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14919 (SFD)Building 78-,,!, Nolan Circle Address Owner Acacia Construction P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailin Address 8141 E. Kaiser Blvd. #310 City p Tel. Zi Anaheim, CA 92808 100 1282-5800 Contractor Sate s - Address State Lic. City & Classif. B..1. 293954 Lic. # 1612 `Arch.; Engr., Designer. ]X,Tlesign ;.Pdl;S3: irvine Ave.. 11141,641-1505 CityZip State Sar3ta .Ana ffeig ts, CA '92 iia # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi an,3 of the Business and Professions Code, and my license is in full force and effect. Ci /1n� -_ `1 "_ 2 1-174 OWNER-BUIUDER 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 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 alleged exemption. Any violation or 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 o/ completion, the owner -builder will have the burden of proving that he did not build or knprove 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) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason No. 1491,9 BUILDING: TYPE CONST. YN OCC: GRP. R3 A.P. Number 6-04-M-021 Legal Description Lot 190 Tract 23268 Project Descriptions - Plan D Acacia Sq. Ft. No. No. Dw. Size 1$35 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated Valuation $112466.90 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. , Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Date owner Infrastructure •�j� ,a9 -, L422 1, V% X11 1.1, 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.) Polfc No. Company Copy 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 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. Dale Owner NOTICE TO APPLICANT. If, 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 permft 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 ateMailing Address City, State, Zip TOTAL REMARKS AMOUNT 573.^/26 ©5.00 q 55 . SO 14€3.41 138.00 11.2�1t 20.00 .00 2,521.51 30.17 ZONE: . BY: Minimum Setback Distances: r Front Setback from Center Line Rear Setback from Rear Prop. Line -S' eStseet Setback from Center Line Side Setback from PropertYLine FINAL DATE INSPECTOR • /^. r��� Issued by. Da ��/r.. Permit Validat4d by: Valirtatihn A CONSTRUCTION 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 CONSTRUCTICN 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 WASH ER(AUTO)(DISH). APPLIANCE DRYER FORMS GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED SEWER O LAUNDRY TRAY 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. SQ. FT. @ c BATH TUB GAS (FINAL) SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1'/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER SERVICE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE JPLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBIN 1 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER O N ![Y 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$-=$ LUMBER GR. FINAL INSP. FRAMING 2�' fj V FINAL INSP. ROOFING - Z VENTILATION J / � �J yQ f✓I7 REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND �J FINISH GRADING FINAL INSPECTION (rs CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESlIN(TIALS GARDEN WALL FINAL