9630 (SFD)Building
Address 78-635 Carnes Circle
Owner
Acacia
Mailing
Address 1021 Rastanchury
City lZip - ITel
Contractor
Address
Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. B 2923954 Lic. # 1612
Arch., Engr.,
Designer .
Address
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
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. after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rite 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 therehum, 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).
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
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 irnprove for the purpose of sale.) .
b 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.)
0 1 am exempt under Sec.�B. & P.C. for this reason
Date -----:..—Owner
WORKERV COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate :)f
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. c om , pany
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 certify that in the performance of thp work for which this permit is issued, I shall not
employ any erson in any manner so as to become subject to the Workers' Compensation
of iF
ornia_
Laws Cal
' , — , 't
- - 4� -' Owner
Date_�_
NOTICE TO APPLICANT: ff, after making this Certificatb 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 Addres
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 tity 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
Maili * ng Addre ' as
City, State, Zi
No. 9630
BUILDING: TYPE CONST.—OCC. GRP.-
A.P. Number
Legal Description X4,14- Ain
0
Project Description "I nl)
Sq. Ft.
Size 4162
No. No. Dw.
Stories Units
New 0 Add 0
Alter 0 Repair 0 -Demolition 0
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
_S R61 - q 13
const.
706.00
Mech.
Electrical
2,1. Al
Plumbing
13F1 . so
S.M.I.
R - 31
Grading
Driveway Enc.
'Infrastructure
2668.16
Arfr, in P11"blic - 4 46,
ILI -
i Th 4344�,2f_t
AA' I
TOTAL
4344 2R
-REMARKS'
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear PrO. 6 ne
—Side Street Setback from Center Line
Side Setback from Property Line
A
FINAL DATE —INSPECTOR
Issued by. —Date_Permit
Validated by:
Validation:
4�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. Fr. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT. @
ROUGH PLUMB. BONDI NG
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
I ROOF DRAINS
CAR P. 0. FT. 0
DRAINAGE PIPING
WALL SO. Fr. @
OTHER APPJEQUIP.
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYST�M- 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.
SO. Fr. RESID @ 1 V4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
MESH
PERMIT FEE
PERMIT FEE
INSULATIONISOUND
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE
CONST. FEE ELECT.FE
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
. V?
/ GROUND PLUMBING WUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
14z
ROUGH PLUMB. BONDI NG
HEATING (ROUGH)
STORAGE TANK
FORMS
j
QqSEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE.
FOUND. REINF.
GAS(ROUGH)/,/2 METER L60P
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.
FINAL INSP.1 tllsli t
FRAMING
FINAL INSP.
ROOFING
Prycj r�90 &'o
117A I ag
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAI%NWG
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS'
GARDEN WALL FINAL
MEN
A i Ax'U'Cls
Tit�JO'Ulla'(Ouinta
jluitbiul�- aIib '*afEt� 34-illi"atlan
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building:,
Code certifying that at the time of issuance this structure was in compliance with the various,
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-635 Carnes Circle
Use Classification Single Family Dwelling Bldg. Permit No. 9630
Group R3 Type Construction VN Fire Zone Use Zone SR
Owner of Building Acacia C'.nnstrticti nn Address 1 021 Rastanchiiry Rnacl
Cit Fullerton CA 92633
City Richard Kirkland
By; .
Date: April 6, 1992
V
Building Official i
POST IN A CONSPICUOUS PLACE -