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09-0238 (RER)P.O. BOX 1504 78-495 CALLE'TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: (09-00000238 Property Address: 51489 AVENIDA VILLA APN: 773 -102 -010 -5 -000000 - Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 4200 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Professionals 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 agWicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: ' ( 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.). (_ 1 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 waii18nt in the Cnntrartnrr' Stwn I innngq Law.l. 1 _ 1 I am exempt under Sec. B.&P.C. for this reason I 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 Address: LQPERMIT Owner: JOSETINA HOLGUIN 51-489 AVENIDA VILLA LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Mq r R 16�M Date: , 3/16/09 ---------------- -------------------- -------- 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 come subject to the workers' compensation laws of California, and agree that, if d ecome su " ct to the workers' compensation provisions of Section 13-1161? �SO / 3700 of the Lab rCo hall fort ith comply with those provisions. CDate:1 `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 .a DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370b OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf Shi§-gggliGatign j5 MpIda. r,Prh nersnn at whnaa rarpian nnrf fnr , whose benefit work js 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 thi of(� ty. to ter upon the above-mentioned property for eaon_aurposes. .of te:— Signature (Applicant or Agent): (A)y ` Application Number 09-00000238 '------- Structure Information EXTERIOR REMODEL + ELEC/MECH CHANGEOUT -----' _ Other struct info . . ---------------------------------------------------------------------------- . CODE EDITION 2007CBC Permit . . . . . BUILDING PERMIT INV FEE Additional desc . Permit Fee . . . . 144.00 Plan Check Fee 46.80 Issue Date Valuation 4200 Expiration Date 9/12/09 Qty Unit Charge Per Extension BASE FEE 90.00 3.00 18.0000 ------------------------------------------------------ THOU BLDG 2,001-25,000 --------------------- 54.00 Permit . . . ELEC-MISCELLANEOUS INV FEE Additional desc . Permit Fee . . . . 82.00 Plan Check Fee 10.25 Issue•Date . . . . Valuation . . . . 0 Expiration Date 9/12/09 Qty Unit Charge Per Extension BASE FEE 30.00 10.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 1.00 37.0000 ---------------------------------------------------------------------------- EA ELEC SVC <=600V/<=200A 37.00 Permit . . . MECHANICAL INV FEE Additional desc . Permit Fee . . . . 81.00 Plan Check Fee 10.13 Issue Date . . . . Valuation 0 Expiration Date 9/12/09 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 18.0000 EA MECH FURNACE <=100K 18.00 1.00 33.0000 ---------------------------------------------------------------------------- EA MECH B/C >3-15HP/>100K-500KBTU 33.00 Permit . . . PLUMBING INV FEE Additional desc . Permit Fee . . . . 105.00 Plan Check Fee 13.13 Issile narP Valuation 0 Expiration Date 9/12/09 Qty Unit Charge Per Extension BASE FEE 30.00 LQPERA11T Application Number 09-00000238 Permit . . . . . . PLUMBING INV FEE Qty Unit Charge Per Extension 3.00 12.0000 EA PLB FIXTURE 36.00 1:00 15.0000 EA PLB WATER HEATER/VENT 15.00 1.00 6.0000 EA PLB WATER INST/ALT/REP 6.00 3.00 6.0000 EA PLB GAS PIPE 1-4 OUTLETS 18.00 ---------------=------------------------------------------------------------ Special Notes and Comments REMODEL TO THE EXTERIOR OF RESIDENCE: WINDOW, HVAC, WATER HEATER, ELECTRICAL SERVICE CHANGEOUT. REPLACE WATER AND GAS PIPING TO ACCOMMODATE RELOCATED FIXTURES. ADDITIONAL'FEES HAVE BEEN ASSESSED FOR WORK BEGUN WITH OUT PERMITS. CODE CASE NO. 09-1578. 2007 CALIFORNIA CODES. March 16, 2009 10:51:43 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN.(SB1473) 1.00 ENERGY REVIEW FEE 4.68 Fee summary Charged Paid Credited Due Permit Fee Total 412.00 .00 .00 412.00 Plan Check Total 80.31 .00 .00 80.31 Other Fee Total 5.68 .00 .00 5.68 Grand Total 497.99 .00 .00 497.99 LQPERMIT K K WAWO Gv�w WT CERTIFICATE OF COMPLIANCE:. RESIDENTIAL (Page) of 4) -CF-IR -Project Title V A Date Project Add ress Building Permit# Documentation Author Telephone Mm Check Date •beld Check /Date Compliance Method (Prescriptive) Climate Zone Enforcement Agency Use Only ✓ Alternative Component Package Method: (check one) C D (Alternative) Package C and Package D choices require HERS rater field verification or dilaa or gnostic testing (see CF -1 Re 3) For Package D Alternative see Appendix B Table 151-C Footnotes 1-14 GENERAL INFORMATION Jotal Conditioned Floor Area (CFA) .-' fte Average Ceiling Height. Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-0 — (5%X CFA) ft Maximum Allowed Total Fi'mestiation Products P le 151-B or 151-C — (20% XCFA) *"'E]Buildin Type: Single Family Multifamily Addition Alteration Building . — (If adding fenestration fill out WS -0 Fenestration Maximum Allowed Area WorkSheetand see Section 8.3.2 for Additions and 8.3.3 for Altwations.) Number of Stories -Number of'Dwelling -Units: 'Floor Construction Type:r Slab/RaisgdLEloor (circle one or both) Front Orientation.orth / SouthCEaO N I West / All Orientations (input front orientation in degrees from True North and circle one). RADLANTR BARM (required in climate zones 2,4,8-15) OPAQUE SURFACES INCLUDING OPAQUE DOORS' Component Type (Wall, Root Floor, Slab Edge, Doors)_ Frame Type (Wood or Metal) Assembly U - factor (for Cavity Continuous. wood . , metal Insulation insulation frame and mass R -7 -Value R -Value assemblies)' Joint Appendix IV Reference Roof Radiant Ba..rier Location/Comments Instilled (attic, garage, Yes :)r No typical, etc.) A I i—Ar 7\ 0-- T A &11 guteuvii i v -z, I v..3 anu IN .4, W111M IS tne basis tor the U7tactor criterion. U -tactors; can not exceed Prescriptive value to show equivalence to R -values. 'CITY OF LA-QUINTA BUILDING & SAFETY DEPT. .APPROVED.- IF RCONSETRUCTION DA Ba Residential Compliance Forms March 2005 �4T-f✓ ij�k.-�r/ CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) a CF -1R Project Title Date FENESTRATION PRODUCTS — U -FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED. AREA WORKSHEET WS-4R—must be included for New Construction, Additions and Alterations. Fenestration #/TypeJPos. Exterior (Front, Left, Orien- [U�-factor' Shading/Overhangs6• 7 Rear, Right, tali_ on, Area SHGC ✓ box if WS -3R is S li ht N, S E, W' 00'-factorz Source? SHGC' Sources' included —ZX0V1UU rub 13 v -� - - ❑ 1 i Cl[Vllohtc �.,•. nn.. ..1.•a°a ._ {7 )..-a z_ � r__ _ ❑ _ ---..b �..•,w.......v.a oaa.0 as uac—Yur�utJ arc ulwa to ule west oI uiwo in any Qtrecnon when the pitch is less than 1:12. See §151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R- 5) Indicate source either from NFRC or Table 116B.. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -311 to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. . . I3VAC SYSTEMS l 3Uq4 U %Jwwt ( *TTEV4 TV1FCw— Cooling Equipment Minimum Type and Capacity. Efficiency Duct Location Duct Thermostat Configuration A/C heat um eva ..cooli SEER or EER attic etc. R -Value a litoapackage) L Residential Compliance Forms March 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -IR Project Title Date 4SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for which he following. are required. Alternative to Sealed Ducts and Refrigerant Charge /TXVs.(See Package D Alternative Package Features for Pro'ect Climate Zone in the RM Appendix B Table 151-0 Fnnt„ntFt 7_1 A OR - - --- For additions and alterations, -duct systems that are not documented to have been previously sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ,ACM Manual and duct systems with more than- 40 linear feet in unconditioned aces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WA,rVI2 TWA 9r`YNTr• rvr•rnx rci Distribution' T e 0 Sealed Ducts all climate zones Installer testing and certification and HERS rater field verificationrequired.) O TXVs, readily accessible (climate zones 2 and 8-15 only) Tank staller testing, and certification and HERS Rater field verificationrequired.). 0 Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field Input' Tank (W or Capacity verification r uired. D nu Alternative to Sealed Ducts and Refrigerant Charge /TXVs.(See Package D Alternative Package Features for Pro'ect Climate Zone in the RM Appendix B Table 151-0 Fnnt„ntFt 7_1 A OR - - --- For additions and alterations, -duct systems that are not documented to have been previously sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ,ACM Manual and duct systems with more than- 40 linear feet in unconditioned aces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WA,rVI2 TWA 9r`YNTr• rvr•rnx rci Water Heater Type Distribution' T e Number instem Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water beater per dwelling unit.. If the water heater is a storage type, 50 is the Energy gallons maximum capacity and recirculation system is o not allowed. Tank Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No heating Distribution water calculations are required, and the system complies automatically. Input' Tank (W or Capacity Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved D Alternative Water Heating table. In this case, the Performance Method must be used and muss be includedin the TykJFuel Cc ` Ql �c�tri submittal. in S stem Check box to verify thata time control is required for a recirculating system pump for a iystem serving multiple Efficiency . unitsRvetome R -Value ` Water Heater Type Distribution' T e Number instem Rated Energy Factor' or . Thermal Efficiency.Loss0/ Tank Water Heater Distribution Number Input' Tank (W or Capacity Factor' or Thermal Standby' External Insulation TykJFuel Cc ` Ql �c�tri a in S stem Btu/hr) Wlons Efficiency Loss % R -Value ` 2,P l glee. I. Water Heater Type Distribution' T e Number instem RatedEnergy Input' (kW or Btu/hr Tank Capacity dons Factor' or . Thermal Efficiency.Loss0/ Standby' Tank External Insulation '.R-Value 1 For sm t gas s .rage water heaters (razed inputs of less than or equal to 75,000 Btu/hr), electro resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greaser than 75,000' Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instaitaneous gas water ti heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation. (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are % �. inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B. Residential Compliance Forms March 2005 S . t CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -IR Project Title Date SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary) Indicate which special features are part of this project The list below only represents special features relevant to the Drescrintive methrui SPECIALFEATURES RE() G HERS RATER VERIFICATION (add extra sheets if necessary) indicate to the HERS Rater which credits, are pad of this project and need verification- ✓ Feature Required Forms if applicable) Description ❑ Metal Framed Walls CF -IR Refrigerant Charge 11 Radiant Barriers CF -IR .- -CF-6R part 6 of 12 1.1 Exterior Shades -WS-4R 0 Cool Roof N/A; Attach CRRC Label to Forms. 13 Dedicated Hydronic Heating Performance Calculation System R aired Attach Run to Forms. 13 Combined Hydronic System Performance Calculation Required;Attach Run to Forms. 0 GasCooling Performance Calculation Rwired. eq 0 Buried Ducts Indicate on building plans. 0 Kitchen Pipe insulation See Section 5.6.2 Distribution Systems in Residential Manual.' ❑ Multiple Water Heaters Per See Table 5-13 or use Dwelling Unit Performance Calculation and attach Run to Forms. 0 Central r Heating System Performance Calculation and 'Run Serving Multiple Dwellings attach to Forms. 0 Non-NAECA Large Water Heater CF. -IR See Table 5-13 or use 0 Indirect Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use 0 Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms' See Table 5-13 or use 11 Solar Water Heating System Performance Calculation and attach Run to Forms 0 Wood Stove Boiler Performance Calculation attach Run to Forms SPECIALFEATURES RE() G HERS RATER VERIFICATION (add extra sheets if necessary) indicate to the HERS Rater which credits, are pad of this project and need verification- ✓ Feature Required Forms Of applicable) Description 0 Duct Sealing CF -6R part 4 of 12 11 Refrigerant Charge CF -6R part 5 of 12 El Thermostatic Ex Panion Valve .- -CF-6R part 6 of 12 Residential Compliance -forms March 2005 Im I J INSTALL THIS SIDE I FACING INTERIOR for real life® CTURING LOCATIONS: MT. VERNON, OH • BEND, OR • STAYTON, OR RINGTOWN PA • CORSICANA, TX • YAKIMA, WA • HAWKINS, WI aNADA • TORONTO, ON, CANADA • SAINT APOLLINAIRE, OC, CANADA tem es of IELD-WEN, Inc, Omgm USA. 1W kon Es a mkmat drED*EK r. . k - n I. SKU# 487602 P INSTALLED RAI NS - 4500145,00 240V HW RC HT HS 3380133.80 20,,V HW RC 0.93 E.F. Made in Mexico; N C vo u � OlU9A��333 I EH ��i��N�� mus IIV 3K4I�� GAL 01261 I K , KW K H 010,9fll 3-71,3 P.O. Box 1504 LA QUINTA, CALIFORNIA'92247-1504 787495 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 submitted in your name listing yourself as the builder of the property improvements specified at We.are.providing you with an Owner -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 notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each. statement below to signify you understand or verify this information. I understand a frequent practice of unlicensed persons is to have the' pcoperty 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, may be 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 acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to r assume this responsibility. Uf3. I understand as. an 'Owner -Builder" I am the responsible party of record on the permit. I understand that'l may protect myself, from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. `--4'. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ,/pe its and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value Cof my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. C6_� ��6.I understand if I am considered an "employer" under state and federal law, I must register with the state and federal rnment, 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 nes -�- 7. [.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. �8. I 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. ,4(— 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ervice, 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.csib.ca.gov for more information about licensed contractors. {` i 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the ` rty legally and financially responsible for proposed construction ctivityTVI�.f l wing address: t11. I agree that, as the party legally and financially'responsible for this proposed construction activity, I will abide by all licabie� 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 other verification acceptable to the a enc is required to be presented when the permit is issued to verify the property owner's signature. Signature of roPerh er Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: 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 owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Bin # Permit # Project Address: 5 _ �/S City of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet ✓efl n CdA V) /49' Owner's Name: � iriti ,/ IVI n A. P. Number: Address: iJ 1" 10q Avet i i /(,z Legal Description: Contractor: PWtu b/ b u I -y" City, ST, Zip: % Qv� h A C 220' Telephone: 7&P--5Y.5-467,b RJ-b,9;-J,,0 Address: Project Description: ) A37/4 ( City, ST, Zip: Nr !ilQ��✓ Telephone: State Lic. # : City Lic. #: wi halo r✓J Arch., Engr., Designer: y 19/G S W Address: ` City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: Project type (circle one): New AdYn Alter Repair Demo Name of Contact Person:�ti# Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: (9D / —(a0 7q Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd- • Rec'd TRACKING PERMIT FEES Nft Plan Sets Plan Check submitted 3 Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechacical Grading plan 2'" Review, ready for correctionstiissue Electrital Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: 3.4 Review, ready for corrections/issue Develcper Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue L6 School Fees Totall Permit Fees Akv 0r? kv1,kd&,-Ak:y i v4v - ,y Q tit if V.,