12-0534 (MECH)P.O. BOX 1504
VOICE (760) 777-7012
7011 "
78-495 CALLE TAMPICO
FAX (760)
LA QUINTA, QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/14./12
Application Number: 00000534 ;-.�
Owner:
Property A_ ddress: 48497--VISTA-PALOMINO
DEAL JOHN F ,
APN: 649-540-005- - -
48497 VISTA PALOMINO
Application description: MECHANICAL
LA QUINTA, CA 92253
Property Zoning:. LOW DENSITY RESIDENTIAL
Application valuation: 21413
•.7
Contractor
Applicant: Architect or. Engineer-
GENERAL AIR - CONDITION Qril�@a�A
31170 RESERVE DRIVE ;
THOUSAND PALMS, CA 922 6
-(760)343-7488
Lia.' No.. 686310
^ -,
•�
y
' LICENSED CONTRACTOR'S DECLARATION • -
— — — — — — ---
- .. .WORKER'S COMPENSATION DECLARATION `
}, I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with .Y
I hereby affirm under penalty of perjury one of the following declarations:
• - Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
have and will. maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C20 License No.: 686310
_I
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is-
•
_
- ate. "ly :19,Siontractor: -- -
/
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 c
- - OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO- Policy Number Z071741501.
' following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to,, - ..
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
i^,
_ construct, alter, improve, demolish, or repairany.structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the.workers' compensation laws of California, -
Section
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of 111 ,
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or •
3700 of the Labor Code, I shall forthwith comply with those'provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
• '
anyapplicant 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
WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
_ Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
,,, and who does the work himself or herself through his or her own employees, provided that the
'DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
- one year of completion, the -owner -builder will have the burden of proving that he or she did not build or
w - -
improve for the purpose of sale.).
- APPLICANT ACKNOWLEDGEMENT • -
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a, permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions'set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)- -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I am exempt under Sec. , B.&P.C. for this reason
the owner; and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
-
-of La Quin ta, its officers, agents and employees for any act or omission related -to the work being
' - - - -
performed under or following issuance of this permit. '
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby -affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.)•
city and county ordinances and state laws relating to building construction, and hereby authorize representatives -
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name:
S' Agentl;
-
ature (Applicant or
'
- Lender's Address:
-
LQPERMIT
: Application Number 12.-000.00534
Permit- MECHANICAL
Additional desc
_.
Permit Fee . . . . 66.00 Plan Check Fee
16.50
Issue.Date Valuation . . . .
0
'Expiration Date 11/10/12
- .Qty Unit Charge Per
Extension`
BASE ,FEE
15.00
2.00 9.0000 EA MECH FURNACE <=100K
18.00
.2.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
33.'00'.
Special Notes .and Comments
HVAC.CHANGE-OUT:'INSTALL ,(1) 3 TON SPLIT
SYSTEM & (1) 5 -TON SPLIT SYSTEM,
-FURNACES, CONDENSERS, INDOOR COILS, 2010
CODES.
:
-----------------.----------------------------
Other Fees ----- BLDG -SIDS ADMIN (SB1473)
1.00
Fee", .summary Charged' Paid Credited
Due
Permit Fee Total 66.00 .00 .00"
66.00
Plan Check Total 16.50" 00 .00
16.50
: Other Fee Total 1.00 .00"_ .00
1..00
Grand Total .83..50 00. .00
83.50 '
LQPERMIT
CaICERTS - CF -1 R Registration,
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CONGRATULATIONS
Secure Home - - � r -
Your CF -IR -ALT -HVAC Registration is complete!
Abour'us You may want to print this page for your records..
Training ? Site Address: 4849
I7 VISTA PALOMINO (3 TON SYS).
La Quinta, CA 92253
CEC Registration: 212-A0024075A-00000000-0000
Rater Directory CF -IR -ALT -HVAC: CLICK, HERE TO DOWNLOAD i
.... _..........._._.....:_...__.: �. _..._.... '-- '-....._.._...__...._.....-...._.. --..._..................._...._._-.-.-.....-..... -_._._..._...._..............._-._.....:_................-...- ........ -'-' -.—..-.....-.......----
Porms Assigned Company: HARRISON ENTERPRISES INC
Membership Benefits Do you know your HERS Rater?
If you do, you may want to send this CF -SR to them.
.Events - CalCERTS Rater ID:
OR
Industry Partners My Rater Quick Select: —Select From Listi
Every CaICERTS rater has a license number.
"News If you need to find the rater by name Click HERE .to search our directory.
uSEND CF 1R TO HERSRATER;
To register for
our monthly
newsletter,
please click here. + [CLICK HERE] to do another
Copyright Oc 2010 CaICERTS, Inc. All rights reserved. Revised: January 11, 2010
[Terms and Conditions] [Privacy Statement] [Class Cancellation Policy]
CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630
Office:.916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787)
Fax: 916-985-3402 Contact Us
• BBB`y
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https://www.calcerts.com/public_cf1R.cfrn?project' id=187098 5/12/2012
Simplified Prescriptive Certificate of Compliance: 2008• Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:.
Date: -
Permit #:
48497 VISTA PALOMINO (3 TON SYS) La Quinta, CA 92253
City of La Quinta'
May 12, 2012
Duct insulation,
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
[]Package Unit '
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
❑ HSPF
[I R 6 (CZ 10-13)
Served by system
If
® Setback
not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1256 sf installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies:. 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. '
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection.and a copy given to the homeowner. At final,.the inspector verifies that the work listed on this
form was in fact the work completed by the installer: The inspector also verifies that each appropriate CF -6R and registered CF -411
forms (no hand filled CF-4Rs allowed) are filled out and sig ned.Beginning October 1, 2010, a registered copy of the CF -1R
and CF -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment.-- -
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25 -
•Condenser Coil and /or
CF, -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
Indoor
Furnace oil and /or
CFt4R forms: MECH-21 and (for split systems) MECH-25
.'
For Split Systems: Duct leakages 15 percent; RC, CCA <_o300 CFM/ton (Minimum Air Flow Requirement), TMAH-
r
Exempted from duct leakage testing,if:
'.,❑ is-Duct-system'was documented to have been previously sealed and confirmed through HERS verification, or
,
❑ 2. Duct systems with less than.40 linear feet in unconditioned space, or �•
3. Existing duct systems are constructed, insulated or sealed with asbestos,
04. The„system;w,ill not be Ducted (ie DucGlessrMini-Split System) (Also -Exempt from Refrigerr r)t Charge)
.,�.
❑ 2: New•HVAC System
Required"Forms rr F°'? �� `;;
. Cut in"or Changeout with"
.v sk ':�� C
CF 6R forms MECH 04, MECH 20-1(1HERS, and (for split sysx tems) MECH22 HERS, ann d
new ducts:' (all new
ducting all new
MECH 25HER5 x? �Yt°' r
CFAR forms MECH 20 and for MECH MECH-25 �
equipment) ..
split systems) .22, and
1 Vii. .� a a q;4 .K •�
., R,
For Split Systeniis:aDuct leakage
r6 percent, RC,. CCA >'350 CFM/ton, FWD,LTMAH, SIMS, and either_HSPP`&.?SPP.
For Packaged Units: Duct
leakage < 6 p center"
,,
1:13. New;Ducts with/orlwithout
Required Forms: . �.
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit ..
CF -6R forms: ME044',MECH-20=HERS systems)
and fors lits stems MECH-25-HERS
and/or indoor coil and/or furnace: -No or some
CF -4R forms: MECH-20and (for split systems) MECH-25
equipment changed.
r - .
For Split Systems: Duct leakage '< 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage'< 6 percent .
-
❑ 4. New Ducting over 40 feet
Required Forms:
_
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH=21
For split system or packaged units: Duct leakage < 15.percentt.' • - :, -
❑EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance. ” ' ' - .
• I certify 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. '
•'The design features identified.on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. .
Name: Danielle Garcia - Signature: Danielle'6nrciu
Company: HARRISON ENTERPRISES INC ti - • Date: May 12,2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 - Phone: (760) 343-7488
Reg: 212-AO024075A-0000000070000 Registration Date/Time:; 2012/05/12.15:10:56• HERS -Provider: CalCERTS, Inc.
.2008 Residential Compliance Forms •; '' + ''�� .. ! �,� ` - + `July 2010
c
CaICERTS, - CF -1 R RegistrationL
_ r
Page 1 of 1.
Public home ` ' • Danielle Garcia logged in [Logout]
'K , • - [Home]
CONGRATULATIONS
Secure Home ', - . 'y
Your CF -1R -ALT -HVAC Registration is complete! "
About Us `You -,may want to print this page for your records...
t • `48497 VISTA PALOMINO (HP.SYS);
} Training ;Site Address: La Quinta, CA 92253 -
CEC Registration: 212-A0024076A-00000000-0000
' Rater Directory CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
_....._......._..._..._.._..:..... _.._........._..............._.._....._......_....._._._.....__._.._... .._............_....-----=-- --- - ...._.._. _._._.._... ............................... -.._....---...._._._..._...__..._....._.._..
Forms Assigned Company: HARRISON ENTERPRISES INC ,
.
Do you know your HERS Rater? r
Membership Benefits- �• ` .If you do, you may want to send this CF -1R to,them.
Events CaICERTS Rater ID: F`
��. OR _
Industry Partners • My Rater Quick Select: Select From List i +
Every CaICERTS rater has a license number.
News If you need to find the rater by name Click HERE to search our, directory.
`ND CF -1R TO HER
SES=RATER
..,:k <a„„„,in..,.E.,z
To register for '
our monthly
newsletter,. `' :' j - [CLICK HERE] to do another
please click here: r F '
_ Copyright (c) 2010 CaICERTS, Inc. All rights reserved. Revised: January 11, 2010
' [Terms and Conditions] [Privacy Statement) [Class Cancellation Policy)
CaICERTS, Inc.', 31 Natoma St Suite 120, Folsom, CA 95630
Office: 916-985-3400,Toll Free: 877 -HERS -11811, (877-437-7787)
Fax: 916-985-3402 Contact U's —
Ile
BBB
Al
• .. r V �' � - .j, _ ' `Sij• a •, • -
L el
https://www.calcerts,.com/public_ cf1R.cf n?project_id=
s
t
Simplified Prescriptive Certificate of Compliance: •2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
48497 VISTA PALOMINO (HP SYS) La-Quinta, CA 92253
City.of La.Quinta
May 12, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
'..Area
Thermostat.
[]Package Unit
® Furnace
❑ Indoor Coil
❑ AFUE °
® SEER • 13.0
❑ COP
® HSPF 7.7
R 6 (CZ 10-13)
❑ R g
Served by system
00 sf
® Setback'
If not already present, must be
® Condensing Unit
[I EER
❑ Resistance
CZ 14-15
+ !—
installed)
❑ Other
• .
1. Equipment Type: Choose the equipment being installed;. if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.,
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and.picks one of the appropriate Options.•Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and sig ned.Beginning October 1; 2010, a registered copy of the CF -111
and CF -611 shall also be on site for final inspection.
® 16 HVAC Changeout
Required Forms: • . -
• All HVAC Equipment
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or -
• Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH=25-HERS
• Furnace
CF -4R forms: MECH-21,and (for split systems) MECH=25 ,
For Split Systems: Duct leakagei<}15percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testinglf: -
,❑ 1;'Ductsystem was documented to have been previously sealed and confirmed through HERS verification, or
0'2. Duct systems with less than 40 linear feet in unconditioned space, or
3. Existing duct systems are constructed, insulated or sealed with asbestos `
❑',4. The system will not be Ducted'(ie ;DuctlessrMini-SpFlit- System.),(Also,Exempt_from.Refrigerrt Charge)
❑ 2. New HVAC System
Requifed Forms k` ll �?
• Cut Wor Changeout with
new ducts (all new
a; r '. fir" . r � . s F
CF 6R f6rmS,,MECH-04, MECH-20 HERS, and'(for split systems) MECH=22 HERS, and -
•,
ducting all new N>
MECH 25�HERS h a° ' ,fi4A �� r
z� ON
CF`4R forms IMECH-20, and (for MECH 22, 25
equipment)` :, x'�
split.systefns) and MECH
.'.. r "! .. Er" of":s ¢ k:sv>
For SplitSystems:hDuct leakage 6 pei ent, RC, CCA > 350 CFM/ton, FWD;,,T , STMS, and either HSPP of PSPP
For Packaged Units: Duct leakage::' 6 percent _ �' j _•.
❑ 3. New,Ducts with/or without
Required Forms: ,
`
Replacement •.
• Includes replacing or installing all new
_
ducting and/or outdoor conde'nsingiunit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace'No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent;,RC,.CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent '
❑ 4. New Ducting over 40 feet
Required Forms: -
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
• I certify 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. I - .
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for. approval with the permit.application.
Name: Danielle Garcia - Signature: Danielle Garcia^,
Company: HARRISON ENTERPRISES INC Date: May 12, 2012',
Address: 31-170 RESERVE DRIVE STE A., License: 686310
City/State/Zip: THOUSAND PALMS/ CA/92276,-,. Phone: (760) 343-7488
Reg: 212-A0024076A-00000000-0000 Registration-Date/Time: 2012/05/12.15:11:57 -HERS Provider: CalCERTS, Inc.
2008 Residential Compliance'Forins" July 2010
„ f I Ei, r .
Work Order
GENERAL AIR CONDITIONING
www.callthegeneral.com Job No: 132945
' 31170 RESERVE DR
THOUSAND PALMS CA 92276
' . 760-343-7488 FAX: 760-343-7494
LIC# 686310 :.
Service At: Customer # 107707 Bill To: Customer # 107707 Rating;
DEAL, JOHN 760-777-9786 HOME DEAL, JOHN'
48497 VISTA PALOMINO 425-417-9217: CELL 8833 NE 36TH ST 425417-9217 CELL
LA QUINTA CA 92253 YARROW POINT WA 98004 ,
Type: RES Source: ROLL . Open Balance:
• Zone: 3 LQ Map: 84944 Payment Method: DUE UPON
Subdivision: RANCHO LA QUINTA C( Credit Limit:
Skill: Tax: RIV • Installation Customer .
Directions -
Instructions BRIAN SOLD 3TON XC21 UPFLOW COMPLETE
AND 2TON HP XP21 WITH CBX32 AIR HANDLER COMPLETE $21413.00 COLLECTED $2000.00 DEP VISA
$19413.00 DUEUPON COMPLETION $2000.00 LNX AND $725.00 IID REBATES (TOTAL) LTO ANTHONY
CONFIRMED INSTALL APPT FOR 5/12 AFTER 11AM CALL CLIENT IF MUCH LATER THAN ill AM
RE;NEW TIME --ANNE
Work Sugg }
Work Done
4
Employee TaskCode
Scheduled Time ,
Call Info
DINO
Job Info
MARTIN'
Call No.: 132945
Booked by: Anne.
.Job No.:
132945.
Taken: 5/11/12 3:13 PM
Type: GASAC
Booked Date: 5/12/12
Class:
REPLACEMENT
Warranties ,
Taken by: Anne
Scheduled: 5/12/12 - 8:OOAM
Sched by: ' AMBER
Type:
GASAC
'
Cust PO:
Pri Level: 5
3
Ld Src: `
TECHM
SalesPerson:' BRIANW
Eq Age:
LS Ref:
IOHPB24IOP
* c
: Loc: CASITA T
Contact:
Size:
Equipment:
COND. LNX.*
J
,
Filters: 1 15201
Assignments
4
Employee TaskCode
Scheduled Time ,
DINO
7:56:00 AM
MARTIN'
8:00:00 AM ' •:
f -
TIM
11:00:00 AM
JAITH
11:00:00 AM
A
Equipment
Warranties ,
Type. Sys Mfg
Model # Serial # ;
Age . • ' Type Parts Ends Labor Ends
F
COND ' LNX
12ACB365P 580IC18153
'
Filters: 1 16251
t_
Loc:MASTER BEDRM
Size:
s
s`580IB23699.
COND LNX
IOHPB24IOP
Filters: 1 16251
: Loc: CASITA T
1
Size:
COND. LNX.*
XC1404823001. 58081306915
Filters: 1 15201
Loc: LVING AREA
; s
Size:
.
COND LNX '
HSB1504823002 58051,33906 •
tY
Filters:1 16251
Loc:KITCHEN
Size:
TAU LNX
G40UH48BO90XO2 5801A06084
Bin. #
Ci / Of .La QCuiilta
Buttdhlg a Safety Dw6n
P.O. Box 1504,78-49S Calle Tampico .
1a.Qutnta, CA 92253 -:(760) 777-7012
Building Permit Application, and Tracking Sheet
Pe,init #
�. ✓
Project Address: 4194IDn V1,GiA p(ljlOm t)
Owner's Name:. Ohl Qa I
A. P. Number.
Address:MA a %II OM. Mo
Legal Description:
City, ST, Zip: L Ch 1)2 2 S 3
Contractor. CQnval Air Cbvdtm f1 i
Telephone: ('•, ,
Project Description: C h ou� tQn
Address: �I �V PV.
City, ST, Zip:Moj�md Pd% C* q22.20-
s t s 5 3 n os
Telephone
State Lia #; City Lia #:
Arch, Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type: , Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 2 3 rj # Stories: # Units:
Name of Contact Person: .R�► i l�1
Telephone # of Contact PersonO K) YA3-1 408q
Estimated Value of Project: $ 21413. 0 0
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
''Ree'd
'[RACKING
PERMIT FEES
PIgn Sets
Plan'Check submitted•
Item
Amount
S"ctural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted '
Mechanical
Giadlag plan
Z'! Review, ready for correctionsrmue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
-
Grading
IN HOUSE: -
2" Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees