11184 (SFD)4,
P.O. BOX 1504
Building 44670 SEELEY78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
ACACIA
Address 1021 BASTAhCHURY
City Zip
FULLERTON 92633
Contractor
ACACIA CONST
Address
SAME
City lZip
No. 11184
BUILDING: TYPE CONST. • OCC. GRP.
P. Number
714 992-08SOILegal Descript
Tel.:
State Lic. City
& Classif. B 293954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State I
Lic. #
I hereby affirm that I a 1166n�sedfunder Prov§ r1� of Chapter 9 (commencing
fg ec)t f Diviso3'of th slnes�d Prot�s o s Code, and my license is in
/� i
OWNER -BUILDER DECLARATION 4 1 ii t
I hereby affirm that I am exempt from the Contractor's Lirense Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any, . city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 Dy 'any applicant for a permit
subjects the applicant to a civil penalty or not more than rive hundred dollars (E500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. N, however, the building
or improvement is sold within one year of completion, the owner-buider will have the burden
of proving that he did not build or improve, for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate oil
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) �..
Policy No. Company
. ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. r
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the.performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Project Description LOT 127 TRACT 2326$
PLAN B-2 PHASE III
Sq. Ft. 1732 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑' Repair ❑ Demolition ❑
Estimated Valuation
93,558
PERMIT AMOUNT
Plan Chk. Del:
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
612
•
Grading
Driveway Enc. �..,.
Infrastructure _ L; / 1/ 2105.06'
i'
TOTAL 3509.16
REMARKS
i
ZONE: BY:
Minimum qathaA Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
2ND FL. SD. FT.
POR. SO. FT. @
GAR. SQ, FT. @
CAR P. SQ. FT. @
WALL SO. FT. @
SQ FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ VAc
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus X$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
CITY OF u OUINTA
aof DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
564-2146
24-HOUR NCtTNIt f WgUWRCTIONS
Owrw ACACIA JUL Z ! 1992
Contractor ACACIA
Pa.. it Number 11184
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOBADDRESS 44670 SEELEY
TYPE OF INSPECTION DTE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING 5i I Z
DO NOT POUR CONCRETE UNTIL ALL A OVE AS BEEN SIGNED
CONCRETE SLAB L
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST F } L
HEATING 8 VENT- A/C
FIREPLACE
ROOF rVA
BOND BEAM
'
O.K. TO WRAP
'
GROUT O 4' O 8'
FRAMING
,L :�
INSULATION
Z cz�/
,.-
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER REPEDfANA
FINALS
ELECTRICAL
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING