9628 (SFD)Tiitt 4
Building 78-660 Carnes Circle
Address
Owner
Mailing
Address 1021 Hastanchury Rc
City lZip - ITel.
tractor
Acacia Construction
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. B 2923954 1 Lic. # 1612
.. -.1 ... -1
Designer
Address Tel.
City Zip State
. I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7 of Division 3 ofthe Business and Professions Code, and my license is in full force and
SIGNATURE DTTE_
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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, prfor'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 exenrpt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031;5 by "any applicant fors 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
build., 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 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
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wo
rker'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 certify that in the performance of thp work for wpich this permit is issued, I shall not
employ any person in any manner so,as to become subject to the Workers' Compensation
Laws of California.
_2 / .; I/
Date' - - Owner I - /' IL
NOTICE TO APPLICANT. 117aftWr making1this Cerefficate of Exemption you should beco . me
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, CIO 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 applicanl� —Date
Mailing Address
City, State, Zip
No. 9628
BUILDING: TYPE CONST. *OCC. GRP.-
A.P. Number
Legal Description Lot 56
Project Description Plan C2
Sq. Ft. No. No. Dw.
Size 1927 Stories - Units
New 0 Add 0 Alter 0 Repair 0 -Demolition 0
3timated Valuation
105,733
PERMIT
-
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
552.OU
Const.
660.5U
Mech.
6U. OU
Electrical
114.47
Plumbing
144.50
S.M.I.
7.42
Grading
Driveway Enc.
Infrastructure
2.378.99
xts in F �L 1. c�
_00':� WZ, 10
27- L1. 0 6 -24-"`U_ 14
4V A
JU7 k1kil
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pro�.'Li ne
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. SQ. FT. @ $
UNITS
COLL. AREA
2ND FL. SO. FT. @
)qIX
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. @
I
DRINKING FOUNTAIN.
SO. 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
-cu. yd.
$ -Plus-x$-=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP q
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSEV
COMPRESSOR HIP
POLE, TEMIPERM
LAVATORY
HEATING SYST�M. FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
FIRE ZONE ROOFING:
SO. FT. @ c
WATER HEATER
MA)L HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
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
/"GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
)qIX
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
9V
EWER OR SEPTIC TANK)(y
ROUGH WIRING.
DUCT WORK
ROCK STORAGE.
FOUND. REINF.
GAS(ROUGH)
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 q
FRAMING F &(OffCt V
FINAL INSP. I
1 //Yl
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
VCPI I
LATHING
MESH
INSULATIONISOUND (j,
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUIRESIINITLALS
GARDEN WALL FINAL