11-1282 (RER)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT.
' - Date: 11/29/11
Application Number: 11-00001282 Owner:
Property Address: Y52630 AVENIDA HERRERA ED CABRITA
APN: 773-294-007-17 -000000- 52630 AVENIDA HERRERA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 1800 — D
Contractor:
Applicant: Architect or Engineer: Owner NOV 2i9 2011
CITYOFLAQUINTA
--' FINANCE DEPT,
-------------------------------------------------------------------------------------------------
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 Professionals Cade, and m`y Licenseis 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
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the 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, d who contra is fo the projects with a contractor(s) licensed
pursuant to the Contractors' State Licens w.l.
1-1 I am exempt under Sec. B.&P.C. o this [on
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: n
Lender's Address: Y
LQPERMIT
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 the work for which thiLis sued, I shall not employ any
person in any manner so as to ome s ct to a wpensation laws of California,
and agree that, if I should beco subj t the rkeation provisions of Section
aa3700aof the Labor Code, I shall rthwi h mply ith ions.
Nal ASI, D
e: {applicant:
WARNING: FAILURE TO.SECURE WORKERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALT S 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 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 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 ermit, or cessation of'work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a infor do is q r ect. agree to comply with all
city and county ordinances and state laws relating to buildin c nstru ion, nd h by a horize representatives
oft ' ounty to enter, upon the above-mentioned property f mspecti n p rpose
Date. .1- Signa re (Applicant or Agent):
Application Number . . . . . 11-00001282
Permit . . . BUILDING PERMIT INV FEE
Additional desc .
Permit Fee . . . . 82.00 Plan Check
Fee
26.65
Issue Date Valuation
. . .
. 1800-.
Expiration Date 5/27/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
13.00 4.0000 HND BLDG 501-2,000
52.00
------------------------------7---------------------------------------------
Special Notes and Comments
REPLACE 4 SINGLE PANED WINDOWS & 2
SLIDING GLASS DOORS..INVESTIGATION FEE
ASSESSED PER 1997 UNIFORM ADMINISTRATIVE
CODE §304.5 FOR WORK BEGUN WITHOUT
BUILDING PERMIT. 2010 CODES.
-----------------------------------------------------------------------------
Other Fees . . ... . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
2.67
Fee summary Charged Paid Credited
Due
------------------------------------=----------
Permit Fee Total 82.00 .00
----------
.00
82.00
Plan Check Total 26.65 .00
.00
26.65
Other Fee Total 3.67 .00
.00
3.67
Grand Total 112.32 .00
.00
112.32
LQPERMIT
Prescriptive Certificate of Compliance: Residei
Residential Alterations
Project Name:
r '
Climate Zoon;—N
CF -IR -ALT
�
Pa e 2 of 5
N of Stories
/. Indicate the type of assembly to include: Hollow Unit .Nasonn: Walls. Solid Unit .Ilason"Y. Solid Concrete Walls, Etc. Additional assemblies can
befound Reference Joint Appendix JAJ. .
. This is the U -Factor based on the thickness of the assembly= in inches.
. The R -value of the insulation to be added on the interior or exterior of the assembly.
The Calculated R -Value is the R- value of the furred out section of the assembly.
E-6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JAJ. The equation is the inverse of Colum
added to Column I. Column K is the inverse from column J.
7*. Insert the calculated U- actor value on to the Opaque Surface Details in Column J
FENESTRATION PROPOSED AREAS
KReplacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C The Tota! Fenestration and West facing Area requirements are not applicable.
❑ Adding 50ft or less of window area -Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C
❑ Adding more than 50ft2 of window area — .A'ewly installed windows shall meet the (1 -Factor and SHGC Value and the Fenestration
Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF- IR -ALT
Orientation
Fenestration Type and Frame
(North. East. PropsedAreaMaximum Maximum NFRC or Default
Window Glass Door or Skylight)
South, West) ft U-factor2' 3 SHGC- 3.4 Values.
V'Y'L 1C)o\.r
Li/so 0,v 0 -X3
Noert4 36' i 10 r O - a-3
tosLS
ati`i on,so '1� �� r rr r K66' , �j O - Z
West Fenestration Area
7-
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50016 glass. the fenestration
area may be the glass area plus a -2 inch frame - around the glass.
2. Enter value from Component Package D Requirements in Table 151-C.
3. Actual fenestration products installed and as indicated in CF -6R -ENV' Form shall be equivalent to or have a lower ( factor andfor a lower
SHGC value than that specified on the CF -I R ALT Form.
4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading.
5.ffapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC *'Default - values found inlable 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS (Conoete if more than 5W offenesiradon Is added
A
B C D E F G
Allowed Existing Fenestration Total Area
CFA of Entire
% of Fenestration Area Fenestration Allowed Proposed Area
Dwelling
CFA Area Removed Area Added A x B) (E -D) + C
Total Fenestration Area
W)
.20
West Fenestration Area
(Required In .
.05 >
CZ's 2. 4 & 7 -15)
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glazing area removed cannot be "counted - twice.. In order to distribute the west glazing area removed to the other orientations
input the west glazing area removed in the Total Fenestration Area row, column A
3. Include the Proposed Area of the West facing fenestration in both Area columns below.
4. To meet compliance. the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Are,
Registration Number: _ _ Registration Date "Time: HERS Provider:
2008 Residential Compliance Forms
t
i
J
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations age I of
Project Name: Climate Zone N N of Stories
53-1, 2, o
General Information
Site Address: Enforcement Agency: Date:
Building Type O Single Family O Multi Family Circe the Front Orientation: N, E, S, W, or degrees
Conditioned Floor Arca (CFA): Project Type: O Alterations ❑ Envelope O Fenestration O Roof O HVAC
Replacement or Change Out ❑ Duct Replacement O Water Heater
NO lWis form Is not to be used for Newly Constructed BudldittPs or Ad&dons
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
O Opening of framed cavity alone -'Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A -C and enter mandatory insulation value in Column H.
O Replacement of entire assembly - Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A - J.
No(t: For furred asumblies. accounting for Continuous Insulation R-vatue• see Page JAI -3 and Equation 4-1. For ealcutotwC furred walls use the Ates and
Famng Construction table below.
1. For Tag,71) indicate the identification name that matches the building plans.
2. Indicate the Assembly Nance or type: RooflCeiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Sit: For
Wood Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thicitness for mass in inches or Spacing between framing members enter: 16 "or 24 "OC: or Other for all other assembly description
such as Concrete Sandwich Panel, Span&el Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone: enter the Standard U facior from Table 151-B, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed arssembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing: otherwise, enter -0
7. Enter the Continuous Insulation R -value for the proposed assembly: otherwise, enter " 0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly (1 -factor in Column J
9. The Proposed Assembly U factor, Column J. must be equal to or less than the Standard U factor in Column E to comply.
Furring Stris Construction Table for Mass Walls Ottl
A B C D
Opaque
A
Surface Details For the furred
i3 I C
portioned of Mus Walls we Furring Strips
D E F
Construction Table below.
G N l I
J
Proposed Properties of Masonry and Concrete
Pre
Standard
Values From JA4 Table
Walls From Reference
T�
iD'
Assembly Name
or T
Framing
Material
and Size,
Thiclaress,
Spacing, U- JA4 Table
or Other' factor Numbers
Frartred Continuous JA4
Cavity Insulation Assembly
R -value R -Value' Cell Value
Proposed
Assembly
U -factor
No(t: For furred asumblies. accounting for Continuous Insulation R-vatue• see Page JAI -3 and Equation 4-1. For ealcutotwC furred walls use the Ates and
Famng Construction table below.
1. For Tag,71) indicate the identification name that matches the building plans.
2. Indicate the Assembly Nance or type: RooflCeiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Sit: For
Wood Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thicitness for mass in inches or Spacing between framing members enter: 16 "or 24 "OC: or Other for all other assembly description
such as Concrete Sandwich Panel, Span&el Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone: enter the Standard U facior from Table 151-B, C or D for each different assembly Name or type.
5. Enter the Table number that closely resembles the proposed arssembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing: otherwise, enter -0
7. Enter the Continuous Insulation R -value for the proposed assembly: otherwise, enter " 0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly (1 -factor in Column J
9. The Proposed Assembly U factor, Column J. must be equal to or less than the Standard U factor in Column E to comply.
Furring Stris Construction Table for Mass Walls Ottl
A B C D
E
F I
G I
H i J K
L M
Proposed Properties of Masonry and Concrete
Added interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 43.5 4.3.6 4.3.7
Joint Appendix
Table 4.3.13
Assembly
•
It°
c
' v ^ 8 " ^
n
Final
Mass
Name or
JA4 Table a
E
L
$ t t
Assemb
' Comment
Thickness'
Type?
Number' < >
a k 2
' < >
U -factor
Registration Number:
2008 Residential Compliance Forms
Registration Date. Time:
HERS Provider:
August 200
PrescH12tive Certificate of Com liance: Residential
C F-1It A,LT
Residential Alterations Pa e 5 of
Project -Name: Climate Zone # # of Stories
D-U—�b `�E+J ON A
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES 13 NO YES: In Climate Zones 2 and 9-16. if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)IDii and the newly installed ducts are to be insulated per §151(f)10.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
13 YES E3 NO YES: In Climate Zones 2 and 9-16. if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per § 152(b) I Di.
❑ YES 11 NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system. cooling or heating coil. or the furnace heat exchanger) the ducts are to be
sealed per § 152(b) I E.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
13EXCEPTION: Duct systems with kss than 40 linear feet in unconditioned space.
O EXCEPTION: Existing ducts,ysterns constructed, insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
0 YES ❑ NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler. outdoor condensing unit of a split system A/C or heat pump. cooling or heating coil. or the furnace heat
ICentral Fan Integrated (CFn Ventilation System and Fan Watt Draw
The ventilation requirements of § 150(o) do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
Q YES O NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced- the airflow and fan watt draw shall be verified Der G l52(b)ICi to meet the requiranents of § 151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Signature:
Company: Date:
Address: If Applicable ❑ CEA or ❑ CEPE
(Certification #):
City/State/Zip: Phone:
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the i orm tion provided to document this
building design on the other applicable compliance forms, worksheets. calculatio , plans d s ifica ons submitted to the enforcement
enc • for approval with this building permit application.
Name:
Signature: D
t
Company: Dat :
Address: License:
CitytState/Zip: Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: _ _ Registration Date Time:
2008 Residential Compliance Forms
HERS Provider:
August 2
FILO TTYARD:
20 FF.E'r
--idNm
---------------
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNEW S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosure's & Forms for Owner -Builders Applying for Construction Permits
MA RTNNT1 NQTiciR TO 1'R VVNED
Dear Property Owner:
An. application for a building permit has bees submitted in your name Iisting yourself as the builder of the property
improvements specified at
-W,e are providing you 'with an Owner -Builder Acknowledgment and Information veri€eatien Fom to make you awam of your
re sa�stbilities and pomble risk you may incur by haivi duspermit-it sued_ in your non as .the
Owner -Budder. We WW Rot issue a baiiding.pe resit untilewhave
r dead, initiated yatsrandegsburrdiag of each'[trsv4;OR,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute tTsis notice
unless You, the property owner, obtain the prior approval of the permitting authority.
MtLZ ZTOIVS• Bead and initial each smteirrentbef#wla signify you ar= or verb chis h-ifo> om
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builders'
ding permit that erroneously implies that the property owner is providing his or her own labor and material personalty. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlit person.
and his or her employees. while working on my property. My homeowner's insurance may not provide coverage for those
injuries- I am Willhully.acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my, property.
I understand bwklwg 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 assume this responsibility.
myselI understand as an "Owner -Builder" I am rite ' nsib" Ie party of record on theit. I understand that I may protect
f from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of Dory
1wn. .
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers a
is and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valt
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe
r'under. state and federal law.
6. I understand if I am considered an "employer" under state and fbdend law, I must register with the state and fede
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploym
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious fin=
risk
&7:1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family resideu
� Y
structures cannot legally build them with the _intent to offer them for sale, unless all work is performed by lim
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfon
under contract with a licensed general building Contractor.
L
I understand as an Owner -Builder if I sell the property for which this peraut is issued,..l may be held liable for any
ancial-or personal. bounce vastained by any subsequent -owners) that result from any latent construction defects in the
rpa".hipor materialserstand d may obtain: more information regarding niy' obligations as an "employee' from the' internal Revenue
, 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 (CSM at I- .
800-321-CSLB (2752) or www.csib.mgov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially yesponsibit foriogosed construction activity at the following address:
Sa(p 2j - -
I_i6
I agree that, as the party legally and fanaucially responsible for this proposed construction activity. I will abide by all
laws and requirements that' govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or c to any of the mformmtion I
fia0sr,ovided on this form.. Licensed contractors are regulated by taws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State Lioense Bond 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 -c ivil oowL It is also
important for you to understand that -if an uWieeosed Contractor or euployee of that individual or firm is ink while vt+m ing
on your property; .you may be bold liable fbr.damagm If you obtain a permit as Owaec-Builder and wisb to hire Conttaetors,
you will be renmrMo for vaifyiug v or not those Contractors are propedy licensed and the st1his of ftir wodcas'
oorntiion insurance oovemge.
Before a building permit can be issued, this form must be completed and signed by the property owner cad retained to
the agency responsible for bmdag.fto.geradt. Now A copy of dwMvVerq* owner's fam noosdaAW4 or
other verification ac [c to aeon , is to be presented when tho permit is iuwA to verify the property
owner's signature. , I
Signature of property owner Date: vv
Note: 7&e 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.
AUFHORL7.ATEON OF AGENT TO ACT ON PROPERTY O N t'S B� �V
Excluding.the Notioe to Property Owner, the oxmption of which I understand is my personal responsibility, I hereby authoriax
the following peraon(s} to act as my agents) to apply for, sign, and file the documents necessary to obloin an Owtter-Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed aboveand I personally filled out the al
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other venfwAtion
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 #. `
City 'of is Quinta.
Building 8t 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: (0 0 11J ,DA
Owner's Name: A
A. P. Number:
Address: Sa(o OA,Js�-1�A
Legal Description:
City, ST, Zip:
Contractor:'
Telephone0a1.
Address:
Project Description: ���� Cz C -4,s ;' ,i b--
City, ST, Zip:
Telephone:
// `� C- A6
State Lie. # :
City Lie.
Arch., Engr., Designer.:
Address:
City, ST, Zip:
Telephone:
}: «':':><" °
>,>,...: ;:.
'ikX:%v'f.Cij�'\Q 'fi:i �:.JJS F'M'}vy"$'�
��;�;,yx.g;;;,_;>.. �.{��;�.y�<• v�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lie. #:
Name of Contact Person:
Sq. Ft:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: ( Boo
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Caned Contact Person
Plan Check Balance
Title 24 Cafes.
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 cormcdonsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees