9632 (SFD)0
Twit 4 4 a"
Building
Address 78-610 Carnes Circle
Owner
Acacia
Mailing
Address 1021 Bastanchury Ro,
City lZip ITel.
Contractor
Acacia Construction
Address
City Izip I Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. — City
& Classif. B 2923954 1 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
TM' of Division 3 of the Business and Professions Code, and my license is in full force and
ffect . , — -//,/ I !",�
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any City of county which requires a
permit to constinict, 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 provision of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of.
s
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exenWtion. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
0 1, asiowner 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 knproves 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.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contract6r'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 of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. rO 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 thp work for which this, permit is issued, I shall not
employ any.person in any rn�nner so as to become subject to the Workers' Compensation
Laws of California.
Date;W - 1 -"- -'ZDw, �, 11i. _Vl/ I" . I I
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 Nam '
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 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 applicani —Date
Mailing Address
City, State, Zip
No. 9632
BUILDING: TYPE CONST.—OCC: GRP.-
A.P. Number
Legal Description T,^+- K I
Project Description o I, r%,2
Sq. Ft. No. No. Dw.
Size 2162 Stories Units
New 0 Add 0 Alter 0 Repair 0 Demolition 0
Estimated Valuation
I I -A SAS
PERMIT
Plan'Chk. del3.--'-
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
V/
706.0
(",-12 -3. 4
13R.5
Grading
Driveway Eric.
Infrastructure 2669.16
krts in Publi! 46.46
TOTAL 4344.28
.REMARKS
—14
,(f ltnt!l -4"A4.28 1
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 — Pe I rmit
f
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. @ $
UNITS
SLAB GRADE
2NO FL SO. Fr. @
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
POR, SO. Fr. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. Fr. @
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN. —
SO. FT. @
GAS (FINAL) 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 SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING 31 1( 4P
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
?Z(:2,Zct I C'�?
j (0
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET:
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTI�M- FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. Fr. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V4 c
SEWAGE DISPOSAL
P.- P
4X^J
LATHING
SO.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE Z PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK
io
GROUND PLUMBING 40NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
A
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGETANK
FORMS
f
AV
SEWER OR SEPTIC TAN . K ROUGH WIRING.
0 76 11
DUCT WORK
ROCKSTORAGE
FOUND. REINF. 4
GAS(ROUGH) METER LOOP
/R(vq( (P
HEATING (FINAL)
OTHER APPJEOUIP.
I
REINF. STEEL z
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. y d.
$_plus_x$_=$
LUMBER GR,
A
FINAL INSY
FRAMING 31 1( 4P
FINAL INSP.
ROOFING
?Z(:2,Zct I C'�?
j (0
REMARKS.
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
P.- P
4X^J
LATHING
MESH
INSULATtONISOUND 01
FINISH GRADING
FINAL INSPECTION -
CER T. OCC.
FENCE FINAL
INSPECTOWS SIGNATURESIINITIALS
GARDEN WALL FINAL