14922 (SFD)a. P.O. BOX 1504 No. 14922
Building 78-495 CALLE TAMPICO
Address 78!'785 Nolan Circle LA QUINTA, CALIFORNIA 92253
Owner Acacia Construction
Mailin
Address 6141 U. Kaiser Blvd. #310
City Zip Tel.
a.he3.t', ca 9280871d 282-5800
Contractor
Same
Address
ity
Zip
State Lic. .
& Classif.'. 8--1 293954
Arch., Engr., DC ign
Designer
l°�,dris Irvine Ave.
Lic. # 1612
T)14) 641-1505
City Ip State
Sale Ana Haig is, CA 927491c. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Di Ision 3 of the Business and Professions Code, and my license is in full force and
effect.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 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, 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 rive hundred dollars ($500).
O 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 improvementsare 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 dM not build or inprove for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business andProfessions 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.)
❑ 1 am exempt under Sec. IB. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Worke1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ..
Policy No. company
Copy is filed with the city. O 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 the 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: If, a1I((1e r making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or th14 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. i
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
BUILDING: TYPE CONST: VN OCC: GRP. 83
A.P. Number 604-233-024
Legal Description Lit 193 Tract 23268
Project Description SFD Plan, a
Acacia
Sq. Ft. 1400 No. - No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
84A4Q.fl
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
466.56
Const.
572.00
Mech.
49.00
Electrical
117.30
Plumbing
144-00
S.M.I.
8.48
Grading
20.00
Driveway Enc.
.00
Infrastructure
111-1908.90
TOTAL
3,306.24
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 -�1/1NSPECTC
Issued by: Date ���•
Validated bv: CRI'
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. 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 property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
t
FORMSA NP
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) b
i
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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.
SQ. FT. @ c
BATH TUB
FINAL INSP.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ec
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL =EES
MICRO FEE
MECH.FEE PL.CK.FEE
JCONST.FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING - ._/I ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLU BI
UNDERGROUND
A.C. UNIT
COLL. AREA
ovSLAB GRADE `
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
t
FORMSA NP
SEWER 009ill
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REIN .
GAS (ROUGH) b
i
METER LOOP
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.
FRAMING
FINAL INSP.
ROOFING Z7
/—'a
/ ) /(` �r n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA ING
MESH It f
INSULATION/SOUN�
FINISH GRADING
FINAL INSPECTION
c
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL