9627 (SFD)T4ht 4 4 Q"
Building 78-650 Ca --nes Circle
Address
Owner
mailing
Address 1021 Ras"nchury Roeid
City lZip ITel.
Contractor
Acacia Construction
Address
City lZip I 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 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
7000) of Division,3 of the Business and Professions Code, and my license is in full force and
effect . I " , y C/
- - " t, � Z// t-�111
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,Buslness and Professions Code: Any city of 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 rile 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).
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, Suisness, 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. 11, however, the building
or Improvement is sold within - one year of completion, the owner-bul7der win have the burden
of proving that he did not build or improve for the purpose of sale.) .
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 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
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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred doflars,($1 00) va(uation
or less.)
I certify that in the performance of thp work for whichAhis permit is issued, I shall not
employ any person in any manner so as to become subjebt to the Workers' Compensation
Laws of California. / 'I : 14y,
. P1.
Datef "'-*owner I—' . /�,
NOTICE TO APPLICANT. If, after making this certificate of Exemption you should becorne
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. 309 7, Civil Code.)
Lenders 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, Zi
No. 9627
BUILDING: TYPE CONST.—OCC. GRP.-
A.P. Number
Legal Description Lot 57
Project Description Plan C3
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:
Validation:
Sq. Ft.
Size 1927
No. No. Dw.
Stories Units
New 0 Add 0
Alter 0 Repair 0 Demolition 0
Estimated Valuation
1-05,733
PERMIT
AMOUNT
Plan Chk. Dlep�
Plan Chk. Bal.
Const.
Mech.
bu. ou
Electrical.,' V
13.4.47
Plumbing
144.50
.S.M.I.
7.42
Grading
Driveway Enc.
Infrastructure
23M . 99
Arts in k=12
c 41.) . UU
54
for
i -t'NsIrl 'Ttr[AL:1 - -39A2.80
TOTAL
TO 4;4 . U U
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:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL. SO. FT. @
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SO. Fr. @
DRINKING FOUNTAIN.
SQ. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
_c.. d.
$-plus-x$-=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP/0/'7
q
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
FIRE ZONE ROOFING:
SO. Fr. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESI D @ 1 V4 c
SEWAGE DISPOSAL
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
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/JaEWER OR SEPTIC TANK7/V ROUGH WIRING.
ov
DUCT WORK
ROCK STORAGE.
FOUND. REINFj
GAS(ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
_c.. d.
$-plus-x$-=$
LUMBER GF1.
FINAL INSP/0/'7
q
FRAMING
FINAL INSP.
ROOFING 2t(&j6L(
?rc wrcke
t
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HcI N G
Y 06 qj()
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL