PAT (14854) + RPL (14656) + SFD (14034)78750 Lowe Dr
14854
14656
14034
• LA Q
UINTA, CALIFORNIA 92253
1 hilliv Valdi2 ,
Mailing BUILDING:- TYPE CONST. ACC; GRP.
Address Same
City Zip
La. Quinta, CA 92253
Contractor
Apr 116a; Construction
Add ss.
flm B0;i 977'
Tel,
772-5058
La Quinta¢ CA 9225 v 3?1--3195
State Lic.City
& Classif. ' S29F' Lic. # `
Arch.,- Engr.,
Designer
Address I Tel.
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and .
effect.
3LGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (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 rile 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
or Improvement 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.)
XI, 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.)
❑ 1 am exempt under Sec B. & P.C. for this reason
f •
Date- / ° { Owner Ar {
WORKERS' COMPENSATION DECLARATION
1 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.)
Po1ic No. Company
Copy 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 ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date _ Owner
NOTICE TO APPLICANT: M, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked-
A.P. Number
Legal Description
Project -Description
Patio. Cower
ATTORNEY'S FEES.
FINAL DATE
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the -above information is correct.
Sq" Ft.ofl
Size, _
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair,❑ ' Demolition ❑
Validated by:
Signature of applicant —Date—
ateMailing
Mailing.Address
Validation:—
alidation:_City,
City,State, Zip
Estimated Valuation..
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
81A 00
Mech.
Electrical
Plumbing
S.M.I.
I' a
Grading
Driveway Enc"
Infrastructure
TOTALg$"°"
REMARKS
.
y/
ZONE: BY:
Minimum Setback.Distances
Front Setback from Center Line
Rear Setback from Rear Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback fr en Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES .UP TO ONE
HUNDRED,THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from y Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF. THE LABOR CODE, INTEREST, AND .
ATTORNEY'S FEES.
FINAL DATE
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.
_
Issued by:
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.
Validated by:
Signature of applicant —Date—
ateMailing
Mailing.Address
Validation:—
alidation:_City,
City,State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT.
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK e
ROOF DRAINS
DRAINAGE PIPING 1
4
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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
BOND BEAM
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR p 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
r
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
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING 16,
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
a
•
Ratter Size L Special
a�cc,
t tett Latch e —
cotttewome Lodger
see %Wflsg vote below
Spetlt� Soofltaa a shoothlwe or qeo Lattice
V
MEN
Site Y wt doll. Stsspa
rural-sl/s- antb
4-10 d smile or bolt ,f(
(� t
wetter spot I�.' .0 1 �0 `_ I•IA�- pest p ' 0 " _
opaclal-L= _ ..
overall lrcgt%!�Z,
Via. Car posts
1 FJAR. P` �Slvr
�•• t♦a,�aa 11,�,.�
�� "J
Ilio. ues1I"
�7/s"ICas` leg screws fate stats at la,e• tootle= 12'
Below trade
Coottotwu Ladner
S -strep or
�atlf
1 • N
t wttsor
_ 4=_ •` '� - Provide 1" �? won-eorr«tw.' bolts
learanc plate
ost To i' 6- - •��IISI
1 l -.. • • I�. i
Joist Meager or solid Slocilag Concrete i ,. •, - ��tl'-
Sail Ssfter to Blocking �� .1 ;. jilt
i
All UWV- w 4- li d nail..: bole ;:,• , y" y+ �
>GX 03 TDP!•. 70 ' . . • N trate ~'v • • ill r .
Marurei XJ== lobed 4eners Ir is esac.
CME T
46. �' �' Ifetils�l► _
`� � L�
; � `1� tbugLs iii !4.1
S JMM SPAN WUCZ � m � dee span SO" 'iAla
t5 20-:0 1 `R 'ti +R 1 .R♦ •► � .� � ' .
(feet s SLChas) F• �'� F�. '-
k b h �-••••17' y,2 11'
bcd 16' o.c. 11-2 10-8 7-11 [-) W 1s10... • • • -20. V• t4
2e' 9-6 s—/ 6-5 N S-2
2x5 u" o.c. 17-10 17-5 3-0 0• eta a
13-7 1"til0..... 11' bap ly'
16' 16-7 15-1 1-1 11-1
2l' 11-3 12-� s<-2 !-7 7-1
32' 10-10 >-11 77-6 7-i
2x4 16' 2l -S 1l-10 11-10 11542t' 17-6 16-3 12-1 12-5
M
Riafirq Note
- S -S a• toad shakes 6/12 pitch 11/12 girt. pitch %= h 101
felt tstd`layt CUSS A
10od, mpuci*:or. t_-,Sles 4:12 pith 11/12 ori..
S -i pitch oath 150 felt aide_ layl . Class A
12' - 10-5 11-0 104
10-2 7-6
C. Salt LT rolled serof side to dra_..
d. kcit r=f 1/12 atax zs- patch.
TYPICAL PNTW = R
• �`�� Cv u�GV
iC250 to 3 (F!2,87j
10-2 7-6
C. Salt LT rolled serof side to dra_..
d. kcit r=f 1/12 atax zs- patch.
TYPICAL PNTW = R
• �`�� Cv u�GV
iC250 to 3 (F!2,87j
P.O. BOX 1504
Building 78-750 , Lowe fir. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner Phil Valdez
Mailing aaxde
Address
City Zip Tel..
Laa Quiata, CA 92253
Contractor
Razo Pools
.Addie _ _ • . .
V22- 56 Bdjstbra' Ct.
City Zip f Tel.'
.,.ndi^, CA 92201 347- 1617
State Lic. a City
& Classif.. C5.3 5739.3 Lic. # 2638
Arch., Engr.,
Designer
Address Tel.
City 7Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000) of Division 3 of the Business, and Professions Code, and my license is in full force ands.
effect.I/--
"_?
SIGNATURE'S ) DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the. Contractors License Law for the following
reason: (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 ctvfl penalty of not more than five hundred dollars (5500). -
❑ 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 or. 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
or Improvement 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.)
•OLam 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 of
Workers 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.
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 twbecome. subject to the Workers' Compensation'
Laws of California.
No. 14656
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Pool anti Spa
Sq. Ft. No. No. Dw.
Size Stories - Units
New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑
Estimated. Valuation $131,,000.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 14-4.00'
Mech. 24.00
Electrical',,..
Plumbing 27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 333.60
REMARKS
Ze Owner `
7/CE TO APPLICANT: h, ager making this Certificate' of Exemption you should become ZONE:' BY:
subject to the Workers' Compensation -provisions o? the Labor Code,' you must forthwith• Minimum Setback DlSfanceS:.
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center Line -
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND i
SHALL SUBJECT AN EMPLOYER- TO CRIMINAL PENALTIES ANDCIVILFINES UP TO ONE. Side Street Setback fromentef Line
HUNDRED THOUSAND DOLLARS, ($100.000), IN ADDITION TO THE COST OF COMPENSATION, Side' Setback op rty Line—
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST; AND
ATTORNEY'S FEES. I /
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPEC IV
expiration it work thereunder is suspended for 180 days. 1 i
I certify that I have read this application and state that the above information is correct. Issued by: Wtee� C'PErmlt
1 agree to comply with all city and county ordinances and'.state laws relating to building • C
construction, and hereby authorize representatives -of. this city to 'enter the above-.
mentioned property for Inspection purposes. Validated by: Q '4w)
Signature of applicant Date j�
Mailing•Address Validation: \�
City, State, Zip
\ r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SQ. FT. ®
SO. 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
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
"DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
SO.FT.GAR ® V4c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [PL.K.FEE
CONST. FEE JELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING '-CLECTRICAL ' J HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING J1 P UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
v
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC QAkK ROUGH WIRING
"DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
I d9
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING
� 3
Y/
L C
�✓ V
/fin
V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
t- x
CITY OF LA QL INTA
BUILDING & SAFETY DE ARTMENT
r�
CONDITIONALLY
ACCEPTED FOR CONSTR f"TION
SUBJECT TO INSTALLATION J f
D `
AND ALL APPLICABLE CO ES
4- DA ff
BY
.V",
POOL AREA TO BE ENCLOSED E.. B
MINIMUM 5 FT. HIGH
ALL GATES TO BE SELF-CLOSIN
AND SELF -LATCHING.
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4
y i i iy i Lr� Ll V 1 1V 1 ��
Contractor ,Cc 2_0 Rda �S Address
Owner Dc,_'i Job Address tp
This form shall be posted on the job with the Building Inspection Card at all times in a
conspicuous place. It is the* responsibility of the General Contractor or the Owner/Builder
to monitor the sub -contractors that are on this list are the same persons performing the
work. Any changes of this list must be approved by the City of La Quinta Department of
Building and Safety prior to work being performed by a changed sub -contractor. Failure to
comply will result in a stoppage of work and/or the voidance of building permit.
TRADE SUB -CONTRACTOR NAME CONTRACTOR'S WORKMAN COMP. CITY BUSINESS
LICENSE NO. NO. ON FILE LICENSE NO.
GRADE/ 3 F �I ��r LOf /3 lvw
EXCAVATE
PIPELINES -
CEMENT/
FOUNDATIONS
CEMENT/WALKS
& DRIVES
ASPHALT
FRAMING
STEEL/ 5�f3g5�.
STRUCTURAL
MASONRY
PLUMBING PCC
LATHING
DRYWALL
PLASTERING
P� u
LES
HVAC
ELECTRICAL
ROOFING
SHEET METAL
FLOORS
GLASS/
GLAZING
INSULATION
SEWAGE DISP
,PAINTING/
DECORATING
N
TILE
1r
CABINETS/
INSTALLATION
ORNAMENTAL
METAL
Building
Address 78-750 LoweDrive
Owner Acacia Construction
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailin
Address 8141 E. Kaiser Blvd. 4310
City Zip Tel.
Anaheim,. CA 92808 (714) 282-580
Contractor
Same
Address
ty IZip I Tel.
State Lic.B_1 293954 (city 1612
& Classif. Lie. #
Arch., Engr., Design
Designer
Addrtei351 Irvine Ave. Te(714) 641-1.50
cit�anta Ana H4`Rts, CA 9015�
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000) 10
of D1�71sion 3 of the Business and Professions Code, and my license is in full f ce andc7t
-tffecl. cXIN t`./� � 1 n-K+`� C, „ 2 _C1 —r 4
1GNATUFE 7: DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyXffirm that I have a certificate of consent to self -insure, or a certificate of
Worker's pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Company
opy 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 or Exemption you should become
subject to the Workers' Compensation provisions or 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. 14034
BUILDING: TYPE CONST. VN OCC. GRP. R3
A.P. Number 604-232-039
Legal Description Lot 169 Tract 23268--3
Project Description $FD Plan C
Acacia Homes
Sq. Ft. 15591 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation ;98e445.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
536.78
Const.
635.00
Mech.
55 .50
Electrical
131.49
Plumbing
144.00
S.M.I.
9.84
Grading
20.00
Driveway Enc.
00
Infrastructure
2,215.02
TOTAL
REMARKS �_
n
l7
ZONE: BY.
Minimum Setback Distances: y
Front Setback from CenferTine--- — --
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
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEZS
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
ROUGH PLUMB. 0
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
I POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FOUND. REINF.
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
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
BOND BEAM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE ---JCONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING Q ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE O
ROUGH PLUMB. 0
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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. S
FRAMING /
FINAL INSP.
ROOFING / /
!
'
4
•y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
' LA ING Z L
MESH
INSULATIONISOUND a
FINISH GRADING
FINAL INSPECTIONzz
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL