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14926 (SFD)f ani P.O. BOX 1504 Builin Address 78-825 Riolan Circle vvr„c, Acacia Construction - 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailin Address 8141 E. Kaiser Blvd. 431€I City Zip Tel. Anaheim, CA 92808 1010282-5800 Contractor Same Address Tel.: State Lic. City & Classif.. $'-1 293954 Lic. # 1612 Arch., Engr.,��SZ Designer Adtl ) 1rVi ne, Agee T11714j 641--1505 Banta Axe Hei(JFK", CA 92r r # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of DiviVonl of the Business and Professions Code, and my license 's in full force and d effect. i1 A�tt_ 'i f. o.—, " % 5_^ < DATE OW NER•BUILDERIDECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Businass 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 file 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) • ❑ I, 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 improve for the purpose of sale.) - ❑ 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 contractors) (rcensed pursuant to the Contractor's License Law.) ❑ 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 yopy is filed with the city,. ❑ 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 thg work for which 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 Date Owner NOTICE TO APPLICANT. ft, after making this Certificate or Exemption you should become subject'tothe Workers' Compensation provisions of the Labor Code, you 'must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE. COST OF COMPENSATION,, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to. expiration if work thereunder is suspended for 180 days. . . I certify 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 Mailing Address City, State, Zip No. 14926 11LDING: TYPE CONST.. OCC: GRP.: P. Number 604-233-028 R3 al Description Lot 197 Tract 23268 ect Description SFD Plan A Acacia ZONE: I BY: Minimum Setback Di 'tances: . ront Setback from Center Line Rear Setback.from Rear Prop. Line Side Street Setback from Center Line Side Setback from,', operty-Line FINAL DATE LIZ INSPECTOR: I ,� ✓ &4V1 Issued by: Date �n Permit�/�� Validated by: i Sq. Ft. 146,0 Size - \ No. No. Dw. Stories Units New ❑ Add�q Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $84,840-00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 486.56 Const. 572.00: Mech. 49.00 Electrical 117.30 Plumbing 144.00 S.M.I. • 8•.48 Grading 20.00 Driveway Enc. w00 Infrastructure 11908.90 TOTAL 3,306 24 REMARKS ZONE: I BY: Minimum Setback Di 'tances: . ront Setback from Center Line Rear Setback.from Rear Prop. Line Side Street Setback from Center Line Side Setback from,', operty-Line FINAL DATE LIZ INSPECTOR: I ,� ✓ &4V1 Issued by: Date �n Permit�/�� Validated by: CDNSTRUCTION ESTIMATE _ NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ 2ND FL. SO.. FT._ POR. • SO. FT. ® GAR. SO. FT. ® CAR P. S0. FT. ®' WALL SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS - MOBILEHOME SVC. POWER OUTLET -YARD SPKLR SYSTEM . BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as prcperty tax valuation ROUGH PLUMB. BONDING - FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (FINAL) TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET` COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB FINAL INSP�� G SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID CCD 1 V. c SEWAGE DISPOSAL SO.FT.GAR ® 3/.c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE 'PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE i ROUGH PLUMB. BONDING - HEATING (ROUGH) STORAGE TANK FORMS SEWER ORN I3 ROUGH WIRING / DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH)I 1z 1 METER LOOP l HEATING (FINAL) OTHER APP.IEOUIP. 1 / REINF. STEEL V GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING. cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP�� G FRAMING 2 1 FINAL INSP. ROOFING VENTILATION ©`LV 12- U / /J REMARKS: FIREZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FI LL MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION26 �/( CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS --/ GARDEN WALL FINAL