-01-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION A. CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 2 of 4) Project Name: Date Prepared: MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms) ❑ ❑ ❑ ❑ ❑ 01 ❑ ❑ ❑ . ❑ Installing Contractor: ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ Ploncheck — The NRCC-MCH-01 - E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. ❑ ❑ ❑ ❑. ❑ ❑ ❑ ❑ ❑ ❑ MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms) Test Performed By: Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptop ce tests for HVAC systems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the some type that requires o test, list the equipment description and the number of systems: Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. The following tests require a Enforcement Agency: Ploncheck — The NRCC-MCH-01 - E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH -12A MCH -13A MCH -14A MCH -15A MCFI-16A MCH -17A MCH -18A Equipment #i of Fault Detection & Automatic Fault Distributed Energy Thermal Energy Supply Air Condenser Water ECMS Requiring Testing units Diagnostics for DX Detection & Storage DX AC Storage (TES) Temperature Reset Reset Controls or Verification Units Diagnostics for Air & Systems Systems Controls Zone CU/FC - 1 &2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ CU/FC - 3 ❑ ❑ o ❑ ❑ ❑ ❑ ❑ o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 MECHANICAL SYSTEMS, CEC-NRCC-MCH-01-E Revised 05115 CALIFORNIA ENERGY COMMISSION"`�' A. CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 3 of 4) Project Name: n /t BOB A N K Date Prepared: 05/17/2016 5/1 7/201G May 2015 MECHANICAL SYSTEMS CEC-NRCC-MCH•01-E Revised 05115 CALIFORNIA ENERGY COMN41SSION A. CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 4 of 4) IProject Name: RABOBANK I Date Prepared: 05/17/2016 I DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: RACHAEL SCHELLEY Documentation Author Signature: cor"pany:. ACCO ENGINEERED SYSTEMS signature Date: 05/24/2016 Address: 265 MCCORMICK AVE. CEA/HERS Certification identification (if applicable): City/State/Zip: COSTA MESA / CA / 92626 Phone: 714/ 352-2226 ext. 183 RESPONSIBLE PERSON'S DECLARATION STATEMENT j 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 Busiriess and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is requ' to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: JUSTIN KIRCHART Responsible Designer Si nate company: ACCO ENGINEERED SYSTEMS - Date signed: 05/24/20 6 Address: 265 MCCORMICK AVE. License: M33976 City/State/Zip: COSTA MESA / CA/92626 Phone: 714/ 352-2226 ext. 120 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 HVAC SYSTEM REQUIREMENTS .� CEC-NRCC-MCH-02-E Revised 05/15 'CALIFORNIA ENERGY COMMISSION' -�- CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Dry System Requirements (Page 1 of 3) Project Name: RABOBANKDate Prepared: 05/17/2016 A. Equipment Tags and System Description' CU/FC-1 &2 CU/FC-3 B. MANDATORY MEASURES Heating Equipment Efficiency3 Cooling Equipment Efficiency3 HVAC or Heat Pump Thermostats Furnace Standby Loss Control Low leakage AHUs Ventilation Demand Control Ventilations Occupant Sensor Ventilation Control6 Shutoff and Reset Controls Out Air and Exhaust Damper Control Isolation Zones Automatic Demand Shed Controls Economizer FDD Duct Insulation C. PRESCRIPTIVE MEASURES T-24 Sections Reference to the Requirements in the Contract Documents2 110.1 or 110.2(a) 80% 4.11 COP 110.1 or 110.2(a) 13 SEER 19 SEER 110.2(b), 110.2(c) YES YES 110.2(d) N/A N/A 110.2(f) N/A N/A 120.1(b) (E)0.15 CFM/FT2 N/A 120.1(c)4 N/A N/A 120.1(c)5,'120.2(e)3 N/A N/A' 120.2(e) YES YES 120.2(f) N/A N/A 120.2(g) N/A N/A 120.2(h) N/A N/A 120.2(i) N/A N/A 120.4 N/A N/A Equipment is sized in conformance with 140.4(a & b) @, , @N Y/N 140.4 (a & b) lTl�'� Supply Fan Pressure Control 140.4(c) N/A N/A Simultaneous Heat/Cools 140.4(d) N/A N/A Economizer 140.4(e) N/A N/A Heat and Cool Air Supply Reset 140.4(f) N/A N/A Electric Resistance Heating' 140.4(g) N/A N/A Duct Leakage Sealing and Testing.10 140.4(1) N/A N/A Notes: 1. Provide equipment tags (e.g. AHU 1 to 10) and system description (e.g. Single Duct VAV reheat) as appropriate. Multiple units with common requirements can be grouped together. 2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system. 3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency requirements are applicable (e.g. full- and part -load) include all. Where appliance standards apply (110.1), identify where equipment is required to be listed per Title 201601 et seq. 4. Identify where the ventilation requirements are documented for each central HVAC system. Include references to both central unit schedules and sequences of operation. If one or more space is naturally ventilated identify where this is documented in the plans and specifications. Multiple zone central air systems must also provide a MCH -03-E form. 5. If one or more space has demand controlled ventilation identify where it is specified including the sensor specifications and the sequence of operation. 6. If one or more space has occupant sensor ventilation control identify where it is specified including the sensor specifications and the sequence of operation 7. If the system is DDC identify the sequences for the system start/stop, optimal start, setback (if required) and setup (if required). For all systems.identify the specification for the thermostats and time clocks.(if applicable). 8. Identify where the heating, cooling and deodbond airflows are scheduled for this system. Include a'reference to the specification of the zone controls. Provide a MCH -03-E form. 9. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies. 10. If duct leakage sealing and testing is required, a MCH -04-A form must be submitted. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA HVAC SYSTEM REQUIREMENTS t"GI . �Fof�.• CEC-NRCC-A4CH-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Wet System Requirements (Page 3 of 3) Project Name: RABOBANK ePrepare` 05/17/2016 . DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: RACHAEL SCHELLEY Documentation Author Signature: Company: ACCO ENGINEERED SYSTEMS Signature Date: 05/24/2016 Address: 2655 MCCORMICK AVE. CEA/HERS certification Identification (if applicable): City/State/zip: COSTA MESA / CA / 92626 phone: 714/ 325-2226 ext. 183 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. I am eligible under Division 3 of the Business and Prcfessions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement' agency for approval with this building permit application. S. I will ensure that a completed signed copy of this Certificate of Compliance shall be made availa with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I under a d that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder pro the building owner at occupancy. Responsible Designer Name: JUSTIN KIRCHART Responsible Designer Signat e: Company: ACCO ENGINEERED SYSTEMS Date Signed: 05/24/20 6 Address: 265 MCCORMICK AVE. License: M33976 City/State/Zip: COSTA MESA / CA / 92626 phone' '714/ 325-2226 ext. 120 CA Building Energy Efficiency Standards,- 2013 Nonresidential Compliance May 2015 Iain # City of La Q uin to Building 8t" Safety Division .78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 19 -1- Building Permit Application and Tracking Sheet Permit # L I b-10 Project Address: S 12 %V tU i {1 Z, mmu-4 Owner's Name: 6ti A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: 1 i W Tel'e'phone:minim Address: `lrj SMS% � A4WI S • Project Description: City, ST, Zip:lCM � A ?,D � t" (2STou Sy I le h o Telephone: P l8 ! l S e� 1 t v State Lic. # :(`> (� City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: '. ...............�...(:...:::....::. C on s[ructi on Type: Occupancy: P Occu Y• State to Lic. #: Project tYPa (circle one): New Add'n Alter Repair air De mo Name of Contact Person: '1/ Sq. Ft.: #Stories: # Units: Telepphone# of Contact Person: &/,p a 1 R' Estimated Value of Project: 2A too , v" o wL)LU A!E)ACE�[��jL�UILc-'AP�CANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"! Review; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees t.:w