BRER2015-0023'&4 4.4 Q"
78-495 CALLE TAMPICO,
LA QUINTA, CALIFORNIA 9225: /
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant
JOSE ROMO
LA QUINTA, CA 92253
BRER2015-0023
53150 AVENIDA VELASCO
774055007
REROOF WITH OWNENS CORNING SHASTA SHINGLE
$5,220.00
LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 3/5/2015
Owner:
JOSE ROMO
LA QUINTA, CA 92253
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: License No.:
Date: 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
per isubjects the applicant to a civil penalty of not more than five hundred dollars
($5 0).:
(71, 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
wihin 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
4,Datek5) — 62 7 _ 1 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:
mtractor:
WNER/BUILDER
c. No.:
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:
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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
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 this city to enter upon the above-
mentioned property for inspection purposes.
OateO�'�/� A; -Signature (Applicant or Agent):
.%f
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
'PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
3/5/15
PAID BY
METHOD
RECEIPT #
CHECK'#
CLTD BY
JOSE ROMO
CASH
R3903
AOR
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
f
PAID DATE
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
3/5/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
JOSE ROMO
CASH
R3903
AOR
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$98.62
3/5/15
PAID BY
METHOD •
RECEIPT #
CHECK #
CLTD BY
JOSE ROMO
CASH
R3903
AOR
Total Paid forRE-ROOF: $147.93 $147.93
TOTALS:4:
.%f
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92.247-1504
78-495%CALLE TAMPICO,
LA QUINTA, CALIFORNIA 92 ; 253
'BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-701-1
Considering Bec i
9 oming an Owner -Builder?
Important information you. need to know BEFORE .pulling your permit!
The term "Own * er-Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each ha's -Benefits or. Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the pernii't"is.not taken
out :in:.:'
..your name,. you are not personally responsible for the construction and you are not an Owner -Builder. lnsteO,,* become a
"Customer and California law provides you- the benefit of protection from poor workmanship, failure to finish ' '.1,
the job and*:finan'cial
risk due to worker injury. a
its and the Least
Benefit/Risk: Hi hei' enefi
nig amount of Risk
Owner -as- Worker is a type of Owner -'Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally, responsible for the coiis[ruction management, knowledge, workmanship, and completion of the' A You,-.
benefit by not paying others to perform this'work for, you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Co -tit is-taket' i
Contractor, the per - n n- ir
'yo%n and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The' benefit of
6 provided by law when you hire only California licensed sub -contractors can turn to werious financial risk if you hire
protection
ro
unlice, contractors to perform any of the work.
Benefit/Risk: Possible Benefit and Si2nificant Financial Risk
Owneir-As-Employer is a type of Owner=Builder where you pay any unlicensed individual to perform any construction work valued at
more thain $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost -savings benefit can turn to serious financial
risk if -you fail to'�.deiductpayroll,,taxes .or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit
with Significant Financial Risk
}
(Health and Safety Code Section 19827) The, -California Legislature declares an "urgent and ' statewide
public interest in assuring" that. contractors comply 'with Contractors' License Law,'' Business _and
Professions Code -and Workers' Compensation Insurance requirements to ensure—property owners are
informed about,. and protected from the following when improving -their -property as Owner -Builders:
Fraudulent representations - Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors - Licensing requirements • Employers tax liabilities
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
• Owner/Builder permit pulled to rebuild structure.
• Unlicensed contractor built substandard structure — must be torn down and replaced.
• Estimated financial injury is $225,000.
■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
■ Owner-Builder'hires brother-in-law to install a new roof.
• Employee falls and sustains. multiple spinal and extremity fractures as well as a head injury and
remains in a coma to this day.
■ The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for
'benefits paid to the injured worker.
Example 3:. Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured .
worker.
Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder" building
permit which erroneously implies that the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and *his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government, withhold payroll taxes, provide workers compensation and disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT
67
P.O. Box 1504
LA- QUINTA, :CALIFORNIA- 92247-1504
78=495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012 +
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures& Forms for .Owner -Builders Applying for Construction Permits
IMPORTANT: NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building Permit has been submi ed ' your name listing yourself as the builder of the 'property
improveriments specified at (� >
We are,providing you with aannwer-Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the'owner cannot execute this
unless you, the property owner, obtain the prior approval of the permitting authority. _ notice
.avau�1r�11V1\ ,
DIRECTIONS_.Readani initial each statement below to sign�you understand or verify this information.
Y
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an.Owner-Builder, maybe held liable and subject to serious financial risk for any.injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries: I am willfully aeting.as an Owner -Builder and am aware of the limits of
on my property. my insurance coverage for injuries to workers.
understand building permits are not required to be signed b?+
�1 l;n y property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
J�&3. I understand as an "Owner -Builder" I am the responsible patty of record on the permit. I understand that I
myself from potential financial risk, by hiring may protect
a licensed Contractor and having the permit filed in his or her name instead of my ,
own.
J 4. I understand Contractors are required by law to be licensed and bonded in California and to list -their numbers on
permits and contracts.
J W 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered, an "employer"
under state and federal law.
M6. I understand if Lam considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll. taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee`." I also understand my failure -to abide by these laws may subject me to serious financial
risk. .
JW7. I understand under California•_Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them , for ;sale, unless all ' work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under. contract with a licensed general building Contractor.
TV15. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for. any -
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
J~V–A9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
eaity,, le all nd financi lly r onsible for proposed construction activity at the following address:
y� 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner. -Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of.a complaint. Your only remedy against unlicensed Contractors- may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to.,hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status' of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to.
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
ether verification acceptable to the agency is required to be presented when the permit is issued to verify dhe property
owner's signature. A
Signature of property owner fr Date:d
Note:-ThefollowingAuthorizatir`
an agent of the property owner t1,..a,
Excluding'the Notice to Property O
the following person(s) to act as my
Permit for my. project.
Scope of Construction Project (or D'c
16' a:
E
Project Location or Address:
Name of Authorized Agent:
Address of Authorized. Agent:
only when designating
Lsibility, I hereby authorize
obtain an Owner -Builder
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy.Note: A copy of the owners driver's.license, form notarization, or other verification
acceptable to the agency isrequired to bepresented when the pennit is issued to ver jy the property owner's signature.
Property Owner's Signature' Dater . G �— ��
STATE OF CALIFORNIA
RESIDENTIAL' ALTERATIONS
-CEC-CFIR-ALT-01-E Revised 06/14
.CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations
Project Name:
CALIFORNIA ENERGY'COMMISSION
CF1R-ALT-01-E �•
(Page 1 of 4.)
Date'Prepared:
A: GENERAL INFORMATION"
01 -
02
Ol Project Name:
02
Date Prepared:'
03, Project Location:
D4
Building Fro nt.Oenlaiion (deg or cardinal):
05. City:
06
Number of Alte ,e welling Units:
09 ° Zip Code:
08
_
Fuel Type; r+` "
09 Climate Zone:
10
Total C-.6rMitioned FloorWr.)eh`(ft2) �
11 Building Type
12
Slab Aleaf(ft2)= - qav
13 Project Scope:
Ta ID AssemblyType
Yp
Yp (inches)
Type
B: BUILDING INSULA_ TION DETAILS (Section 150.2(b)1)x,�
01 -
02
Ol ; - 02"=`':: •
03 04
05
06 w 07I
08:rf09 10 11
_
L
a
rPropo ed
10,p <. Required -
.
Frame
Frame
1int Appendix JA4
'Continuous
CRRC PI .odud ID _
, Number
Frame Depth
Spacing
Cavity . Insulation
Reference
Ta ID AssemblyType
Yp
Yp (inches)
Type
(inches)
R -value, R -value t-faytor Table Cell LI -Factor, Comments
Registration Number: r
CA Building
NOTESi _ w ..
• Roof area covered by, builiiln"g?integrate olta
d phot anelS and solar thermal panels are exempt from the above. Cool Roof requirements.
• Liquid field applieddcoaLings stallation
must comply withd criteria from section 110.8(1)4.
Registration Date/Time:
HERS Provider
Energy Efficiency StandraY X013 Residential Compliance
June 014.
;'
rS
C. ROOF REPLACEMENT (Prescriptive Alteration, Sed ,�o�n�150.2(b)iH)�,�, �� _ - • -
01 -
02
03
04 ,'
051, 06
T67z9 08 09 10 it 12 13
Method
'
`!#oof
L
R -value
Proposed Minimum Required
��Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
R ectance Reflectance mittance (Optional) Reflectance Emittance (Optional)
of
-Compliance
tch
Exce ion
CRRC PI .odud ID _
, Number
Deck.
t+�P�od'uct Type _ InSulal o
4
3 Z
ohi}i' s
- y
wt��cc
Registration Number: r
CA Building
NOTESi _ w ..
• Roof area covered by, builiiln"g?integrate olta
d phot anelS and solar thermal panels are exempt from the above. Cool Roof requirements.
• Liquid field applieddcoaLings stallation
must comply withd criteria from section 110.8(1)4.
L
•�i�` �
- ,
X13 .. -
Y
00
Registration Number: r
CA Building
Registration Date/Time:
HERS Provider
Energy Efficiency StandraY X013 Residential Compliance
June 014.
;'
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFi R -ALT -01-E Revised 06/14 ,,' .. CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE &1R -ALT -01-E
Prescriptive Residential Alterations . (Page 4 of 4)
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT,
1. 1 certify,that this Certificate of Compliance documentation is.acctirate and complete.
Documentation Author Name:
Documentation Author Signature:`
Company:
Signature Date: '3'49'
Address:
CEA/HERS Certification Ide'tifi�catiom(ifapplicable): �.
City/State/ZIP:
Phone:.
�w
'
�.e nom%;•,
RESPONSIBLE PERSON'S DECLARATION STATEMENT aL
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information this Certificate Compliance is true "' d"
provided on of and correct.
2. lam eligible under Division 3 of the Business and Professions Code to accept responsibility for the building desiN.,vor system design Identified on this Certificate of Compliance (responsible
designer).
3. That the energyfeatures and performance specifications, materials, compoge'hts; an manufacturedFdeevicesIfor the building design or system design identified on this Certificate of
io le
Compliance conform the requirements of Title 24, Part 1 and Part 6 of the California Code of•Reg tions.
4. The building design features or system design features identified on th s Certificate of Cornpliance are consiiste to w"�•i. he information provided on other applicable compliance documents;
worksheets, calculations, plans and specifications submitted tothe enforcement agerieyfor pproval with this uilding permit application.
5. twill ensure that a registered copy of this Certificate of Complianceshall 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 registered�coy copy of this Certi Compliance is required to be included with the documentation the builder provides to the building
.cate�,bf
owner at occupancy. ' ., A sit
Responsible Designer Name:IN . tQe*s,pe
L..n...�r ,. gymiiW-.
ble Designer Signature:
/•
Company: ". 4 -e
Signed:
Address: :. Ve NPO
TMA
License:
City/State/Zip:
Phone:
"A
For assistance ouestions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-33010.
z -
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
Description: REROOF WITH OWNENS CORNING SHASTA SHINGLE
Type: R&ROOF Subtype:
Status: ISSUED
Applied: 3/5/2015 AOR
Approved: 3/5/2015 AOR
Parcel No: 774055007 Site Address: 51150 AVENIDA VELASCO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 216
Lot: 8
Issued: 3/5/2015 AOR
UNIT 21
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning: -
Finaled:
Valuation: $5,220.00 Occupancy Type:
Construction Type:
Expired: 9/1/2015 AOR
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: REROOF WITH SHASTA WHITE ASPHALT OWENS CORNING SHINGLES. 2013 CALIFORNIA ENERGY CODE.
Printed: Thursday, March 05, 2015 5:15:12 PM 1 of 2
. SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PRE -ROOF
FINAL"*
C
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
•
BY
BY
RE -ROOF -FIRST 2,000
101-0000-42404
0
$49.31
$49.31
3/5/15
R3903
CASH
JOSE ROMO
AOR
SF
RE -ROOF -FIRST 2,000
101-0000-42600
0
$98.62
$98.62
3/5/15
R3903
CASH
JOSE ROMO
AOR
SF PC
Total Paid for RE -ROOF: $147.93 $147.93
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PRE -ROOF
FINAL"*
PARENT PROJECTS
BOND INFORMATION
Printed: Thursday, March 05, 2015 5:15:12 PM 2 of 2 CsrsTEMs
.. - �,a
:•A..•: . -
.'
Bin tff
, _
:Qty of La Qurnta.
wfaink..&T Safety Division
P.O: Boz 1504, 78-4.95 Calle Tampico .
Permit #_'
La Quints, CA 92253 - (7.60) 777-7012
J.
{. B uilding, Permit Application and Tracking;,Sheet
Y,
Project Address: = O ��
Owner's Name: «fes
A.-P. Number 4• % '
'Address_ s
Legal Description: , ;
cty Zip
ContractO cor.
t .� v syr er/ c
-Telephone
Project.Description:
,.Address*.*
�`�.�+'��•+
city st Zip:..
/L� / � 6'1��� ►�
Telephones
:.r;:.;> ` ' -;� . <N,:r -::"ale
L."Y
State Lic.'.#':
City Lic. P..
7_
Arch :,"En" gr �Dcstgncr:=
Address
/"
•
:j '� :+ �
Telephone.:
`J.C1Ji: �: qv vn;'!::-)-:'v:�:�:F�'i^:�'''iC:"4-r+':`:Ji
... -
Construction Type Occupancy:
`
"
; .j-: '--rJ ) c•. off"`.:;,;:.:
�� + '
State Ltcemo
# 1.. i
````"' ='` ' " r x
, ,•,., <.;
Project typc(circle one) New `Add'n: Alter- Repair D '
Namc;of Contactlsto�i� p
Sq�Ft, 1 : Q
#. Stories;
• ��
Telephone #of Contact'Person:
=•Estimated°Valucof Project, 0- r;-
WRITE <�r• ^ ;,
=v at 1 APPLICANT OO NOT. WRITE OW
#
-Submittal"i' r
•1Zcq'd
Reed.
'�� � i�, +1 TRACKING.
T-P);RMITI1 rS
.
" -
Plan Sets .,
Plan Clicck'submittcd- k f
Item` h�` 1,��� Amount
-Sir uc u Calcs.
' ` :'"
Rcvuwcd, ready for corrections
:
Cbee`kDepostt
z+
,
jai
•,
ati
apPlta`n Ate?
j ��}-Y�'
4A�rr
Balance"
Tfuss Calu.•,'.{�
�M
Called Contact Person
A�
{Plan}Chcck
t ;� ,
•,
I clic 24 Giles.
Plans pielted up
1
�4'
xConstruel�on
Flood plain plan
Plans
Mech'an t" w t
resubmitted .:t'
cal ,'
Grading plan
2" Review, ready for corrcetionsrssue
i'�_
E�ectrical� -r i
;R
-Subeon(actor List
Called Contact Person , ;,
Plumbing
..Grant Dccd
Plans piclitftp
11.0.A.Approval
ti
.Plans resubmiticd.
Grading
IN ROUSE:-
°'011'cvicw, ready for correctionsfissue'
Dcvcloper Impact:Fcc
Planning Approval `
"
Callcd Contact Pcrson •.,
A.T.P.P
f
`,Pub. Wks. Appr
Date of permit issue
School.Fc(s
Total Permit Fees