9615 (SFD)T-iht 4
Building 78-590 Car -Ties Circle
Address ,
Acacia
Mailing
Address ' 1OZ-1 BastanchUrV Ro
City Zip
Contractor
Acacia Construction
Address
sam��
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LDING: TYPE CONST
P. Number
_nQQA ILegal Description
State Lic. city
& Classif. B 2923954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City Zip
State
Lic. #
LICENSED CPNTRACTOWS DECLARATION
I hereby affirm that I am licensed under pnrAsions of Chapter 9 (commencing with Section
7 of Division 3 of the Business and Professions Code, and my license is in full force and
t
SIGNATURE ATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec.. 7031.5.Business and PIrolessions Code: Any city - 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 Me's 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 PIrolessions Code. or that. he is exenW therehom, and the basis
for in afleged exemption. Any viDkfion of Section 7031.5 W 'any applicant for a per -it
s bgo
u is the applicant to a civil penally of not more than five hund1red dolt2n; (S500).
0 1, 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,
�.Professtons Code: The Contractor's License Law does not apply to an owner of"property who
builds or improves thereon and who does such work himseff or through ft'own employees,
;rovided -that such onprovernents are not intended or offered for safe. fl, however, the building
orlimprovement is sold within one year of compladon, " owner4kailder will have the burden
of proving that he did not build or kriprove for the purpose ofsale.)
b, 1, as owner of the property, am exclusively contracting with licensed contractors to con,-
struct the project. (Sec. 7044, Business and Professions Code: The Contractoes License Law
does not apply to an owner of property who builds or kniproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
0 1 am exempt under Sec. & P.C. for this reason
Date —Owner
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to seffminsure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. r_mpany — -
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
CE"FICATE OF EKEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H Me permit is for am humhed dollars ($100) vakiation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
=any person in any manner so as to become subject to the Workers' Compensation
California. ..V / . / I -
Date' 'I _; Owner 'A", 1� 1400, - . Irt — .— - - I
NOTICE TO APPLICANT: ff.'after making Oda Ceftiticare of Egamption you should becorne
subject to the Workers' Compensabor; provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag 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 Add
This is a building permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days -
I cer tify 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, Zi
Lot 6 3
Project Description Plan. A2
No.
_OCC'. GRP.
ZONE: BY:
Minimum Setback Distances:
—Front Setback from Center Lin
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:
Sq. Ft.
Size 1362
No.
Stories
No. Dw.
Units
New 0 Add 0
Alter 0 Repair 0 -Demolition 0
Estimated Valuation
74,631
PERMIT
AMOUNT
Plan Chk. DeNp.
Plan Chk. Bal.
446.34
Const�,
527.00
Mech.
4 7. OF Ow
Electrical,,
90.61
Plumbing
120.50
S.M.I.
5.25
Grading
Driveway Eric.
Infrastructure
1679.19
nnrip-i �n
1)7*4 —"A--9 4
N Al
1p- - -- �A�Vff 'I
I U f4l. 1 !T, I:,. 0--y
TOTAL
2915.89
REMARKS
ZONE: BY:
Minimum Setback Distances:
—Front Setback from Center Lin
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. @ $
UNITS
SLAB GRADE 10'(7
2ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. 'SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
GAS (ROUGH) 1,pl
DRAINAGE PIPING
WALL 0. FT. @
I
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING 7
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:'
IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET�
COMPRESSOR HP
POLE, TEMPERM
ILAVATORY
HEATING SYST�M- FORCED GRAVITY
AMPERES SERV ENT
ISHOWER
BOILER. B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTALFEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK I
e GROUND PLUMBING-7&/Cl
NDERGROUND
A.C. UNIT
COLL, AREA -
SLAB GRADE 10'(7
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
fil �v ,
SEWER OR SEPTIC TANK
'jo , ?e�
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) 1,pl
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./,0�)Zht&?
FRAMING 7
FINAL INSP.
61flfl- /A -
ROOFING A vtq( Lp
REMARKS:'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
WTNG
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREVINITIALS
GARDEN WALL FINAL