07842 (SFD)Building
Address
Owner
4,4 Qu
P.O. BOX 1504
ALLE
78-59S Bradford Circle LA QUINOTACCAL FORNpIA 92253
18 Acacia Construction
Mailing
Address 1021 W. $aStenchury
City lZip Tel.
Contractor
City , lZip I Tel.
State Lic. 'I City
& Classif. zL l _ ;,,., , „ s Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 33 of the BusinesssundfPr , essions Code, and my license is in full force and
effect �/I
SIGNATURE .`"* - DATE
,/� OWNER -BUILDER DECLARATION
I hereti' 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 ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
❑ I, asowner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ACopy Is filed with the city. ❑ Certified copy is hereby furnished.
r -
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($too) 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: If, after making this Cerfificate of 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 it 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 Date
Mailing Address
City, State, Zip
�;l
No.
BUILDING: TYPE CONST. OCC. GRP.
078$2
A.P. Number Acacias Homes
Legal Description Tract 23268 Plan C-2
Project Description Wt 84
I
Sq. Ft. 927
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation
$1055"3
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
552.00
Const.
660.50
Mech.
60.00
Electrical
914.47
Plumbing
144.50
S.M.I.
7.42
Grading
Driveway Enc.
Infrastructure
-, 2378.99
TOTAL
3,927.88 'cr,f?_/ f'
REMARKS
t0
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 INSPECTOR
Issued by: Date 6/4/" Permit
Validated by:
Validation:
CCNSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SO. FT.
ROUGH PLUMB.
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SD. FT.
O
DRAINAGE PIPING
WALL SO. FT.
DUCT WORK
DRINKING FOUNTAIN.
SO. FT. ®
/a
URINAL
ESTIMATED CONSTRUCTION VALUATION $
METER LOOP
WATER PIPING
NOTE: Not to be used as property tax valuation
OTHER APPJEOUIP.
FLOOR DRAIN
MECHANICAL FEES
GAS (FINAL)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYE14
GROUT
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR ® V4c
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
SETBACK
UND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ,
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSVclzfTfo41'
SEWER
O
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �j
/a
GAS (ROUGH) i t
�v
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. / Vjqa / [�
/
FRAMING
FINAL INSP. Gy /(o
l `�
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION C � V l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
JUN -07-191 FRI 09:22 ID:SWAN CATHEDRAL CIT`r' TEL N0:619 324 6091
wrbf
409W(V
R.O. sox Ism
16100 GIILIf ESTADO
M ONINTA. CALIFORNIA t22S,1
tt0P5 P01
Contractor �`� Owner � (r
Address 4 d ? 4Q2111�f -O- Job Address � -
X- . �i '/K 67 /Jr/ — 2 iV _ -01-01 %l — cam►
La
Quinta City License No. Expires: 92 Bldg. Permit No.:
This form shall be posted on the job with the Building inspection Card end it
Shall be the duty of the General Contractor or if Owner-Ruilder Permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License !lumber, Contractors License number and a current certificate
of Workman's Com ensation Insurance Certificate when he starts the job. Ta4lure
to comply may cause Building Inspectors to stop work, or complaints to be filed
Against such contractors or owners.
CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO.
EXPIRES
Grade i Excavate
2-
Pipelines
3.
Cement -Foundations
4-
Cement Walks i Drives
5-
Asphalt Paving
6•
Framing
7-
Steel Structural,
B.
Masonry
9.
plumbing ,1 �OAT�.15C� zzf7
G
C �� •'
Lathing
ll•
Drywall
L2-
Plastering _
13.
XVAC
[4.
Electrical
1s.
v-"-
Roofing
L6.
Sheet Metal
17,
Floors -All Types
16.
Glass - Clazinq
19.
insulation/Weatherstrip
20-
Sewage Disposal
21-
Painting/Decorating
23•
Tile —
--
23.
Cabinets -Installations
24-
Ornamental Metal
25-
Fences/Blockwalis
26.
Landscaping
27.,
Others
28.
DO NOT RI M VE THIS CARD
Before Final Building Inspection Will Be Made
This Form Must Be Comeleted and Filed With Title 24 rmlams anA Plans