08-1624 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-000016°24
Prop rty Address:""8-0-85-5—PASEO—DE
ROSARIO
APN:
766-110-016-56 -33597
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
20000
Applicant:
Architect or Engineer:
LICENSED_CONTRACTOR
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/25/08
Owner:
R.I. +AJC nes ,Lie. Zoa
O i $-`loo A-ve m,) e, 4-7, :5 -
LA
LA QUINTA,-CA 92253
Contractor:
TESERRA
P.O.: BOX 1280
COACHELLA, CA 92236
(76b)3'98-9222
Lic. No.:.656128
`-•- — — —y — — --- — -. — — — — — — — — — — — — — — — — — — — - — — — ---
- — —
I hereby affirm under' penalty'of.perjury,t t icensed under provisions of'Chepter'9 (commencing with
Secyon,7,0001 of'Division 3 of the Busin s and Pr io Code; and my License is in full force and'effect.
License ss: C8i C2.7 C29 No.: 656128
Contractor: '
hereby affirm under penalty of perjury that m exemptfrom the Contractor's State Lic— -e�aw-for.ihe„
following reason (Sec. 7031.5, Business.0 d Professions Code:,Any city' or, county that requires a permit to -
construct, 'alter. improve, demolish, or r6pair 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 IChapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code). or
that he or she is exempt therefrom and.the bans for the alleged exemption. Any violation of Section 7031.5 by
any applicant for" 'permit subjects the applicant to a civil penalty ofnot more than five hundred dollars 1$5001.:. .
(_ 1 I; as owner of the property,. or my employees with wages,as,theii sole compensation, will do the work, and
the structure isnot intended.or offered for saleISec: 7044; Business and Professions Code: The
Contracotors' State License Law,does not apply, to an owner of property whbuilds or'imptoves thereon,
and who does the work himsejror 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.).
(_ 1 1, 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 ownei 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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
&6
s
WORKER'S COMPENSATION DECLARATION'!q
I hereby affirm under. penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self-insure,fo�,workers' coin pefiSation;.as• rovided
for by Section 3700 of the Labor Code, for.the_performance of the work for;whichh ermit 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 isissued. , My!workers' compensation
insurance carrier and policy number are:
Carrier' SEABRIGHT Policy Number BB1080510
I certify that, inthe Performa a of work for which this permit is issued, I shall not employ any
person in any manner so as; beco u ject,to the workers' compensation laws. of California,
and agree that, if I should beco 'tie wor ers' compensation provisions of Section
/?/23�o of the Labor Code.. I shams r . t those provisions.
Date: .r - yC Applicant:. s
WARNING; FAILURE -TO SECURE WORKER -.CO.ENSATION COVERA IS -UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P$ Ay7fES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS'($100,000). IN ADDITION TO CIPHE 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 Buildingand,Safetyfor a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whosebehalf 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 s rmi4 or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that th bove i tion' cor=ec>ta, ree to comply with all
city and county ordinances and state laws relating to building t do d hereborize representatives
of this cpOy to enter upon the above-mentioned propert r i e ' urpo1pp
Date: 7�y�} Signature (Applicant or -Agent)
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:08-00001624
Property Address:
80855_P. EO'6_DE ROSARIO
APN:
766-110-016=56 -33597
Application description:
POOL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
20000
Applicant:
T444t 4 VOICE (760) 777-7012
v FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
Architect or Engineer:
BUILDING PERMIT
Date: 11/10/09
Owner:
R.T. HUGHES CO., LLC
78900 AVENUE 47, STE. 200 0
LA QUINTA, CA 92253
C
Contractor:*
COMPETITIVE WEST POOL CONS N
PO BOX 5865 `At/�li��,t�
LA QUINTA, CA 92248 C�
(760) 625-2512 •��t�G�% 9 O/
Lic. No.: 916827 �, y
v
`LICENSED CONTRACTOR'S DECLARATION
hereby affirm under_penalfy of perjury that I am licensed under provisions of'Chapter 9.(commencing• with
Section 7000) of Division 3 of the Business'and Professionals Code, -and myticense is in full force and effect.
License Class: C53 License No.: '•916827
ate: ff�ractor.
•OWNER -BUILDER DECLARATION
I, hereby affirm under penaltyof perjury that I am exemprfrom the Contractor's State License -Law-'for the
fol lowing.reason,(Sec. 7031:5, Business and.Professions Code: Any city or county thatrequires 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 orshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permitsubjectsthe applicant to a�civil penaltyof not 'more than five hundred dollars'5500).:
6_ 1 •1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
`=ifie 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,
andwho does the work himself or herself: through hisor her own employees, provided that the
.. improvements are'nof intended or offered for sale. 'If; however; the building or, improvement is sold within
one year of completion,,the-owner-builder, will have theburden 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 Coder 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
-
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of, perjury one of the following declarations: t
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 requiredby-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: 's
Carrier EXEMPT 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 subject to the workers' compensationlaws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall for � ith comply with those provisions.
ate:0/9 /q '5ricant
WARNING: FAIL RL E TO SECURE WORKERS' C166PENSAMN COVERAGE IS UNLAWFUL, AND SHALL
SU6JEC7r-AN`EMPLO41R TO CRIMINAL PENALTIES AND CIVILFINES 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,'ANO ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to theDirector 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 Ibecomes 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 his county to enter upon the above-mentioned property for inspection purposes.
Date: 1 ��Z ' nature (Applicant or Agent): ✓�
Application Number . . . . . 08-00001624
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
207.00 Plan Check
Fee
134.55
Issue Date . . . .
9/30/08 Valuation
. . .
. 20000
Expiration Date
3/29/09
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check
Fee
6:50
Issue Date . . . .
9/30/08 Valuation
. . .
. 0
.Expiration Date
3/29/09
Qty Unit Charge
Per
Extension '
BASE FEE
15.00
1.00 11.0000
----------------------------------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
'Additional desc .
Permit Fee . . . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
9/30/08 Valuation
0
Expiration Date
3/29/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING
POOL
30.00
Permit . . .
PLUMBING
Additional desc .
.Permit Fee . . . .
33.00 Plan Check
Fee
8.25
Issue Date . . . .
9/30/08 Valuation
. . . .
0
Expiration Date
3/29/09
Qty . Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS
SHALL BE IN
LQPERNIIT
Application Number . . . . . 08-00001624
----------------------------------------------------------------------------
Special Notes.and Comments
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.
BBQ
PER APPROVED PLAN.
CHANGE OF CONTRACTOR FEE ASSESSED
TO
COMPLETE POOL CONSTRUCTION.
November 10, 2009 10:S9:S4 AM khensel.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . CHANGE OF
CONTRACTOR
4.50
Fee summary Charged
-----------------
Paid
Credited
----------
Due
--------------------
Permit Fee Total 311.00
311.00
----------
.00
.00
Plan Check Total 160.55
160.55
.00
.00
Other Fee Total 4.50
.00
.00
4.50
Grand Total 476.05
471.55
00
4.50
LQPERMIT
Bin #
City of La .Quinta
Building 8i: Safety Division
P.O. Box 1504, `78-495 Calle Tampico
La Quinta, CA 92253- (760) 777-7012 .
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: ke
w
A. P. Number:
Address:
Legal Description:.
City, ST, Zip:
Contractor: CUR l �1(/2 ivPSf
o0� �'o�t5'�.QaC�.tixJ
T phone:
Address: `78—frO Odlle ,'
,`g 0-10l
Project Description:
City, ST, Zip: CA QVi nii/4 CA
g 12 S3
C1/4/ 16415 a,C 001 C04",,&CJa
ele hone• 6 O-
TP G - i
1 S z.
a S
0 >J
� o /s
L
State Lic. # :
City.Lic. #:
D���,
Arch., Engr., Designer:a"w
>� VK s 6_03-ij'
z�
Address:
00 8(05
City, ST, Zip:O
8 . -6 7s-1
0 D
Telephone:
State Lic. #:
Name of Contact Person:
t
<:'•.�ProJe
C i Co Cyhj VA
Construction T
nstructi o e: Occupancy:
Type:
ct type (circle one):
: N w Add'n Alter Repair t Dem 0
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: -716-6- - 615- d? S` / 2
Estimated Value of Project:
APPLICANT: DONOT WRITE BELOW THIS LINE 1
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
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
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER BUILDER
This form _shall be costed on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. .Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed
by applicant. "Un file" Is not an acceptable response.
Trade / Classification
Cont rector
State.:Contractor s License
Workei.r Com ensatioi;lrisurance<
City Business
License`. ': ..
Company Name
Classification
le.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(kx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies).
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx) '
EARTHWORK (C-' 2) . ;.
•CONCRETE (C-81 •`. ..
,
_
FRAMING IC -51 :. .
STRUCT:`STEEL
MASONRY .0 29)
y2 /v+/ISO �t/R
Ci a q
7 37 a.6
•3l ' li
)PQF
PLUMBING IC -36)
C/CRi�w�tl}-fit(; fnoal 4- Si0A
G"36 C-
5009
!! 2010
P/oR C��ei�D
LLMlG919 oH°1
1�2 of
/D Oo %
2•�/Q
LATH;TLASTER (C-35)
DRYWALL (C-9) . ..:
HVAC. (G20)< . >_
ELECTRICAL. (d-I0Y . .
'SHE ETA (C-43) `
FLOORING (C=
.GLAZING• (C-17):'
:INSULATION IC=21
SEWAGE DISP (C-42)
PAINTING .(C=33)
CERAMIC TILE'(C-54)
CABINETS (C-6)
FENCING (C=13) .
LANDSCAPING (C-27)
POOL (C-53)
(-OA1�i1/2 fv�5'f
C - s3.
9 168a-
6 Lo/o
/ 0 y603
Application Number . . . . . 08-00001624
Permit . . .
BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . .
207.00 Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . . .
20000
Expiration Date . .
3/24/09
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit . . .
MECH POOL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
3/24/09
Qty Unit.Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
--------------------------------------------=-------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . . .
0
Expiration. Date
3/24/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
----------------------------------------------------------------------------
EA ELEC PRIVATE SWIMMING
POOL
30.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
33.00 Plan Check
Fee
8.25
Issue Date . . . .
Valuation
. . . .
0
Expiration Date .
3/24/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL, SPA, ALARMS/BARRIERS
SHALL BE IN
LQPERMIT
f
LQPERMIT
Gas
an
Non
J ELEVATIOW SECTION - BPA
STEPPING PADS BY OTHERS
L SECTION -BPA
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DECKING BYOTHERS
I DECK
PRE -PEBBLE
N
NN
SPECIFICATIONS N
M
NP
Nm
TYPE Siff X O O
SURFACE AREA OF POOL '(mm
.
PERIMETER DEPTHS NPL MAX Q a-
m
SPA SPECIFICATIONS TILEJrtn
N
GVE 60 Fr. TILE TYLE w"
AT *36', EIGHT FLUSH MOUNTED DIRECTIONAL SPADAM WALLWOn-T8tl11E— l x o
IRO -THERAPY JETS, TILE VENEER FACE, BRICK
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I, TILE SPILLWAYS, SOFT WHITE PEBBLE TEC PA�sa�SPA AT "'a'� ° N Z
-RIOR FINISH WITH TILE WATER LINE DETAIL, SRUMAYWK I ri m uSED BOND BEAM AT •67' WITH MEDITERRANEAN ErEaALNOT®
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IPPER$EXCAVATION / STEEL HOW 00
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ELEVATION b ••
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IT RBB 3
CONSTRUCTED B-" WITH TILE, Ir 2C R cr
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42' ALFRESCO GRILL WITH ROTISSERIE, 'te e AST�
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IAND GFI WILLWAYTYIE SIS
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ANP.IXf. WN18
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RAISED BOND BEAM AT *18' WITH TILE ADOL HIR s� FO WWF
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.E
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OMINER TO
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OF DEPT. "' TAKE NOTICE THAT THIS DPAWNO B THE BOIEPROPHt1YOFrEseaA AID TMTAWUMVffDWF
SAF EN WRIRBFPERIMONOF TEGER A IB PPONBnm BY LAI.
ILDINGAPPPOVES FLM Pom AN EWWBO IO GR on ND HAS RFAO,IE RTMRCNSIaIRESANO NOTCES ABWE
APPROVED acwTAW BW IMMING POOL PLAN FOR:_��
FOR O STRUCTION MAGALA ESTATES LOT 56
$ 80-855 OASEO DE ROSARID
ICITY
q17�,
/ BY CO ,ADDRESSiGTARLA�ESTATES PAGE BOOK
K PAGE N0. Cm
pg:
ujw
STEPPING PADS BY OTHERS
DECKING EXPANSION JOINTS FOR
'RESENTATION ONLY, FIELD LAYOUT
L VARY.
"TION AUTHORIZATION
SCALE
°= 1
DATE
DRAWN BY
MB
SOLD BY
GRAHAM
CHECKED BY
Co
Ln
I-
0
LLJ
Q
(n
Li
Q
Q
Q
JOB
REVISIONS DATE:
1
n
L+
3
4
5
6
SELECTIONS
STONE
TILE
SALES FIELD
BOULDERS
DECK COLOR
JANDY
PEBBIPLAS
SIGNATURE
DRAINAGE NOTE DmImpa and ftmbn for ganmrs ord poli M often
=IBM Otherwise MOA
.'..."T?'ac;.,:
:Fr PER CEC 680.22. SINK To AF GRILL LIGHT.
LENGTH OF GAS PIPE LENGTH VARIES
DIAM. OF GAS PIPE
r
2 OUTDOOR KITCHEN NEAR POOL
FRONT ELEVATION
1/21f=1
ev,�o pF
o R coQ1 Fpr
e cT�oN ; 'l
PROVIDE VENT, WASTE, AND
PLUMBING FOR SINK ON SEPARATE
CONSTRUCTION DOCUMENT.
WATERTIGHT CEC 680.6 8, 680:22(2)
ELEC. RECEPTACLE
:SHALL NOT BE LESS THAN
10 FT... FROM POOL WALL
IGHT SWITCH
FI DUPLEX
OUTLET.
6X8X 16 CMU AT
FRONT AND SIDE WALLS
SOLID GROUT
BBQ:
I.C.B.O. #
ANSI #�/__
BTU SV<9?1 �
U. L. APPROVED.
C`T/1► it . r.. — — . .
Bin #
City of. La QuInta
Building & Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
a I Building Permit Application and Tracking Sheet
Project Address: t1t� Owner's Name:
"Sf
!
A. P. Number: C �' Address:
Legal Description: (i� City, ST, Zip: Z-1
Contractor: e Telephone:
Address: b-- &U Project Description: WAr
City, ST, Zip:`. ` �s� �"1 LZ:' // . W /S !%%.
Telephone: gZZZ.
State Lic. # :City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:\���.�
Telephone: Construction Type: - ! Occupancy:
—film
State Lic. #: Project type (circle one): Ne Add'n Alter Repair Demo
Name of Contact Person:Franh Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:(766) 2 Gv- CJZ g I Estimated Value of Project: 2— p K
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Re 'd Recd
Pub. Wks. Appr Date of permit issue
School Fees
Total Permit Fees
q
Plan Sets
TRACKING .
Plan Check submitted
PERMTT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called. Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
ph,...►.—
Pub. Wks. Appr Date of permit issue
School Fees
Total Permit Fees