9613 (SFD)Building
Address 78-(
Owner
Aca--ia
Address 1021 BastanchurV Ro.--,
City I zip ITel.
Contractor
ACaCia Construction
City , lZip 'I Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. city
& Classif. B 2923954 1 Lic. # 1612
Arch., Engr.,
Designer
Address —FTe-
City Zip State
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. -?(4.
C
SIGNATURE- DATE
OVMEPBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buskiess and PIridessions Code: Any city or county which requires a
permit to construct, after, imarove. demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permill to No,a sWed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 lcommericing with Section 7000) of
Division 3 of the Business and Professions Coft or that.he is exempt therelmm, and the basis
for. the alleged exemption. Any violation of Section 7031.5 W 'any applicant for a permit
subjects the applicant to a civil penalty of not more Um five hundred dollars (S500).
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. (Sac. 7044. Suisness and
Professions Code: The Coriftaor's License Law does not apply to ari 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 sage. N, however. the building
or Improvement is sold within 'one year of completion, the owner -builder will have Me burden
of proving that he did not build or kriprove for the purpose of safe.) .
b I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Bu.-�Iness and. Professions Code: The Contractor's License Law
does not apply to an owner -of property who builds or impmves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to Me Contractors License Law.)
0 1 am exempt under Sec. & P.C. for this reason
Date Owner
WORKEWT COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wcrker*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 which this permit is issued, I shall not
employ anyyer�on in any manner so as to become subject to the Wo*ers' Compensation
Laws of California.
Date—Li- , --- Owner
NOTICE TO APPLICANT If efter'malft this Certificate of Exemption you should become
subject to the Workers' compensation provftions of the Labor Code. you must forthwith
comply with such provisions or this penrift 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.)
Lenderjs Name
Lenders Add
This is a building permit when property filled out signed and validated, and is subject to
expiration it work t ereunder 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 applicani —Date
Mailing Address
City, State, Zip
No. 9613
I
BUILDING: TYPE CONST.—OCC. GRP.-
A.P. Number
ILegal Description Lot 73
Project Description Plan A-2
Sq. Ft. 1362 No. No. Dw.
Size Stories Units
New 0 Add 0 Alter 0 Repair 0 -Demolition 0
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
446.34
Const.
527.00
Mech.
47.00
Electrical
90.61
Plumbing
120.50
S.M.11.
5.25
Grading
Driveway Eric.
Infrastructure
1699.19
J4
TOTAL
_2915.89
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setbac k from, Rear Prop. LiAe�
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. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ. 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 DRYEFt
FRAMING I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
Le
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMAR . KS:
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.
SO. FT. @ c
-BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID @ 11% c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBIL
TOTAL FEES
MICRO FEE ��FEE
PL.CK.FEE
CONST. FEE ELECT.FEE
__7LUMB. FEE
SMITEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLU UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE.
FOUND. REINF.
GAS(ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
,GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.yd.
$_plus_x$_=$
LUM R.
FINAL INSP. Ifek/
FRAMING I
FINAL INSP.
ROOFING Of/ V-1
Le
'It
REMAR . KS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
CA11
LATHIVG L?/,?
MESH
INSULATIONISOUNDt&l(q/qt
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL