7836 (SFD)9 TA
Building
Address
uwner
Acacia Contructiort
Mailing
Address 2022 Bastanchury
City • Zip Tel.
Contractor
Address
IZip ITel.
State Lic. City
& Classif. I Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Arcn., tngr., I
Designer
Address Tel.
CityI Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaYl am licensed under proykIions of Chapter 9 (commencing with Section
7000) of Division 3 o the Business and rofA'ssio Wcode, and my license is in full force and
effect. L`O
S GNATUR - /Y 'DATE
OWNER -BUILDER DECLARATION
I he eby affirm that I am exempt from the Contractor's License Law for the following
reasonr(Sec. 7031.5,Business and Professions Code: Any city, or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 by any 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, 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. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, 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 contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner t
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) '
Policy No. Company
Dopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) 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
I hereby 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.'
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 this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Dale
Mailing Address
City, State, Zip
No.
LDING: TYPE CONST.• OCC: GRP.:
07836
836
A.P. Number `Acaelw RR1ttfQQ
Legal Description Time+ PKAMA RTAn f1_2
Project Description tot 100
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT' ,
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback 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
Issued by:
Validated by:
Validation:
_INSPECTOR
55%4/9 Q -Permit
CCNSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
GH PLUMB. BONDING
HEATING (ROUGH)
STORAGETANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
• DRAINAGE PIPING
CAR P. SO. FT.
WATER SYSTEM
GRADING
cu. yd.
-Plus-XS-=$
WALL SO. FT.
LUMBER GR.
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP. 1� [ 1,$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
W'ATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER, B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
It
FINAL INSPECTION
Ruao
CERT. OCC.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES --[--MICRO
FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
�3
SETBACK
PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE G /� jkGROUND
GH PLUMB. BONDING
HEATING (ROUGH)
STORAGETANK
FORMS
EWER OR SE ROUGH WIRING.
DUCT WORK
ROCK STORAGE
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-XS-=$
LUMBER GR.
FINAL INSP. e r j,d
/&RAMING
FINAL INSP. 1� [ 1,$
n
ROOFING /--
(((
% / 90 ' ^
(�(Y xwc-,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I SULATION/SOUND- G G d
FINISH GRADING
It
FINAL INSPECTION
Ruao
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL