9629 (SFD)T,it4t 4 4 Q"
Building
Address 78-665 Carnes Circle
Owner
Mailing '
Address 1021 Bastanchury Road
City Zip ITel,
Fn1.1P_rtnn 1 92633
Contractor
Acacia Construction
Address
amp -
City , lZip 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 lZip State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secti n
7 tof Division 3;of the Business and Professions Code, and my license is in full force aond
SIGNATURE DATE
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, 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 = exemption.. Any violation of Section 7031.5 by 'any applicant for a permit
subjects ficant to a civil penalty of not more than rive 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. H, 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 1, asowner 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 - - i
0 Copy Is filed with the city. _P Certifi6d 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 (S100) valuation
or less.)
I certify that in the performance of thp work for Which this permit is issued, I shall not
=any.pers�on in any manner so as to become'subject to the Workers' Compensation
California. �� &
i - "i r!L " 0 ". , ;W
Date wner
INT. -after making this Ceffificabe of Exemption you should become
NOTICE TO APPLIC) If,
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 car illy 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 aut prize representatives -of this city to enter the above-.
mentioned property for inspecTion purposes.
Signature of applicant —Date
Mailing Address
City, State, ZI
No. 9629
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description Lot 71
Project Description Plan D 2
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size 2.162
No. No. Dw.
Stories Units
New 0 Add 0
Alter 0 Repair 0
-Demolition 0
Side Setback from Property Line
FINAL DATE
—INSPECTOR
Issued by:
—Date_Permit
Validated by:
Validation:
Estimated Valuation
118,585
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
586.90
Const.
706.00
Mech.
66.50
Electrical
123.43
Plumbing
138.50
S.M.I.
8.33 -
Grading
Driveway Enc.
Infrastructure
2668.16
Arts in Public
4
4S44 '18
TOTAL
4344.28
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
SLAB GRADE
2ND FL. SO. FT. @
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOMESVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
ROCK STORAGE.
DRAINAGE PIPING
WALL SO. FT. @
DRINKING FOUNTAIN.
SO. FT. @
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER SERVICE
IFLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMPERM
[LAVATORY
HEATING SYSTEM. FORCED GRAVITY
1AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
SO. Fr. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID @ 1% c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
E SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEt
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR -
SETBACK
VGROUND PLUMBIN,3-�/,?/q(,�,o UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 0
SEWER OR SEPTIC TANK ROUGH WIRING,
DUCT WORK
ROCK STORAGE.
FOUND. REINF,,,n
GAS(ROUGH) M ER LOOP
HEATING (FINAL)
I 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 I NSP.
FRAMING Oct
FINAL INSP.
ROOFING
ef 6J.7 910 W-Lif
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAT loll
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
A 6
CERT. OCC.
FENCE FINAL
INSPECTOWS SIGNATURESIINITIALS
GARDEN WALL FINAL