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14918 (SFD)in Addtless 78-^758-Iblan. Circle Owner Acacia Construction P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Address 8143 B. Raises Blvd. 0310 City Zip Tel. Anaheim, CA 92808 1010282-5800 Contractor - Same Zip Tel.: State Lic. City & Classif. 8-7 293354 Lic. # 1612 Arch., Engr., Desi. Designer DG g U-Tga Irvine. dive. (�1411641-1505 nta Ana fleigIf s, CA 921004 LICENSED CONTRACTOR'S DECLARATION I hereby aff'rtn that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divf iion,33oof the Business and Professions Code, and my license is in full force and effect. ' L A1t1+2,'S- -! SIGNATURE '.� DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following, reason: (Sec. 7031.5,Bpsiness. and Professions Code: Any city or county which requires a permit to construct, atter, 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 of Section 7031.5 by 'any applicant for a permit subjeots the applicant to a civil penalty of not more than rove 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) ycensed pursuant to the Contractor's License Law.) ❑ I 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 city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff 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 sous to become subject to the Workers' Compensation Laws of California Date Owner NOTICE TO APPLICANT: M, after making this Certificate or 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. "r 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. 14918 BUILDING: TYPE CONST..VN OCC. GRP. R3 A.P. Number 604-233-020 Legal Description Lot 189 Tract 23258 Project Description SFD .P1an C Acacia Sq. Ft. No. No. Dw. Size 1591. Stories Units New ❑ Add ❑ Alter ❑ - Repair ❑ Demolition ❑ Estimated Valuation $98t445.00 PERMIT AMOUNT Plan Chk. Dep. Distances: Plan Chk. Bal. 536.79 Const. 635.00 Mech. 55.5.0 Electrical 131..49 Plumbing 144.00 S.M.I. 9.84 Grading 20.80 Driveway Enc. 00 Infrastructure 2,215.02 Validated by: i Validation: �. m TOTAL 3,747.63 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, INSPECTOR^� Issued by: Date Permit Validated by: i Validation: �. m CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING; FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. - SQ. FT. WALL SQ. FT. SQ. 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 COLL. AREA FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FO MS GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED SEWER OR 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER SERVICE 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 �I PLUMBING „(� ELECTRICAL HEATING & AIR COND. SOLAR [ i [ t E!►` SET C GROUND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA S ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FO MS SEWER OR A K -ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 6ZA 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. 1 FINAL INSP. Q FRAMING r� FINAL INSP. ROOFING VENTILATION fi/ ///��� REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL A1119 r MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION qi CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESlINITIALS GARDEN WALL FINAL -d