15359 (SFD)P.O. BOX 1504 No. 15359
Building 78-495 CALLE TAMPICO
Address 7$-760 Nolan Circle LA QUINTA, CALIFORNIA 92253
Owner
Acacia Construction
Mailing
BUILDING: TYPE CONST. V` L`� OCC. GRP. R3
Address 8141 E. Kaiser Blvd., #310 A.P. Number 604--2.33-019
City Zip Tel.
Anaheim 92803 714-282-5800 Legal Description Lot 1�$ Tract 2326$
Contractor Project Description SM Plan A2R
same as above
Address
State Lic.
& Classif.. 213954
Arch., Engr.,
Designer DC Design
Address
2.13351 Irvine Ave.
Tela
Lic. # 1612
Tel.
714--641-1.505
State
Santa Ma Haiglhta 92707 Lic. a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divi do_3of the Business and Professions Code, and my license is in full force a d_
effecI. 1
$ I ('zee, _4,..�.. �°k-1 G - 2_3 - �"�
SIGNATURE A DATE
OWNER-13UILDEII 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 requiresa
permit to construct, atter, 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).
❑ 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 a contractor(s) (kensed,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
Copy is filed with the ci. ❑ 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, N, after 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 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 it 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
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 Lines
�.,
FINAL DATE I
Issued by: Date
Validated I
Validation:
Sq. Ft.
Size 1400
No.
Stories
No. Dw.
Units
New IN Add ❑
Alter ❑
Repair ❑ Demolition ❑
r
Estimated Valuation
M,840.00
m
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
486.56
Const.
572.00
Mech.
49.90
Electrical
117.30
Plumbing
144.00
S.M.I.
13.48
Grading
20.00
Driveway Enc.
Infrastructure
1908.90
TOTALI'S3306.24
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 Lines
�.,
FINAL DATE I
Issued by: Date
Validated I
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWQ FEES
1ST FL. SO. FT. ® $
2N0 FL. SD. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTIC N 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ER ORS
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
TEMP. POLE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
WATER HEATER
SO.FT.GAR ® 3/ec
HOUSE SEWER
FINAL INSP.
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 PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRAD
ROUGH PLUMB.lal'oBONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER ORS
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
tGAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP. '
REINF. STEEL i
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. 2 /L
VV 'v✓
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FRAMING '
ROOFING
'
�/
�y
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/J
LA IN �ff
MESH
r
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL