9616 (SFD)T4tyl 4 4 a"
Building
Address 78-630 Carnes Circle
Owner
. Acacia
Mailing
Address 1021 Hastanchtiry Road
City lZip ITel.
Contractor
Achcia Construction
Address
City lZip JTel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. B 2523954 Lic. # 1612
Arch., Engr.,
Designer
Address Tel.
City lZi . p State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under 6rovisions 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. — I. _, 4 4
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.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 (S500).
0 1, as owner of the property, ormy 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 properly 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 lh6 purpose of safe.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions CDde:-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 �u�uant 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. 0 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
I certify that in the performance of thp work for which this permit is issued, I shall not
employ any person i . n any manner so as -to become subject to.the Workers' Compensation
Laws of California.
iA
Date wner
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 Addle
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 applicant —Date
Mailing Address
City, State, Zip
LDING: TYPE CONST
Number
Legal Description Lot 59
Project Description Plan A3
No. 9616
_OCC'. GRP.-
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_Permit
Validated by:
Validatidh:
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. Dep�.�
Plan Chk. Bal. -
446.34
Const.-
527.00
Mech.
47.00
Electrical
-90.61
Plumbing
120.50
S.M.1.1,
5.25
Grading
Driveway Eric.
Infrastructure
1679.19
f�Alz O'� 4 A
fj"," I AA -)A-04 - 44
—89,
Sit
"CM -1
Tr _AL -1 - 15-.
I 4Y
TOTAL
2915.89
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
INSPECTOR
Issued by: Date_Permit
Validated by:
Validatidh:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL. SO. FT. @
ix
YARD SPKLA SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
ROUGH WIRING.
DRAINAGE PIPING
WALL SO. Fr. @
ROCK STORAGE.
DRINKING FOUNTAIN.
SO. FT. @
GAS(ROUGH) Al A IV"
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYST9M- FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. Fr. @ c
BATH TUB
REMARKS:
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID @ I V4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK
. I I/
GROUND PLU &�ONDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ix
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�10SEWER OR SEPTIC TANK;rr�l I
ROUGH WIRING.
DUCT WORK
ROCK STORAGE.
FOUND. REIN
GAS(ROUGH) Al A IV"
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.
$-plus-x$-=$
LUMBER GR.
IN
FINAL INSP-/6/;A/ tly)
FRAMING 0// -t Aa
V
FINAL INSP.
ROOFING WAY
If
4P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
&ATHING
V
MESH
INSULATIONISOUNDV-q
FINISH GRADING
FINAL INSPECTION- A
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL. FINAL