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BMCH2015-0065or 78-495 CALLE TAMPICO O.�i D VOICE (760).777-7125 LA'QUINTA,'CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/9/2015 Application Number: BMCH2OIS-0065 • Owner: Property Address: 53167 AVENIDA DIAZ KEN MASTER APN: 774041020 53167 AVENIDA DIAZ Application Description: MASTER/ADD HVAC 15SEER/8.7HSPF LA QUINTA, CA 92253 Property Zoning: Application Valuation: $5,000.00 Applicant: Contractor: BLAIR AIR INC DBA BLAIR HEATIN BLAIR AIR INC DBA BLAIR HEATIN 653 OLEANDER ROAD 653 OLEANDER ROAD PALM SPRINGS, CA 92264 PALM SPRINGS, CA 92264 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 Pro scions Code, and my License is in full force and effect. License Classy C20 C . License No.: 953427 Date / J Contra J' L k - 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).: ( 11, 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 ) 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 Name: Lender's (760)537-1120 Llc. No.: 953427 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 r which this permit is issued. J ave 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 bee sub to the workers' compensation provisions of Section 37�00 of �the Lab Cod shall forthwith comply with those provisions. Date: Applicant 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 corre . I agree to comply with all city and county ordinances and state laws relating buing construction, and hereby authorize representatives of this city to en r upo t mentioned property for inspection purposes. �1 . /i Date: � � / J Signature (Applicant or Agen[y—/— STATE OF CALIFORNIA �! ,ALTERATIONS - HVAC CEC-CFIR-ALT-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E `Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat. Required R -value Floor Area (sq ft) ❑ Packaged System Mkvaporator Coil N% AFUE COP ❑ R-6 (CZ 2, 8-13) Ducting Served by system Setback ,❑, �Sp•System Split ❑ Condensing Unit ❑ Compressor S Qlit J ❑ R-8' (CZ 11, 14, 15) Ducting I UCX�sgft (if not already Mini SEER fJ HSPF ❑ R-6 (all CZ's) Plenums present must ❑ Furnace ❑ Lineset1 1 EER ❑ R-5 or R7.5) Lineset° be installed) ❑ TXV HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled -out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. ❑ 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF111-ALT-02-E '. Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS' Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage (< lS%, or < 109 to outside, or seal all accessible leaks), Air Flow Z 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. -There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts3 CFIR-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.S8W/CFM), Air Flow ;-> 350 CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site foe Final: All New Ducts3 and one or more of the following CFIR-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: New ducting but less than All New Ducts3 CFIR-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (<_15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. ' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24); or Refrigerant Charge verification MECH-25 3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may.consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) ° R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over•1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-25/8", 2.5 -3T -2Y4", 3.5 to 4T -2y.", ST -4y." Contractor (Documentation Author's /Responsible Designer'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. lam eligible under Division 3 of the California Business and Professions Code to accept responsibility -for the information -on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). I . . 4. 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 CCR. 5. The building design features or system design features identified on this Certificate o Compliance are consistent with the information it provided on other applicable compliance documents, worksheets, calculation pl and specifications submitted the enforcement agency for approval with this building permit application. Responsible D A�Apy: igner Name: Responsible Designer Sig Date Sign 1/� license: ' 3Yz, vSv� Company : Address: G y/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy,Hotline at: 1-800-772-3300 STATE OF CALIFORNIA ALTERATIONS TO SPACE CONDITIONING SYSTEMS CEC-CF1 R -ALT -02-E (Revised 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF1R-ALT-HVAC) (Page 1 of 6) Project Name: ,A A4 r 6n -Date Prepared: 3-4715 A. GENERAL INFORMATION - 01 02 CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF1R-ALT-02 document for each dwelling unit. 06 07 08 01 Project Name: S�Iex-S: 1 02 Date Prepared: 03 Project Location:' 'Lo tie . i A Z 04 Building Type: 05 CA City: LA Q V j A 06 Dwelling Unit Name: 07 Zip Code: ZZ S-3 08 Dwelling Unit CFA (ft2): 09 Climate Zone: 30 Number of space conditioning (SC) systems AIV In this dwelling unit: B. Space Conditioning (SC) System Information - 01 02 03 04 05 06 07 08 09 10 SC System Identification or Name SC System Location or Area Served CFA served by this SC System (ft2): Is the SC system a ducted system? Installing a refrigerant containing component? Installing new SC System components? Installing more than 40 feet of ducts? Installing entirely new duct system? Installing entirely new SC system? Alteration Type: t vhi 1, �c� res 600 No /VO /Vo AIV Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA ALTERATIONS TO SPACE CONDITIONING SYSTEMS rNMr-M-) CEC-CF1 R -ALT -02-E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF1R-ALT-HVAC) (Page 2 of 6) Project Name: Date Prepared: C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib) of 02 System Identification or Name New Duct R -Value c <<First system of <<calculated Type C in Section field: if A09= CZ B above» 1-10, 12, 13, then "R-6."; else if A09=CZ 11, 14-16 _ then "R-8." Required Documentation: CF211-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R & CF3R-MCH-20-H — Duct Leakage Verification - Leakage rate compliance: <— 15%, or15 10% leakage to outside, or seal all accessible leaks Exceptions: Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 duct leakage testing requirements Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider: June 2014 STATE OF CALIFORNIA -ALTERATIONS TO SPACE CONDITIONING SYSTEMS M 11 NITaOl CEC-CFIR-ALT-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION -mss' .CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF1R-ALT-HVAC) (Page 4 of 6) Project Name: f� /� �� n Date Prepared: E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, F) 01 02 03 04 05 06• 07 08 09 10 11 System Altered Heating Heating Minimum Cooling Cooling Minimum Required Identification or Heating System Heating Efficiency Efficiency Altered Efficiency Efficiency Thermostat New Duct Name Type Component Typ'eI<n Value Cooling System Type Cooling Components Type value Type R -Value Q ' �5S 1 F4f 1/ /Z55 ISU�jS�, Un IV Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R & CF3R-MCH-20-H Duct Leakage Verification required. -Leakage rate compliance: 5 6%. CF2R & CF3R-MCH-22 Fan Efficacy Verification - CF2R & CF3R-MCH-23 System Air Flow Rate Verification -Compliance: Fan Efficacy <_ 0.58 W/cfm and System Airflow >_ 350 cfm/ton. - Alternative Compliance: CF2R & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification. .CF2R & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ2, 8-15). Exceptions: - Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements. Note: An "entirely new or replacement duct system" means at least 75 percent of the duct system is new duct material; and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA -ALTERATIONS TO SPACE CONDITIONING SYSTEMS "U_lm CEC-CFIR-ALT-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF1R-ALT-HVAC) (Page 6 of 6) Project Name: Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: �- - Documentation Author Signature: t-vSvr Company:Signature � NJ14 al p Date: f P6 Address:CEA/ fa 6�� d�ea���.7p- HERS Certification Identification (if applicable): City/State/Zip: ' I'-, S p—I ^ C/4 9'��b q Phone: 53 / //ZO 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 design identified 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. 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 registered 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 registered copy of this Certificate of Compliance is required to be included with the d cumen ion the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Company: DIA/,a Date Signed: -3 Address: O/eAN/,%r 'DD License: % City/State/Zip: pz:�i-44S' ,e� n� S C A Phone: 760 _5-- %'//ZD Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 t • ' • < '� E" Y �3 r� X �... � vk 4 �li{a� 4n,Rp� S � .f. '�:@ �� �>� xy.i �e�x i•'S� 0 ��. -.S P R� �;S E > Tz4"C' -.. ; �3y",S ,i kk N. „f 'FAID�DATEK ..a ... ._<DESCRIPTION�E <` ,gr�ACCOGtVT� a.;QTY nAMOUNT ct #ea,Ts w a�PAI{D�" BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Y"rsblr.aM1t'f,'P �' ^r^4,' f .,. i�`�!v;.4, 3w {lam£ 1 k','i—'rcg-!..4 PAID BY Er _' $ `Y . A.; HECK # BY `�T bz a - A-%, x, A...,x9;.,:- >,..._.., _....: w>a' _,n..3.> e...d;a,•`- cc.:l'.H,'�' £' �,.x hmxt.';9.- .5a r s :• s;� aCLTD �,, t .. Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 -' ' zAMp z -TS§y£ �,;3-.::-.4' ,..'r"�tF c"s. TbL-k''1iE.:';5`r"?Js3 .�`n-'�:,K�:q§.i. sYACC(QUNT< c }� 9 &'".. 3.' '.: �"b� ',>,,,,.$0.00 $1 .(5-'P'SL,a.'.,•..- PAID>DATE:: P,:. 3 ,. DESCRIPTION ? QTY AMOUNTqq w, PAID cc iT.Y � HVAC CHANGEOUT - SPLIT-SYSTEM 101-0000-42402 0 $72.52 $0.00 ry PK:,{;y_s%'k +i: .3're,::: iL:{. ,� 4:T o '3I .,P} #4. K ''..'{k!''i 't ^ & BY: t;,`RECEIPT#�";: .. CHECK . F: CLTD `§'T'Y 'vi*4P'.: rx� :'Y.'"......X3 .Y. S.�"a>�.72 t,.;.key`,a�ey �... kcsS'iy:x§^*i'A`�.?e. 3Ty?' n ACCOUNTE&§ "g`3 .+x . , QTYi41NI0UNT"? ix.,i�i Y' .wr' 'Sk.F:HI3fP .. F ��s . �h£rsy{'.:e"k'{y: -< 'PAID K .DESCRIP,TIONbr s `�i FPAIDDATE- HVAC CHANGEOUT - SPLIT -SYSTEM PC . 101-0000-42600 0 4$36.26 $0.00 t :4..rF•: r:,ra ::.. METO< bs:; Is:r-'XSfrx-'Su2' £'f C+dH.a:E- CK #[ `a4PAIDBY D BY .y.' 3wa'.­§.iR ,.E4.•:t:S,E f „CL�' ., Total PaidlorCHANGEOUT: $108.78 $0.00, 9 $ -. 4 +d4 !t•`e'�s DRIPTIONY§€��Y, A f "•�tihACCO,RU�}: Nb T4 i �av 'xY' bSA:wMi:�nS�F .. YP H.IfD'lP•Dy"A TEOUNTgp fki _..Cr r+� Qr%x TY� r@ham yfP'1t PAI:D: PERMIT ISSUANCE .101-0000-42404 0 „ $91.85 $0.00 METHOD�s M.: -i .r§�;.zri.'c.--;"-, i�,.�`z"ii�'''..,K #�> :• a: K'�' BY _��RECEIPT z.CHECK#€ :.•� ,CLTD Total Paid forPERMIT ISSUANCE: $91.85 $0.00 • 00 c 1 Description: MASTER/ADD HVAC 15SEER/8.7HSPF Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 3/9/2015 SKH Parcel No: 774041020 Site Address: 53167 AVENIDA DIAZ LA QUINTA,CA 92253 Approved: Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 178 Lot: 10 Issued: UNIT 18 Lot Sq Ft: 0 Building Sq Ft: 0' Zoning: Finaled: Valuation: $5,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT - 15SEER/8.7HSPF SPLIT SYSTEM [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. Printed: Monday, March 09, 2015 11:41:27 AM 1 of 2 SYSTEMS ADDITIONAL NAME TYPE NAME ADDRESSI CONTACTS_CHRONOLOGY CITY STATE ZIP PHONE FAX EMAIL APPLICANT. BLAIR AIR INC DBA BLAIR HEATIN 653 OLEANDER ROAD PALM SPRINGS CA 92264 ( Printed: Monday, March 09, 2015 11:41:27 AM 1 of 2 SYSTEMS Printed: Monday, March 09, 2015 11:41:27 AM 2 of 2 SYS7EM5 CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $0.00 SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $108.78 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE MECHANICAL FINAL" Printed: Monday, March 09, 2015 11:41:27 AM 2 of 2 SYS7EM5 Bin # City of La Quinta. Building &r 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: j 3 ((o� U� DIA2_ Owner's Name: K i A _ 2 A. P. Number: Address: �j ((� % V,. Legal Description: City, ST, Zip: L_.A_ C�IUINl'A , � Contractor: k� j t ' , N)! , f Telephone: p 'sr Address: O e A 7V e,� ]% Project Description: �o I e) N A City, ST, Zip: �-M N, S;) P_ l N S i C, A M11\J1 S 14-4e* M +0AT)D Telephone: : ;y y� I A 2 � A ' � C A N State Lie. #: City Lie. #: C-)... Q F� 0 /V\< Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lie. #: :„-:::<:<:;:::::,:..<;;;;:;.t:;:<>;s: ;:w:: uI<:i'IL::Wiiiirii}i3y Lif<%:>Y��v::,t;•'•: ;<:::::.;:t:;:;.•:•:•::Y. Construction Type: S 1 e Occupancy: Project type (circle one): New Add'n) Alter Repair Demo Name of Contact Person: Sq. Ft.: I # Stories: ! # Units: Telephone #,of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE i/ Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan Check Deposit Truss Caics.. Called Contact Person Plan Check Balance. Title 24 Cala. 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 ROUSE:- '"' Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees